Lumbar puncture rejections are commonplace in Zambia. GHA blogger, Ifeoma Ozodiegwu, shares some insights on their importance in the prevention of HIV deaths in Zambia.

The woman lay on her side, one arm supporting her head, one eye half closed. She was wearing a blouse and a chitenge wrapper*. Two relatives stood by her side like guardian angels, concern written on their faces. The resident doctor has just recommended that she go through a lumbar puncture. The intern was speaking to the family to get informed consent for the procedure. I stood in the corner and watched. I was volunteering at a Zambian hospital.

The unanimous response from the patient and her relatives was “no”. The intern tried to explain what a “no” meant. The patient needed the procedure to diagnose her condition and it was against the hospital’s policy to treat a patient blindly. I stepped in and joined my voice with that of the intern doctor but they remained adamant. The final answer was negative.

Lumbar puncture rejections are commonplace in Zambia; even in dire circumstances. In a 2009 study, over 90% of the study participants had negative attitudes towards lumbar punctures. Many care seekers associate lumbar punctures with death or paralysis. To compound the issue, a well-known local media organization had also criticized hospitals’ handling of spinal taps stating that, “Countless people have died after having this seemingly simple procedure done”.

What makes Lumbar Punctures Important?

According to the NHS Choices website, Lumbar puncture can be used to detect a variety of health issues like meningitis, subarachnoid hemorrhage and Guillain-Barre syndrome. Lumbar punctures can also be used to administer medication into the cerebrospinal fluid (CSF).

Research has shown that individuals infected with HIV are at increased risk of tuberculosis meningitis (TBM), a serious complication of tuberculosis infection. Given Zambia’s high HIV prevalence, rate physicians recommend lumbar punctures to ensure early detection of TBM, which if left untreated can lead to neurological damage and premature death.

However, this CSF collection technique poses some risks and should not be performed if a patient has a skin infection on the needle entry site or there are unequal pressures within some parts of the brain. A judgment call is required if a patient has an elevated intracranial pressure, a clotting disorder or a brain abscess but the procedure can still be carried out if the risks outweigh the benefits.

I raised my concerns about the risks associated with lumbar punctures with a Zambian resident physician and she said that in her place of practice at a public hospital, efforts are made to ensure that lumbar punctures are safe for patients and CT scans are done prior to a lumbar puncture if they suspect that it will be too risky for the patient. She also mentioned that many patients refuse to undergo a lumbar puncture until they are terminally ill and at that point, the procedure is just a formality as they often pass on afterwards thus fueling misbeliefs.

I tried to research lumbar puncture safety in Zambia and came up with nothing. Therefore, I cannot comment on safety conditions associated with the procedure in Zambia

An Important Message

In the same hospital where I was volunteering, just a few steps behind the lady who refused to have a lumbar puncture done, a dusty sign above her head read “Lumbar Puncture Saves Lives”. This is a message that is so important but it does not seem to filter through to the intended audience. In the fight to prevent premature deaths from HIV in Zambia, NGO, their partners and Governmental Health Agencies need to prioritize the messaging surrounding lumbar punctures. If misconceptions continue and increase, individuals that are co-infected with HIV and TB will not receive the treatment they need, and will risk spreading TB to others in their communities.

Health promotion campaigns, patient counseling and peer advocates are necessary to change the current negative trends surrounding lumbar punctures whereas public and private health facilities need to ensure that lumbar punctures are performed in the best safety conditions to assuage the concerns of their patrons. It will be laudable if a research study can be conducted within Zambian health facilities to quantify the number of lives saved by lumbar punctures and investigate if physicians follow guidelines when performing the procedure. This will inform efforts to strengthen capacity if issues are detected. If the results of the research study are positive, they can be shared with the public to counter existing misconceptions.

*Chitenge wrapper: a wrapper made from waxed cloth