Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

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  • 1 Department of Neurology, University of Michigan, Ann Arbor, Michigan;
  • 2 Department of Psychiatry, University College London, London, United Kingdom;
  • 3 Camden and Islington NHS Foundation Trust, London, United Kingdom;
  • 4 Department of Neurology, University of Rochester, Rochester, New York;
  • 5 Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia;
  • 6 University Teaching Hospitals, Children’s Hospital, Lusaka, Zambia;
  • 7 ZAMBART, University of Zambia, Lusaka, Zambia;
  • 8 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom;
  • 9 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
  • 10 Department of Neurology, Michigan State University, East Lansing, Michigan

Lumbar puncture (LP) is underused for neuroinfectious disease diagnosis in Zambia, but reasons for poor uptake remain speculative. This cross-sectional study assessed LP knowledge, attitudes, and practices among patients/caregivers and healthcare workers (HCWs) and predictors of LP completion. Patients with suspected CNS infection, caregivers, and HCWs at the University Teaching Hospitals in 2016 were eligible. Questions adapted from the existing literature were used for a LP knowledge score. Predictors of knowledge scores were assessed independently for patients/caregivers and HCWs. Predictors of LP completion were assessed using multivariable logistic regression. Among 123 patients/caregivers, LP knowledge was poor. Pediatric caregivers were more likely than adult patients/caregivers to report LP could be replaced by neuroimaging (90% versus 78%, P < 0.001) and cause paralysis (57% versus 39%, P = 0.01). There were no significant predictors of the knowledge score among patients/caregivers. Among HCWs, 28% said LP makes patients clinically worse, and 60% reported it could cause paralysis. The increased knowledge score was associated with greater wealth (P = 0.03) and personally knowing someone who underwent LP (P < 0.001). Lumbar puncture was completed on 67/112 (57%) patients and was associated with an increased knowledge score (OR: 1.62 [95% CI: 1.19–2.23]). Pediatric patients (OR: 0.18 [95% CI: 0.07–0.47]) and those with a fear of paralysis (OR 0.29 [95% CI: 0.11–0.77]) were less likely to undergo LP. Improving LP-related knowledge may improve uptake. Healthcare workers sense of LP risk may also play a role in encouraging/discouraging use.

Author Notes

Address correspondence to Melissa A. Elafros, Department of Neurology, University of Michigan, F2647 UH South SPC 5223, 1500 E medical Center Dr., Ann Arbor, MI 48109. E-mail: elafrome@med.umich.edu

Financial support: This study was funded by NIH 5R25NS065729-11, R01NS094037, Norman Kagan Endowed Scholarship in Graduate and Professional Studies; Blake W. H. Smith Scholarship.

Authors’ addresses: Melissa A. Elafros, Department of Neurology, University of Michigan, Ann Arbor, MI, E-mail: elafrome@med.umich.edu. Clara Belessiotis, Department of Psychiatry, University College London, London, United Kingdom, and Camden and Islington NHS Foundation Trust, London, United Kingdom, E-mail: clara.belessiotis@googlemail.com. Gretchen L. Birbeck, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, E-mail: gretchen_birbeck@urmc.rochester.edu. Virginia Bond, Zambart, School of Public Health, University of Zambia, Lusaka, Zambia, E-mail: gbond@zambart.org.zm. Izukanji Sikazwe, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, E-mail: izukanji.sikazwe@cidrz.org. Michelle P. Kvalsund, Michigan State University Clinical Center, East Lansing, MI, E-mail: michelle.kvalsund@hc.msu.edu.

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