{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:51:01Z","timestamp":1776081061672,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS094037"],"award-info":[{"award-number":["R01NS094037"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["5R25NS065729-11"],"award-info":[{"award-number":["5R25NS065729-11"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007709","name":"Michigan State University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007709","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Uptake of lumbar puncture (LP) remains low in regions with a high prevalence of central nervous system (CNS) infections like Zambia. Efforts to improve uptake are hindered by limited understanding of factors influencing LP uptake.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Semistructured qualitative interviews were conducted with patients with suspected CNS infection, caregivers, doctors and nurses at the University Teaching Hospitals in 2016. Questions focused on LP experiences, knowledge, the consent process and health system barriers to LP among patients with an LP indication. Interviews were transcribed, translated to English and analysed using a thematic approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We recruited 24 adult patients, 36 caregivers of adult patients, 63 caregivers of paediatric patients, 20 doctors and 30 nurses (173 in total). LP barriers arose from both patients\/caregivers and health providers and included community apprehension about LP, proxy (family) consensus consent practices, competing clinical demands, wariness of patient\/caregiver responses, limitations in consumables and time to complete the LP. This could result in consent not being obtained correctly. LP enablers included patient\/caregiver perceived LP utility, provider comfort with LP and in-person counselling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LP uptake is a complex sociocultural process influenced by patient, healthcare and community-level factors. Interventions to improve uptake must address multiple barriers to be successful.<\/jats:p><\/jats:sec>","DOI":"10.1093\/trstmh\/trab124","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T19:13:02Z","timestamp":1626894782000},"page":"322-327","source":"Crossref","is-referenced-by-count":12,"title":["A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia"],"prefix":"10.1093","volume":"116","author":[{"given":"Melissa A","family":"Elafros","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara","family":"Belessiotis-Richards","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University College London, London, W1T 7BN, UK"},{"name":"Camden and Islington NHS Foundation Trust, London, NW1 OPE, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gretchen L","family":"Birbeck","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester, Rochester, NY 14642, USA"},{"name":"Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, 10101, Zambia"},{"name":"University Teaching Hospitals, Children's Hospital, Lusaka, 10101, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"Bond","sequence":"additional","affiliation":[{"name":"Zambart, School of Public Health, University of Zambia, Lusaka, 10101, Zambia"},{"name":"Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izukanji","family":"Sikazwe","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Research in Zambia, Lusaka, 10101, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle P","family":"Kvalsund","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Rochester, Rochester, NY 14642, USA"},{"name":"Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, 10101, Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"issue":"12","key":"2022040410230653800_bib1","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1016\/S1474-4422(18)30387-9","article-title":"Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"17","year":"2018","journal-title":"Lancet Neurol"},{"issue":"7","key":"2022040410230653800_bib2","doi-asserted-by":"crossref","first-page":"e0200067","DOI":"10.1371\/journal.pone.0200067","article-title":"Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: a prospective study","volume":"13","author":"Gudina","year":"2018","journal-title":"PloS One"},{"issue":"11","key":"2022040410230653800_bib3","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1093\/cid\/ciu596","article-title":"The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis","volume":"59","author":"Rolfes","year":"2014","journal-title":"Clinical Infect Dis"},{"issue":"2","key":"2022040410230653800_bib4","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1111\/hiv.12283","article-title":"HIV and new onset seizures: slipping through the cracks in HIV care and treatment","volume":"17","author":"Sikazwe","year":"2016","journal-title":"HIV Med"},{"issue":"1","key":"2022040410230653800_bib5","first-page":"7","article-title":"Analysis of the indications for routine lumbar puncture and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in East Africa","volume":"8","author":"Herbert","year":"2006","journal-title":"Tanzan Health Res Bull"},{"issue":"2","key":"2022040410230653800_bib6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.55320\/mjz.46.2.503","article-title":"Aetiology of encephalitis and meningitis in children aged 1-59 months admitted to the Children's Hospital, Lusaka, Zambia","volume":"46","author":"Imamba","year":"2019","journal-title":"Med J Zambia"},{"issue":"10","key":"2022040410230653800_bib7","first-page":"485","article-title":"Lumbar puncture refusal in febrile convulsion","volume":"41","author":"Ling","year":"2000","journal-title":"Singapore Med J"},{"issue":"2","key":"2022040410230653800_bib8","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1542\/hpeds.2011-0034","article-title":"Why do some parents refuse consent for lumbar puncture on their child? 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