Abstract Details

Title Factors associated with poor lumbar puncture uptake in Zambia

Topic Global Health and Neuroepidemiology

Presentation(s) Global Health Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 011

Background

In much of sub-Saharan Africa, LP uptake is poor despite clear indications for the procedure. LP non-performance is often attributed to patient/family refusal, but other health systems and provider factors have not been systematically evaluated.

Objective Evaluate health systems and provider factors associated with lumbar puncture (LP) uptake in Zambia.

Design/Methods

Within a prospective cohort of people with HIV and new-onset seizures at three Zambian hospitals, sociodemographic and clinical data were collected <2 weeks after index seizure. Research resources facilitated extensive, clinically relevant diagnostic studies if cerebrospinal fluid was obtained, but LP completion was at the discretion of treating clinicians. Participants, their proxies and providers were clearly informed about the additional testing available.

Results

257 participants were enrolled, 184 (72%) adults, 144 (56%) urban. Adults were 38+10 years, 52% male. Children were 6.6+4.6 years, 53% male. Half were on antiretroviral therapy. LP was performed in 119 (65%) of adults and 24 (33%) of children and in 100 (69%) of urban and 43 (38%) of rural participants. In multivariate logistic regression analyses in the overall cohort, LP uptake (i.e. LP completion) was significantly less likely at one rural site (OR 0.23; 95%CI 0.07-0.70) compared to other sites and among children relative to adults (OR 0.19; 95%CI 0.09, 0.39). Worse WHO HIV Disease Stage was associated with increased odds of undergoing LP (OR 1.31; 95% CI1.01-1.70). Among adults, only site was associated with LP uptake (site A: OR 0.29; 95%CI 0.09-0.96, p<0.04). Amongst children, focal seizures (OR 0.15; 95%CI 0.03-0.75, p=0.02) and meningismus (OR 9.28; 95%CI 1.27-67.9, p=0.03) were associated with LP uptake.

Conclusions

Poor LP uptake in Zambia is likely multi-factorial and related to health systems and provider factors in addition to patient/family preference. Further research is necessary to better understand this complex problem and identify interventions to improve LP uptake in this region.

Authors/Disclosures
Deanna Saylor, MD, MHS (Johns Hopkins Hospital) PRESENTER	The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.
Melissa Elafros, MD, PhD (Michigan Medicine)	The institution of Dr. Elafros has received research support from National Institute of Neurologic Disorders and Stroke . The institution of Dr. Elafros has received research support from National Center for Advancing Translational Sciences. The institution of Dr. Elafros has received research support from National Institute of Diabetes and Digestive and Kidney Diseases .
	No disclosure on file
	No disclosure on file
Omar Siddiqi, MD (Beth Israel Deaconess Medical Center)	The institution of Dr. Siddiqi has received research support from NIH.
Izukanje Sikazwe	No disclosure on file
Gretchen L. Birbeck, MD, MPH, DTMH, FAAN (University of Rochester/CHET)	An immediate family member of Dr. Birbeck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Birbeck has a non-compensated relationship as a Ambassador for Zambia with RSTMH that is relevant to AAN interests or activities.