Clemence Marimo

Background Southern Africa, like other parts of the world, has always strived to deliver quality health professions education. These efforts have been influenced to a larger extent by the socio-economic and cultural context of the region, but also by what happens globally. The global disruption caused by the COVID-19 pandemic necessitated the implementation of emergency remote teaching (ERT) to continue delivering on the mandate of educating future health professionals in 2020. The purpose of this research was to describe the change process through which selected health professions education institutions (HPEIs) in the Southern African region adjusted their academic programmes for remote learning and teaching during the COVID-19 related pandemic. Methods A mixed methods study with a case study design was applied using the ADKAR model as a conceptual framework for data interpretation. The study population consisted of educators, students, and administrators in undergraduate medical a...

BACKGROUND Zambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training non-physician clinical students in Zambia, due to the shortage of qualified medical lecturers and learning resources at training locations. To address this shortage and strengthen the MLP program, a self-directed e-learning platform for medical education with an eHealth component was introduced. MLP students were provided with tablets that were pre-loaded with e-learning and eHealth content for offline access. OBJECTIVE To identify MLP students and medical lecturers’ perceptions of self-directed e-learning and eHealth with an offline-based tablet as a training and healthcare practice support tool during the first year of full implementation. METHODS We conducted in-depth qualitative interviews with eight MLP students and six lecturers and two focus group discussions with 16 students to gain insigh...

Sub-Saharan Africa has the highest number of HIV/AIDS cases globally which contrasts with the lack of population-based studies of oral Kaposi's sarcoma (OKS); one of the clinical cardinal signs of HIV/AIDS. To date, no study has investigated the incidence of OKS in African populations affected by the HIV/AIDS epidemic. It is, therefore, the purpose of this study to assess the burden of OKS in the Zimbabwean population over a 10 year period. A descriptive epidemiological study was undertaken to assess the burden of OKS by determining the frequencies, incidence and cumulative rates, the lifetime risk and chances of developing OKS according to site (topography), gender, age, race/ethnic origin of the Zimbabwean population. A total of 445 incident cases of OKS from the upper and lower lips, oral vestibule, retromolar area, floor of mouth, tongue, cheek, mucosa, gums, hard and soft palate were accessed from the Zimbabwe National Cancer Registry (ZNCR). Cases from the skin, pharynx, larynx and the major salivary glands were excluded from the study. This comprised the population of Zimbabwe during the 10 year period 1988-1997. The population figures used for this study were fro the 1992 Census Zimbabwe National Report. The study population was standardized by the direct method against the world standard population to calculate the age standardized incidence rate (ASIR). The SPSS statistical software programme (SPSS Inc. 2001, USA) was used for the statistical analysis. OKS comprised 0.92% of total body malignancies and 51% of oral malignancies with a mean age of study cases of 37.6 years and median age of32 years. Histology of the primary (64.5%) and clinical diagnosis (34.6%) were the predominant methods of diagnosis. OKS affected nearly only blacks and males more than females, with a male to female ratio of 1.9:1. The most affected age groups by OKS were the 30 to 34 years for male and 25 to 29 years for both females and the whole population. Other notable peaks in OKS rates were in the 0 to 4 year and the 75+ age groups. OKS mostly affected the palate (70.2%) followed by, in descending order, the tongue (13.3%) and mouth (8.3%). The age adjusted age standardized incidence rate (ASIR) of OKS exponentially increased the entire study period bypassing oral squamous cell carcinoma (OSCC) as the predominant oral malignancy in 1994. Among AIDS-associated malignancies, OKS accounted for 98% while the balance comprised Burkitt's lymphoma, Hodgkin's and Non-Hodgkin's lymphomas, haemangiosarcoma and lymphoma not specified. OKS was the commonest malignancy of young adults affecting males more than females. OKS steady increased for the entire study period overtaking SCC in 1994 to become the commonest oral malignancy for the remainder of the study period. The palate was the most affected intra-oral site by OKS. These findings are attributable to the high human immunodeficiency virus infection (HIV) rates recorded for

Lipomas are among the most common tumors of the human body. However, they are uncommon in the oral cavity. In the oral cavity they present as a slow growing, painless, and asymptomatic yellowish submucosal mass. Surgical excision is the treatment of choice with recurrence not expected. They have been known to grow to large sizes causing mastication and speech difficulties. The usual lesions consist of a well circumscribed, lobulated mass of mature fat cells. In other situations the covering mucosa becomes ulcerated and presents difficulties in diagnosis. The present report is of a patient who presented with a gigantic lipoma on the tip of the tongue which had been present for 3 years. She now had difficulty with speech and mastication as the tongue tumor now completely filled the oral cavity. An incision biopsy confirmed the tumor as lipoma. The tumor was surgically excised with restoration of normal tongue function, speech and masticatory capacity. Histopathologic examination of the excised tumor confirmed that it was a lipoma.

Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiological agent for Kaposi's sarcoma (KS). Both KSHV and KS are endemic in sub-Saharan Africa where approximately 84% of global KS cases occur. Nevertheless, whole-genome sequencing of KSHV has only been completed using isolates from Western countries-where KS is not endemic. The lack of whole-genome KSHV sequence data from the most clinically important geographical region, sub-Saharan Africa, represents an important gap as it remains unclear whether genomic diversity has a role on KSHV pathogenesis. We hypothesized that distinct KSHV genotypes might be present in sub-Saharan Africa compared to Western countries. Using a KSHV-targeted enrichment protocol followed by Illumina deep-sequencing, we generated and analyzed sixteen unique Zambian, KS-derived, KSHV genomes. We enriched KSHV DNA over cellular DNA 1,851 to 18,235-fold. Enrichment provided coverage levels up to 24,740-fold; therefore, supporting highly confident polymorphism analysis. Multiple alignment of the sixteen newly sequenced KSHV genomes showed low level variability across the entire central conserved region. This variability resulted in distinct phylogenetic clustering between Zambian KSHV genomic sequences and those derived from Western countries. Importantly, the phylogenetic segregation of Zambian from Western sequences occurred irrespective of inclusion of the highly variable genes K1 and K15. We also show that four genes within the more conserved region of the KSHV genome contained polymorphisms that partially, but not fully, contributed to the unique Zambian KSHV whole-genome phylogenetic structure. Taken together, our data suggest that the whole KSHV genome should be taken into consideration for accurate viral characterization. Our results represent the largest number of KSHV whole-genomic sequences published to date and the first time that multiple genomes have been sequenced from sub-Saharan Africa, a geographic area where KS is highly endemic. Based on our new sequence data, it is apparent that whole-genome KSHV diversity is greater than previously appreciated and differential phylogenetic clustering exists between viral genomes of Zambia and Western countries. Furthermore, individual genes may be insufficient for KSHV genetic characterization. Continued investigation of the KSHV genetic landscape is necessary in order to effectively understand the role of viral evolution and sequence diversity on KSHV gene functions and pathogenesis.

To present our experience on the epidemiology, clinical features, management, and survival of patients with oral malignant melanoma. Records of patients with a histologic diagnosis of primary oral mucosal malignant melanoma seen over a 23-year period were retrospectively reviewed. There were 6 females and 2 males, ranging in age from 18 to 60 years; 4 cases in the maxilla, 2 in the mandible, 1 on the lower lip, and 1 on the buccal mucosa. Local recurrences developed in 2 patients who eventually died with clinical metastatic cervical nodal disease. Follow-up ranged from 6 months to 16 years 3 months. Surgery was the only treatment available. Primary oral mucosal melanoma is rare, with a 3 to 1 female to male ratio and an average age of 41.7 years at presentation. It is most common in the maxilla and has poor prognosis despite apparent adequate local surgical control.

The occurrence of primary oral melanoma is very rare. Large clinical series suggesting appropriate treatment modalities are lacking; the clinician has to rely on case reports to gain insight into the management of this tumor, which is much more aggressive than its skin counterpart. Patients and methods The cases of 5 patients with primary oral melanoma during a 6-year period were retrospectively reviewed. Four patients presented with tumors located in the maxilla. Preoperative workup included microscopic examination of incisional biopsy specimens for the confirmation of the diagnosis and thorough imaging of the body to rule out distant metastases. Histologically significant vertical invasion was found in all patients. No patient had distant metastases initially, and only 1 patient presented with neck disease. Primary treatment included wide local excision in 4 patients and therapeutic modified radical neck dissection in the 1 patient with neck node involvement on presentation. One patient was treated primarily with radiation therapy due to medically compromised status. Adjuvant immunochemotherapy (DAV protocol) was administered to 4 patients. Radiation therapy was used in an adjuvant fashion in 3 patients. All of the patients developed distant metastases to the lung and liver and eventually died of their disease. Survival ranged from 14 to 38 months (mean, 25.6 months). Local recurrence occurred in 1 patient and was attributed to positive surgical margins. Contralateral neck disease developed in the patient who underwent therapeutic neck dissection. The prognosis of primary oral melanoma remains poor despite adequate locoregional control of the disease. It seems that diagnosis is made late in the course of the disease when the primary tumor has already shed microscopic distant metastases.