Cardiac disease complicates 0.2-4% of all pregnancies in western countries with 53 countries showing increasing trends in high-risk cardiac related pregnancies from 0.7% (2007-2010) to 10.9% (2015 -2018). The mean prevalence of heart disease in pregnancy is 616 per 100, 000 deliveries with a four-fold increase in mortality in South Africa as an exemplar. Cardiac disease has effects on neonatal outcomes such as prematurity, growth restriction, birth asphyxia and foetal demise. In Zambia, 10% of deaths due to noncommunicable diseases within the general population are cardiovascular related. However there is paucity of data indicating the prevalence and clinical trajectory of cardiac disease in pregnancy. Therefore, we aimed to understand obstetric characteristics and neonatal outcomes of pregnant women with cardiac disease presenting to the Women and Newborn hospital in Lusaka, Zambia We conducted a comprehensive retrospective review of obstetrics records for a 15-year period (2004 to 2019) for all deliveries that occurred at the Women and Newborn Hospital. The hospital serves as the largest referral centre for the country and located within the capital city, Lusaka. Data was collected using a pretested data collection chart. We performed descriptive statistics and reported results as frequencies or medians with corresponding interquartile ranges. We identified 349 pregnancies. The prevalence of cardiac disease in pregnancy was 0.14% with a general uptrend in cases per year. The average age was 29 years SD 6years, median parity was 3 (IQR 1-4), median gestation age at delivery was 38 weeks (IQR 36-39), the commonest mode of delivery was vaginal (82.85 vs 17.15), with a about a quarter having instrumental deliveries, median neonates birth weight was 3kg IQR (2.6 -3.3). Overall, most babies were born in good condition (94.34% vs 5.66%) with an APGAR score of 9 for most infants.Cardiac disease in pregnancy is common in Zambia. Healthcare providers need to be abreast with guidelines on preconceptual, antenatal and postnatal management of women with cardiac disease to enhance favorable outcomes.

Background Since the globe was faced with the COVID-19 pandemic in December 2019, numerous adjustments have been made in all sectors to curtail the spread of infection. Most elementary and tertiary schools were closed or suspended until the transmission rates dropped. Following the outbreak of COVID-19, medical schools in Zambia have sought ways to replace face-to-face medical learning with virtual clinical teaching. The objectives of this study were to explore the perceptions of online learning among University of Zambia medical students and understand the barriers and facilitators to effective online learning. Methods A qualitative descriptive approach was used, enrolling final year medical students from the University of Zambia; the consenting participants were sampled purposively and interviewed through virtual platforms until data saturation was reached upon interviewing the 11th participant. A total of 14 participants were interviewed, audio recorded, transcribed verbatim and data was analyzed using six steps of thematic analysis. Results Three broad themes arose from the interviews: online learning perceptions, facilitators and barriers to online learning. Regarding perceptions of online learning, they highlighted that the delivery was simple to understand, with convenient scheduling and the benefit of being able to refer back to the recorded lectures. Some barriers encountered during the online learning were poor network connection, frequent power outages, lack of patient-student interaction and challenges with learning space in their homes. The facilitators were self-paced learning, availability of lecturers and the desire to complete their training despite the lockdown being in effect. Conclusions Most medical students had positive perceptions of online learning despite its challenges. With the improvement in technology, online education should be incorporated into the traditional training of medical students to get the best outcomes.