Violet Kayamba

Breast and cervical cancers remain leading causes of cancer-related morbidity and mortality among women globally, particularly in low- and middle-income countries. The World Health Organization (WHO) has prioritised both cancers through the Global Breast Cancer Initiative and the global cervical cancer elimination strategy, which targets 70% screening coverage using high-performance tests among women aged 35 and 45 years. Despite Zambia’s expansion of cervical cancer prevention services, little is known about the population-level uptake of breast and cervical cancer screening and the sociodemographic factors that drive it. This study assessed the determinants of breast and cervical cancer screening uptake among women aged 15–49 years using data from the 2024 Zambia Demographic and Health Survey (ZDHS). We categorised the women into four mutually exclusive groups: no screening, breast-only screening, cervical-only screening, and breast and cervical screening. Survey weights were applied to account for the complex sampling design of the survey. Associations were examined using survey-adjusted multinomial logistic regression. All analyses were conducted using Stata 14.2. Among the 13,876 women included in the analysis, 68.84% reported no cancer screening, 4.67% reported breast-only screening, 17.87% reported cervical-only screening, and 8.63% reported both breast and cervical screening. Screening uptake increased with age but remained below recommended targets even among priority age groups: 43.8% of women aged 35–39 years and 51.3% of women aged 45–49 years reported any cervical cancer screening (cervical-only or combined). In multivariable adjusted analyses, these patterns were largely confirmed. Women aged 45–49 years were significantly more likely to undergo cervical-only screening (RRR 9.64; 95% CI 6.66–13.96) and combined screening (RRR 12.01; 95% CI 7.35–19.63) compared with adolescents aged 15–19 years. For breast-only screening, older age (35–44 years) and higher parity were the principal significant determinants, with women of parity 6 or more nearly twice as likely to report breast-only screening compared with nulliparous women (RRR 2.22; 95% CI 1.25–3.93). Higher education was associated with increased cervical-only (RRR 1.36; 95% CI 1.03–1.79) and combined screening (RRR 1.43; 95% CI 1.03–2.00). In contrast, rural residence was associated with lower cervical-only screening uptake (RRR 0.76; 95% CI 0.63–0.93), and high community poverty was associated with lower cervical-only (RRR 0.44; 95% CI 0.33–0.59) and combined screening (RRR 0.63; 95% CI 0.44–0.92). Breast and cervical cancer screening coverage among women aged 15–49 years in Zambia remains low, with substantial socio-demographic and geographic inequities. Screening uptake was strongly associated with age, parity, educational attainment, contraceptive use, and media exposure, while rural residence and high community poverty were consistent barriers across screening outcomes. Coverage remains markedly below the WHO 70% cervical cancer screening target, and no structured breast cancer early detection programme currently exists to address the growing burden of breast cancer among reproductive-age women in Zambia. Strengthening integrated screening strategies within reproductive health, primary care, and HIV service platforms, alongside targeted community-based outreach and health education, is essential for improving early detection and reducing the burden of women’s cancers in Zambia.

Leadership and mentorship play an important role in supporting the career development of health professionals. In many African countries, supervision activities focus on technical and operational aspects rather than catalysing career and leadership development. Thus, mentorship and coaching interventions need to be implemented in African healthcare institutions as components of health systems strengthening strategies. Due to its holistic nature, cancer care involves interprofessional collaborations to develop and provide a problem-solving mindset. It is therefore an area that would benefit from leadership and mentorship, mainly in a limited-resources context. The identified benefits from leadership development in cancer care in Africa led to the creation of the African Cancer Leaders Institute (ACLI) of the African Organization for Research and Training in Cancer (AORTIC), consisting of mentors and trainees from Africa and the USA. ACLI trainees are selected through a competitive application process. During the ACLI biennial meetings, coinciding with the AORTIC conference, trainees, including early-stage/mid-career investigators, oncologists, nurses, advocates and other health professionals, meet to learn about best practices in cancer research, grant writing, scientific reporting, mentor relationships, academic pressures and professional-personal life balance. This paper describes the goals of the ACLI, its mission and achievements, the vision behind creating such important programmes and the benefits of its participants in leadership, coaching and mentorship in improving cancer care in Africa.

Background. Effective leadership is essential for the performance of healthcare systems, and university faculty play a key role in educating healthcare professionals. However, in many countries, including Zambia, health professions training does not include substantial leadership training. To address this need, faculty at Zambian universities designed and launched a leadership training programme to equip health professions faculty with the knowledge and skills necessary to impart leadership competencies to their students. Objective. To evaluate programme efficacy by assessing changes in trainees’ leadership knowledge and behaviours. The results of this evaluation will help inform these and other universities about the utility of an in-house leadership programme. Methods. Using a mixed-methods study design framed by the Kirkpatrick model for programme evaluation, we administered a survey to trainees (n=35) before and immediately after the programme. The survey included 5-point scales on which participants self-rated their knowledge and skills in leadership competencies. One month after the programme, semi-structured focus groups were conducted to gather trainees’ perceptions of the programme. Descriptive statistics were calculated for quantitative data and categorised qualitative data according to salient, recurring themes. Results. Analyses of qualitative and quantitative data from the 35 faculty trainees revealed that they enjoyed the programme and experienced growth in all leadership competencies taught, although they felt that more time could have been allocated to workshops. Trainees’ leadership knowledge increased by an average of 48% across all nine domains taught, with the greatest growth in ‘social and emotional intelligence’ (73%) and ‘diversity, inclusion and equity’ (58%). Trainees also reported substantial growth (42%) in their confidence of their leadership behaviours. Other areas of significant growth included ‘using tools and strategies to address microaggressions’ (88%) and ‘exploring types of microaggressions faced by diverse groups’ (84%). Conclusion. These results indicate that a short, intentional and locally relevant training programme can address gaps in leadership training and effectively equip faculty with leadership knowledge and skills. Unique elements of this programme include its development by an interdisciplinary team of university faculty who also taught the workshops, the use of a ‘train-the-trainer’ model to promote programme sustainability, and collaboration among three academic institutions in the development and assessment of the course. This programme could serve as a model for academic institutions interested in developing leadership courses for faculty.

Background: Esophageal and gastric cancers have a high incidence and mortality in the US. Understanding the risk factors and trends associated with these cancers is crucial for developing effective prevention strategies.Objective: This descriptive study analyzed time trends for esophageal and gastric cancer incidence and related modifiable risk factors.Methods: Data from the Surveillance, Epidemiology, and End Results Survey Program (1975-2020), and the National Health and Nutrition Examination Survey (1988-2018) were used. Temporal trends in incidence rates and risk factor prevalence were determined, including for groups defined by sex, race, and subtype.Results: Esophageal squamous cell carcinoma rates declined, particularly among Black males (from 16.1 to 1.5 per 100,000), while esophageal adenocarcinoma rates increased among White males (from 0.7 to 4.3 per 100,000). Cardia gastric cancer rates remained stable, with higher incidence among males (average 3.1 per 100,000 compared to 0.7 per 100,000), whereas non-cardia gastric cancer incidence decreased for all. The percentage of the population that was overweight/obese increased from 52.4% to 73.8%. In contrast, prevalence of heavy alcohol drinking and current smoking decreased while the prevalence of inadequate intakes of nutrients such as calcium, particularly folate, significantly improved. Recently, inactivity prevalence has decreased, but >50% of the population remains physically inactive.Conclusion: Trends in modifiable lifestyle factors, such as increased obesity, reduced heavy alcohol consumption, and changing dietary habits, could explain some of the observed trends in esophageal and gastric cancer rates. Therefore, continued public health efforts are needed to address modifiable risk factors and reduce cancer incidence..

Introduction: Helicobacter pylori (H. pylori) infection is highly prevalent in Zambia, with an estimated population prevalence of 79%. However, data on eradication treatment outcomes in routine clinical practice are lacking. Methods: We conducted a single-arm cohort study in Lusaka, Zambia, to evaluate the effectiveness of empirical H. pylori eradication therapy using stool antigen testing (SAT). Symptomatic patients with confirmed H. pylori infection were treated empirically with clarithromycin-, tinidazole-, and omeprazole-based regimens. Eradication was assessed using SAT at least four weeks after completion of therapy. Demographic and clinical factors associated with treatment outcomes were analysed using multivariate logistic regression in Stata version 15. Results: Of 331 patients tested, 216 (65%) were positive for H. pylori infection. Post-treatment SAT results were available for 139 (64%) patients, of whom 93 (67%) were female. The median age was 43 years (interquartile range: 36–54). Overall, eradication was achieved in 85 patients, yielding a treatment success rate of 61%. Multivariate analysis demonstrated that a history of prior eradication attempts (odds ratio [OR] 0.20, 95% confidence interval [CI]: 0.04–0.60) was independently associated with treatment failure. In contrast, the occurrence of dysgeusia during therapy (OR 3.20, 95% CI: 1.20–8.70) and prior proton pump inhibitor use (OR 5.30, 95% CI: 1.40–19.80) were associated with higher odds of eradication. Conclusion: The effectiveness of empirical clarithromycin-based therapy for H. pylori infection in Zambia is suboptimal and falls below internationally recommended targets. These findings underscore the need to reassess empirical treatment strategies, particularly among patients with previous eradication attempts, and highlight the importance of locally informed antibiotic selection.

Background: Despite increasingly refined diagnostic strategies and regularly updated treatment guidelines, real‐world outcomes of Helicobacter pylori management remain variable. Antimicrobial resistance alone does not fully explain these discrepancies, suggesting important challenges in the implementation of evidence‐based care. Aims: To identify recurring implementation‐related challenges across the Helicobacter pylori care pathway and highlight priorities for improving real‐world management. Methods: This expert‐informed review integrated relevant literature, international guideline documents, and structured international expert prioritisation. An initial list of implementation‐related pitfalls was developed through literature review, clinical experience, and discussions among the coordinating authors and selected co‐authors. Twenty‐six experts from five continents participated in a structured consultation process and rated predefined pitfalls using a 5‐point Likert scale. Median scores were used for relative prioritisation. Results: Treatment selection and patient management emerged as the domains most consistently prioritised by participating experts. High‐impact pitfalls included empirical triple therapy in high‐resistance settings, inadequate patient counselling, and empirical retreatment without escalation. Additional challenges were identified across diagnostic, treatment, and follow‐up domains, highlighting persistent implementation‐related barriers throughout the care pathway. Conclusions: Recurring implementation‐related challenges remain important barriers to optimal Helicobacter pylori management. Structured expert prioritisation highlights potential targets for improvement and supports further research and implementation‐focused strategies to improve delivery of care.

Introduction: Without any intervention, a more than six‐fold increase in gastric cancer cases is expected in sub‐Saharan Africa (SSA) among people born between 2008 and 2017. Therefore, initiatives aimed at curbing this projected increase are urgently required. In this review, we highlight the efforts made in two SSA countries, Zambia and Nigeria. Methodology: A thorough review of the published literature on gastric cancer in both countries was conducted. We did not employ any time limits, and all information sources were consistent with our predetermined objectives. Articles in English were obtained from Google Scholar, Scopus, PubMed, and AJOL. We also conducted an in‐depth analysis of the gastric cancer risk factors reported in Zambia. Results: Zambia and Nigeria lack active population‐based gastric cancer prevention programs. However, concerted efforts are being made to understand the occurrence of gastric cancer and its major risk factor, Helicobacter pylori ( H. pylori ) infection. As in other countries, H. pylori resistance to commonly used antibiotics affects the success rate of eradication therapy. Initiatives are underway to collect robust data and design optimal therapies for H. pylori eradication that are suitable for the SSA population. Conclusion: Zambia and Nigeria have recently made significant strides in collating information on gastric cancer and its risk factors. This is despite the many prevailing challenges, compounded by resource limitations.

BACKGROUND: Research productivity and impact are essential indicators of institutional performance; however, the University of Zambia (UNZA) School of Medicine lacks a systematic bibliometric appraisal. Benchmarking faculty-level output and impact provides evidence to guide strategic investments, faculty development, and resource allocation. OBJECTIVE: To investigate and analyse research productivity and impact among faculty members of the UNZA School of Medicine and determine whether these matrices differ between basic science and clinical departments. METHODS: We conducted a retrospective bibliometric study of the academic staff listed on the 2025 UNZA School of Medicine roster with publications indexed in Google Scholar. For each faculty member, we extracted publication counts, citations, H-index, mean citations per paper, and covariates (department and sex). Data were de identified. Descriptive statistics (medians, IQRs, and time-series plots) were used to characterise productivity and impact trends. Group comparisons between clinical and basic sciences were performed using the Mann–Whitney U test for continuous variables and categorical variables. Multivariable regression analysis identified independent predictors of productivity and impact after adjusting for academic position and department. RESULTS: Among 80 faculty members (65% clinical, 35% basic sciences), there were 2,185 publications since 1998, with a median of 12 papers per lecturer (IQR 4–38). Scholarly impact was reflected in a median of 173 citations (IQR 38–382) and an H index of 4.5 (IQR 2–11). Regression analyses showed that affiliation with the clinical sciences department was associated with greater publication output (β = 22.2, p = 0.03), independent of academic position, although citation counts did not differ significantly by department. Citation trends demonstrated a sharp rise after 2015, approaching 4,000 by 2025. Professors consistently held the highest average citations until 2023, when lecturers surpassed them. CONCLUSION: Research productivity and impact at UNZA, School of Medicine have risen sharply since 2015, with clinical sciences affiliation associated with higher publication output and growing citation visibility across ranks, underscoring the expanding institutional research strength.

Diagnosis of upper gastrointestinal (UGI) mucosal lesions primarily uses endoscopy. Based on our preliminary work in Zambia which showed that free blood in