Papers by Clemence Marimo
Medicina oral, patologia oral y cirugia bucal, 2006
Lipomas are among the most common tumors of the human body. However, they are uncommon in the ora... more 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 th...
Background Southern Africa, like other parts of the world, has always strived to deliver quality ... more 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...
Journal of Oral and Maxillofacial Surgery, 2007
Purpose: To present our experience on the epidemiology, clinical features, management, and surviv... more Purpose: To present our experience on the epidemiology, clinical features, management, and survival of patients with oral malignant melanoma. Patients and Methods: Records of patients with a histologic diagnosis of primary oral mucosal malignant melanoma seen over a 23-year period were retrospectively reviewed. Results: 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. Conclusion: 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.
Background Southern Africa, like other parts of the world, has always strived to deliver quality ... more 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 he... more 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...
Journal of Virology & Antiviral Research
Journal of Virology & Antiviral Research
Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tac... more Background: Zambia faces a severe shortage of health workers, particularly in rural areas. To tackle this shortage, the Medical Licentiate program was initiated at Chainama College of Health Sciences in the capital, Lusaka, in 2002. The objective of the program was to alleviate the shortage of human resources in curative care. On-the-job training is conducted in decentralized teaching hospitals throughout Zambia. However, the program faces significant challenges such as shortages of senior medical instructors and learning materials.
Staphylococcus aureus is implicated in nosocomial infections worldwide and is associated with a v... more Staphylococcus aureus is implicated in nosocomial infections worldwide and is associated with a variety of infections such as endocarditis, food poisoning, toxic shock syndrome, septicaemia, skin and soft tissue infections, and bone infections. The emergence and spread of multi-drug resistant strains of S. aureus, particularly methicillin-resistant strains, is worrisome as they are resistant to many antibiotics. However, there is sparse information on the burden of methicillin-resistant Staphylococcus aureus in Zambia. Knowledge of antimicrobial susceptibility patterns of bacterial pathogens is crucial for optimal treatment of patients. It is also important for monitoring the spread of resistant organisms in hospitals and communities. The objective of this study was to identify and determine the antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus at the University Teaching Hospital in Lusaka, Zambia. A total of 95 stored isolates of suspected methicillin-resistant Staphylococcus aureus from pus and blood specimens collected from June 2009 to December 2012 at the University Teaching Hospital were analysed. Conventional microbiological methods and Clinical Laboratory Standards Institute criteria were used to identify and determine the antimicrobial susceptibility of isolates. Of the 95 S. aureus isolates, 43% were identified as methicillin-resistant Staphylococcus aureus strains. These methicillin-resistant Staphylococcus aureus strains were resistant to trimethoprim/sulfamethoxazole (100%), ciprofloxacin (95%), penicillin (95%), erythromycin (79%), tetracycline (76%) and gentamicin (67%). Multi-drug resistance to a combination of, four, five, six and seven antibiotics was observed in 17.5%, 27.5%, 35%, and 17.5% of the methicillin resistant Staphylococcus aureus isolates, respectively. The prevalence of multi-drug resistant methicillin resistant Staphylococcus aureus at the University Teaching Hospital was found to be high. Regular surveillance for multi-drug infections is recommended for infection control and to guide treatment.
Central African Journal of Medicine, 2010
Sub-Saharan Africa has the highest number of HIV/AIDS cases globally which contrasts with the lac... more 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
Staphylococcus aureus is implicated in nosocomial infections worldwide and is associated with a v... more Staphylococcus aureus is implicated in nosocomial infections worldwide and is associated with a variety of infections such as endocarditis, food poisoning, toxic shock syndrome, septicaemia, skin and soft tissue infections, and bone infections. The emergence and spread of multi-drug resistant strains of S. aureus, particularly methicillin- resistant strains, is worrisome as they are resistant to many antibiotics. However, there is sparse information on the burden of methicillin-resistant Staphylococcus aureus in Zambia. Knowledge of antimicrobial susceptibility patterns of bacterial pathogens is crucial for optimal treatment of patients. It is also important for monitoring the spread of resistant organisms in hospitals and communities. The objective of this study was to identify and determine the antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus at the University Teaching Hospital in Lusaka, Zambia. A total of 95 stored isolates of suspected methicillin-resistant Staphylococcus aureus from pus and blood specimens collected from June 2009 to December 2012 at the University Teaching Hospital were analysed. Conventional microbiological methods and Clinical Laboratory Standards Institute criteria were used to identify and determine the antimicrobial susceptibility of isolates. Of the 95 S. aureus isolates, 43% were identified as methicillin-resistant Staphylococcus aureus strains. These methicillin- resistant Staphylococcus aureus strains were resistant to trimethoprim/sulfamethoxazole (100%), ciprofloxacin (95%), penicillin (95%), erythromycin (79%), tetracycline (76%) and gentamicin (67%). Multi-drug resistance to a combination of, four, five, six and seven antibiotics was observed in 17.5%, 27.5%, 35%, and 17.5% of the methicillin resistant Staphylococcus aureus isolates, respectively. The prevalence of multi-drug resistant methicillin resistant Staphylococcus aureus at the University Teaching Hospital was found to be high. Regular surveillance for multi-drug infections is recommended for infection control and to guide treatment.
Key Words: MRSA, Staphylococcusaureus, Multi-drug resistance, Antimicrobial susceptibility
The Central African journal of medicine
Annual reports from the few cancer registries in Africa are the only reliable assessment of the b... more Annual reports from the few cancer registries in Africa are the only reliable assessment of the burden of cancer using population-based data. Similar reports for oral malignancies have not been undertaken. The purpose of this study was to assess the burden of oral malignancies in Zimbabwe over a 10 year period using population-based data. A descriptive epidemiological study was undertaken to assess the burden of oral malignancies by determining the frequencies, incidence and cumulative rates, the lifetime risk and chances of developing an oral malignancy according to site (topography), gender, age, morphology and race/ethnic origin of the Zimbabwean population. A total of 873 incident cases of oral malignancies 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 a 10 year period 1988 to 1997. The population figures used for this study were from the 1992 Census Zimbabwe National Report. The study population was standardised by the direct method against the world standard population to calculate the age standardized incidence rate (ASIR). The SPSS statistical software program (SPSS Inc.2001, USA) was used for the statistical analysis. Oral malignancies comprised 1.8% of total body malignancies with high histological confirmation of the diagnosis (77.3%). The 25 to 29 and 30 to 34 five-year age groups were the most and equally affected by oral malignancies. The mean age was 43.9 years and median age was 41 years [standard deviation (SD) = 17.7] excluding 53 cases of'unknown age'. Oral Kaposi's sarcoma (OKS) and oral squamous cell carcinoma (OSCC) were the predominant forms of oral malignancy. The palate was the most commonly affected site by oral malignancy followed by, in descending order, the tongue, mouth, floor of mouth and the gum. Blacks were affected more than whites and males more than females (sex ratio = 1.97:1). The palate and the tongue were the most commonly affected sites in blacks and whites respectively. OKS affected mostly young adults while OSCC was the commonest malignancy of the elderly. The tongue had more OSCC (60.4%) than OKS (31%). Lip cancer was three times more common in whites than in blacks and affected mostly the elderly, though females irrespective of race had a higher lifetime risk for malignancy of the lower lip. The high incidence of OKS among young adults was due to the HIV/AIDS epidemic.
Medicina oral, patologia oral y cirugia bucal
Lipomas are among the most common tumors of the human body. However, they are uncommon in the ora... more 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.
Journal of Virology, 2015
Kaposi's ... more 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.
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2007
To present our experience on the epidemiology, clinical features, management, and survival of pat... more 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.
To present our experience on the epidemiology, clinical features, management, and survival of pat... more 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.
Journal of Oral and Maxillofacial Surgery, 2007
The occurrence of primary oral melanoma is very rare. Large clinical series suggesting appropriat... more 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.
Medical journal of Zambia
Schistosomiasis is endemic in Zambia. Chronics chistosomiasis is associated with significant morb... more Schistosomiasis is endemic in Zambia. Chronics chistosomiasis is associated with significant morbidity. We report a case of a 10 year old girl with Schistosoma mansoni infection presenting with recurrent abdominal pain and multiple abdominal masses diagnosed on biopsy and stool microscopy. The case highlights the pathology associated with chronic intestinal schistosomiasis and its importance as a cause of childhood Disease morbidity in Zambia.
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Papers by Clemence Marimo
Key Words: MRSA, Staphylococcusaureus, Multi-drug resistance, Antimicrobial susceptibility
Key Words: MRSA, Staphylococcusaureus, Multi-drug resistance, Antimicrobial susceptibility
Zambia faces a severe shortage of human resources in health, particularly in rural and hard- to-reach areas. Health care workers are overburdened at rural facilities to deliver quality health care, compromising the health of Zambia’s rural population. As a national response, the Ministry of Health identified the need to train, recruit and retain adequate staff at all levels and initiated the Medical Licentiate (ML) programme for Clinical Officers in 2002 aiming to provide quality and competitive education and training. Our project focuses on an essential aspect of humanitarian aid: sustainably teaching and training health care staff to strengthen the quality of health care delivery in rural areas. Face-to-face training as the way to learn about medical issues through experience, application and discussion with mentors, is combined with e-learning that enhances teaching and training with technology, online and offline.
Method
A mixed-methods approach - employing questionnaires, learner diaries, pre- and post-tests, individual interviews and focus groups - evaluated the relevance of blended-learning with 52 ML students and 16 ML lecturers. The focus of the evaluation was on educational quality, acceptance and usability.
Results
Overall, acceptance and usability of the tablet-based learning was rated positive, as well as relevancy for medical practice. The evaluation tools were adapted and proved to create valid evidence on how a blended-learning approach for medical training translates into better quality of medical education.
Conclusion
The evaluation of tablet-based learning embedded in a blended-learning approach for MLS showed to be relevant. The tools for evaluation provide a valid evaluation methodology. Tablet-based medical learning opens new possibilities for humanitarian aid to sustainably strengthen the healthcare force in resource-low countries.