Attention in this discussion of Zambia is directed to the following: geography; the people; history; government; the economy; foreign relations; defense; and relations between Zambia and the US. In 1986, the population totaled 7 million with an annual growth rate of 3.7%. The infant mortality rate is 87/1000 with a life expectancy of 51 years. Zambia, located in south-central Africa, is bordered by Zaire, Tanzania, Malawi, Mozambique, Zimbabwe, Botswana, Angola, and Namibia. The population is made up of over 70 Bantu-speaking tribes. Expatriates, mostly British (15,000 in 1986) or South African, live primarily in Lusaka where they are employed in mines and related activities. Some ancestors of present-day Zambians most likely arrived about 2000 years ago and eventually displaced or absorbed indigenous stone age hunters and gatherers. The major waves of Bantu-speaking immigrants began in the 15th century; the greatest influx occurred in the late 17th to the early 19th centuries. After the mid-19th century, the area was penetrated by Western explorers. In 1888, Northern and Southern Rhodesia (now Zambia and Zimbabwe) were proclaimed a British sphere of influence. Southern Rhodesia was annexed formally and granted self-government in 1923. Independence was realized on October 24, 1964. Zambia was the 1st British territory to become a republic immediately upon realizing independence. The constitution promulgated on August 25, 1973, abrogated the original 1964 constitution, and this new constitution and the national elections that followed in December 1973 were the final steps in achieving what is termed a "1-party participatory democracy." President Kenneth Kaunda is the major figure in the country's politics. He has wide popular support and traditionally has bridged the rivalries among the country's various regions and ethnic groups. The economy of Zambia is based primarily on its majority state-owned copper industry, which is the only significant source of foreign exchange. Copper production has dropped to less than 500,000 metric tons/year from a high of 720,000 in 1976. Beginning in late 1982, Zambian government leaders took several important steps to deal with the country's economic plight, including restricting public spending, reducing government subsidies, raising farm producer incentives, and devaluing the currency. The US maintains a substantial foreign assistance program in Zambia. PMID:12178072
In 1964, at independence, Zambia's economic future looked brighter than that of most other developing countries. Its copper production accounted for 8% of total world production, and only neighboring Zaire outpaced it in the production of cobalt. Its Central Province around Kabwe held rich deposits of both zinc and lead; uranium deposits also had been found, but their projected yield remained undetermined. Since 1974, the decline in the price of copper and the increase in the price of oil have played havoc with Zambia's balance of payments. Copper, which accounted for 40% of the gross national product (GNP) and 98% of all foreign exchange in 1964, shrank to 12% of the GNP in 1978 while still generating most of the foreign exchange. As a result, imports were cut back markedly from $1.5 billion in 1973 to $690 million in 1983. Although this trend is beginning to make a U-turn, Zambia's economic situation is grave. In 1984 the GNP continued to register negative growth and inflation stood at 25%. With its urbanization rate doubling from 21% in 1964 to 43% in 1985, Zambia is now the most urbanized country south of the Sahara. Zambia's 1985 population is estimated to be 6.8 million. Between 1963 and 1969, the average annual population growth rate was 2.5: it was 3.1% between 1969-80. The current birthrate of about 48/1000 is expected to decline only marginally in the next 15 years, but the death rate is declining more rapidly -- from 19/1000 in the late 1960s to 15/1000 in 1985. Life expectancy is expected to rise from the current 51 years to about 58 years. As a result of the high growth rate, Zambia's population is young, with a median age of about 16.3 years. Traditional African values stress the importance of large families. Zambia's total fertility rate was 6.9 in 1985. According to the World Bank, only 1% of married women of childbearing age in 1982 used contraceptives. Although tribal links are weakening, Zambia still counts 73 officially recognized tribes. Together, they speak about 40 different dialects. Zambia now apportions over 15% of its national budget to education. Despite some noticeable progress, the public health structure remains deficient. Principal health problems include malaria, tuberculosis, and, in Northern Province and Luapula Province, sleeping sickness and river blindness. About 2/3 of the labor force, an estimated 2.2 million persons in 1982, still work in agriculture. Female labor force participation is lower in Zambia than in many African nations. PMID:12267904
Summary This country profile for Zambia was compiled between 1998 and 2002. The objectives of the exercise were to first of all avail policymakers, other key decision makers and leaders in Zambia, information about mental health in Zambia in order to assist policy and services development. Secondly, to facilitate comparative analyses of mental health services between countries. The work involved
John Mayeya; Roy Chazulwa; Petronella Ntambo Mayeya; Edward Mbewe; Lonia Mwape Magolo; Friday Kasisi; Annel Chishimba Bowa
Retraces the contribution of the Catholic Church to schooling in Northern Rhodesia (currently Zambia) from 1891-1924. Provides background on the development of the Church in Zambia. Discusses Catholic and government perspectives on schooling and conversion, Catholic schooling in Zambia, and the African response to Catholic schooling. (CMK)
In Mansa District, Zambia, people are unaware of the risk factors of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). To remedy this, the District HIV Prevention and Care Team invited a member of the Positive and Living Squad (PALS), John Luonde, to speak at educational sessions for various target audiences. Goals included providing information, dissipating misinformation, alleviating community fears, and mobilizing people through specific activities that addressed identified needs. The sessions began with the testimony of John Luonde and a simple question and answer period, which were followed by focus groups, often with a video, for more difficult or sensitive topics. Information materials were distributed and a condom demonstration was conducted. Although some institutions initially refused permission because of the holiday season or the possible impact on staff, Luonde returned to cover the missed groups. More than 105 people from 9 sectors of the community participated. Groups that were represented included the Mansa Sports Club, the Mutende Deaf Branch, a factory, the local army and police, and physicians from the Mansa Hospital Board. Questions from the different groups were similar. Participants saw that, although anyone could contract AIDS (the central theme of the project), they could still hope for productive years with proper treatment, self-care, and diet. Most participants wanted to change their sexual behavior and Luonde was asked to return. Women and people with physical disabilities need to be targeted. Although condoms were previously seen as promoting promiscuity, institutions are now requesting their distribution. The team is collaborating with a social marketing organization on condom use promotion. Distribution sites include bars, restaurants, filling stations, supermarkets, and hair dressers. At the request of the community, a meeting was held with the director of the Mansa Hospital Board to develop policy guidelines and to plan sessions on hospital care of persons with HIV and staff attitude toward them. PMID:12288110
Explores the origins and development of the Catholic Church's involvement in secular schooling in Zambia. Illustrates that at the primary level, government's secularization led to the hand over of these schools; but at the secondary level a more universal type of Catholic school developed. (CMK)
Objective: To describe the state of mental health services in Zambia.Conclusions: Mental health services in Zambia are in a dreadful state, partly brought about by being afforded a low priority rating, in turn through a miscalculation. Richer countries may be in a position to help remedy Zambia's problems in this area.
These MISR images of Zambia and Botswana, Africa were acquired on August 25, 2000 during Terra orbit 3655. The left image is a 'true' color view from the vertical-viewing (nadir) camera. True color means that the images acquired through MISR's red, green, and blue filters, respectively, are displayed as red, green, and blue when creating the digital image. The middle image combines data from the green, red, and near-infrared bands. The right image contains red band data only, but is a composite of imagery from the nadir (An), 70.5-degrees forward (Df), and 70.5-degrees aftward (Da) cameras. The color variations in the multi-angle composite arise not from how the different parts of the scene reflect light at different wavelengths, but rather, at different angles.
The distinctive fan-like feature on the left of each image is the highly vegetated Okavango Delta, a mosaiced network of grasslands and water channels, observed here during the dry season. The town of Maunis at its southeastern edge. Note how the plant life, which is highly reflective in the near-infrared, shows up as bright red in the middle image. Vegetation also preferentially reflects light back toward the source of illumination, so in the right image, the Df camera image, which is displayed in green, is brighter in this region.The body of water in the upper right is the Itezhi-Tezhi Dam, fed by the Kafue River in Zambia. At the lower left, south of the Okavango Delta, is Lake Ngami. A smoke plume is present at the southern edge of the lake. This plume and others show up in shades of blue and purple in the multi-angle composite as a result of the manner in which the smoke particles scatter sunlight.Other landmarks include the Ntwetwe Pan, whose western edge is visible as the bright area in the lower right. The Zambezi River enters from the upper left and wends its way southeast, passing the Caprivi Strip, a narrow panhandle in northeast Namibia. The greater abundance of vegetation here testifies to the high rainfall that occurs during the wet season. Near the right-hand edge of the images is the location where the Zambezi plunges into Victoria Falls, considered to be among the most spectacular waterfalls in the world.MISR was built and is managed by NASA's Jet Propulsion Laboratory, Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.
Not all floods are unwanted. Heavy rainfall in southern Africa between December 2003 and April 2004 provided central Zambia with floodwaters needed to support the diverse uses of water within the Kafue Flats area. The Kafue Flats are home to about one million people and provide a rich inland fishery, habitat for an array of unique wildlife, and the means for hydroelectricity production. The Flats falls between two dams: Upstream to the west (not visible here) is the Izhi-tezhi, and downstream (middle right of the images) is the Kafue Gorge dam. Since the construction of these dams, the flooded area has been reduced and the timing and intensity of the inundation has changed. During June 2004 an agreement was made with the hydroelectricity company to restore water releases from the dams according to a more natural flooding regime. These images from NASA's Multi-angle Imaging SpectroRadiometer (MISR) illustrate surface changes to the wetlands and other surfaces in central Zambia resulting from an unusually lengthy wet season. The Kafue Flats appear relatively dry on July 19, 2003 (upper images), with the Kafue River visible as a slender dark line that snakes from east to west on its way to join the Zambezi (visible in the lower right-hand corner). On July 21, 2004 (lower images), well into the dry season, much of the 6,500-square kilometer area of the Kafue Flats remains inundated. To the east of the Kafue Flats is Lusaka, the Zambian capital, visible as a pale area in the middle right of the picture, north of the river. In the upper portions of these images is the prominent roundish shape of the Lukanga Swamp, another important wetland.
The images along the left are natural-color views from MISR's nadir camera, and the images along the right are angular composites in which red band data from MISR's 46o forward, nadir, and 46o backward viewing cameras is displayed as red, green and blue, respectively. In order to preserve brightness variations among the various cameras, the data from each camera were processed identically. Here, color changes indicate surface texture, and are influenced by terrain, vegetation structure, soil type and soil moisture content. Wet surfaces or areas with standing water appear blue in this display because sun glitter makes smooth, wet surfaces look brighter at the backward camera's view angle. Mostly the landscape appears somewhat purple, indicating that most of the surfaces scatter sunlight in both backward and forward directions. Areas that appear with a slight greenish hue can indicate sparce vegetation, since the nadir camera is more likely to sight the gaps between the trees or shrubs, and since vegetation is darker (in the red band) than the underlying soil surface. Areas which preferentially exhibit a red or pink hue correspond with wetland vegetation. The plateau of the Kafue National Park, to the west of Lukanga Swamp, appears brighter in 2004 compared with 2003, which indicates weaker absorption at the red band. Overall, the 2004 image exhibits a subtle blue hue (preference for forward-scattering) compared with 2003, which indicates overall surface changes that may be a result of enhanced surface wetness. The Multiangle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire globe between 82o north and 82o south latitude. These data products were generated from a portion of the imagery acquired during Terra orbits 19072 and 24421. The panels cover an area of 235 kilometers x 239 kilometers, and utilize data from blocks 100 to 103 within World Reference System-2 path 172. MISR was built and is managed by NASA's Jet Propulsion Laboratory, Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.
be advanced to the high court, and then the Supreme Court. Local courts are supervised by a presiding justice, who in some courts sits with a number of court justices (Tranberg Hansen, 1996, p123). Copper to a market-oriented multi-party democracy. The people of Zambia elect their President once every five years
In colonial Zambia, the school served as a key means of Christian conversion and Church growth. During this period, the provision of education was almost the total preserve of the missionaries. Even by the time of Zambia's Independence in 1964, sixty-six per cent of the primary schools were operated by missionaries and about thirty per cent were run by Catholics.
This guide is designed for language teachers training Peace Corps volunteers in Nyanja for service in Zambia, and focuses on daily communication skills in that context. It consists of a language "survival kit" of useful phrases and vocabulary, conjugation of the verb "to be," the Zambia national anthem, extensive notes on verb tenses and…
Since the early 1990s and, perhaps, as one effect of the emergence of the uni-polar world, there have been a lot of "democratizing" activities in the Sub-Saharan context, with Zambia, a central African country of about 10 million, at the forefront of these processes. While democracy, in one form or another, has come to Zambia, socio-economic…
Human immunodeficiency virus (HIV) related cancers in children are not as common and as well described as in adults. An HIV epidemic has been prevalent in Zambia since 1983-1984. To study the effect of the epidemic on the epidemiology of cancers in children a retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia. All the histopathological records
This series of MODIS images shows biomass burning in southern Africa in April, May, and June of 2002. The images span a number of different viewpoints of the region, but the country of Angola, with its highly dendritic (carved by rivers) geological formations are common to them all. Many of the images show part of four countries: Angola (usually at left), Zambia (right), Botswana (bottom right), and Namibia (bottom left). In many images, at lower center, the Okavango River creates a green broomstick-shaped delta in Boptwsana.
Because of the high incidence of congenital syphilis at the University Teaching Hospital, Lusaka, Zambia, the potential risks of congenital infection and fetal loss due to syphilis were assessed by screening 202 antenatal patients, 340 pregnant women admitted to the hospital whose pregnancies ended in either spontaneous abortion or stillbirth, and 469 consecutive babies delivered at the hospital. Primary serological screening was performed with the rapid plasma reagin test, and reactive sera were confirmed by the Treponema pallidum haemagglutination test. In all cases detailed histories were obtained and patients were examined for clinical signs of syphilis. The TPHA test result was reactive in 12.5% of antenatal patients and in 42% of women who aborted in the later half of pregnancy. Among 469 consecutive babies delivered at the hospital, 30 had reactive results to the TPHA test; of these two were stillborn and four had signs of congenital syphilis at birth. Thus, syphilis appears to affect adversely an appreciably high number of pregnant women in Zambia. For this reason a special campaign to screen adequately and treat pregnant women and neonates is needed. PMID:6756542
Ratnam, A V; Din, S N; Hira, S K; Bhat, G J; Wacha, D S; Rukmini, A; Mulenga, R C
Although Zambia has enjoyed decent economic growth, its employment growth and labor productivity have continued to stagnate. What factors explain the stagnation? This Capstone project aims to answer this question through empirical analysis...
Zambia is a constitutional republic governed by a democratically elected president and a unicameral national assembly. International and local observers considered national elections held in 2011 to be generally free and fair. Security forces reported to ...
1 www.deafrica.net Botswana Ghana Mali Senegal Tanzania Zambia Development and Energy in Africa countries Â· Senegal to Tanzania Â· Ethiopia to South Africa Â· Plus 14 in between! Â· Wide selection of energy (DEA) Regional Workshop, Arusha, 16-18 Oct. 2007 #12;2 www.deafrica.net Botswana Ghana Mali Senegal
Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of
Emily Waters; Elizabeth Stringer; Bridget Mugisa; Salome Temba; Kasonde Bowa; David Linyama
Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of
Emily Waters; Elizabeth Stringer; Bridget Mugisa; Salome Temba; Kasonde Bowa; David Linyama
Long-Term Feasibility of Agriculture in Zambia Julio Herrera Estrada1, Prof. Eric Wood2, Prof on Agriculture Climate change is having impacts on many meteorological variables and characteristics to these changes, especially those related to rain. Agriculture is crucial for developing countries both
Increasing access to antiretroviral therapy (ART), especially in urban areas in Zambia, has transformed the landscape of the HIV epidemic to include hope. Drawing upon long-term ethnographic research, this article briefly describes the religious ideas of a cohort of former students of a Catholic mission boarding school for boys. The discussion outlines their understanding of masculinity and charts their responses,
Soil microbial community responses to farm management strategies in Zambia Lorena Gomez, Ari that preserve soil organic matter and improve crop productivity. Microbial communities in soil are involved expedient analyses of soil microbial communities, bypassing the problems of pure-culturing (Roesch et al
This study uses Data Envelopment Analysis (DEA) to estimate the degree of technical, allocative and cost efficiency in individual public and private health centres in Zambia; and to identify the relative inefficiencies in the use of various inputs among individual health centers. About 83% of the 40 health centres were technically inefficient; and 88% of them were both allocatively and
Felix Masiye; Joses M. Kirigia; Ali Emrouznejad; Luis G. Sambo; Abdou Mounkaila; Davis Chimfwembe; David Okello
In Zambia, continuous assessment (CA) is defined as an on-going, diagnostic, classroom-based process that uses a variety of assessment tools to measure learner performance (MOE, 2005:5). Over the years, examinations have been used for selection and certification, without formal considerations on school-based continuous assessment as a component in…
The Mississippi Consortium for International Development's (MCID's) intervention involved the development, publication and distribution of an Integrated Foundations of Learning Kit, focused on numeracy. This intervention was aligned with Zambia's priorities and strategies and matched the requirements of the Textbooks and Learning Materials Program…
Background Past case reports have indicated that lymphatic filariasis (LF) occurs in Zambia, but knowledge about its geographical distribution and prevalence pattern, and the underlying potential environmental drivers, has been limited. As a background for planning and implementation of control, a country-wide mapping survey was undertaken between 2003 and 2011. Here the mapping activities are outlined, the findings across the numerous survey sites are presented, and the ecological requirements of the LF distribution are explored. Methodology/Principal findings Approximately 10,000 adult volunteers from 108 geo-referenced survey sites across Zambia were examined for circulating filarial antigens (CFA) with rapid format ICT cards, and a map indicating the distribution of CFA prevalences in Zambia was prepared. 78% of survey sites had CFA positive cases, with prevalences ranging between 1% and 54%. Most positive survey sites had low prevalence, but six foci with more than 15% prevalence were identified. The observed geographical variation in prevalence pattern was examined in more detail using a species distribution modeling approach to explore environmental requirements for parasite presence, and to predict potential suitable habitats over unsurveyed areas. Of note, areas associated with human modification of the landscape appeared to play an important role for the general presence of LF, whereas temperature (measured as averaged seasonal land surface temperature) seemed to be an important determinant of medium-high prevalence levels. Conclusions/significance LF was found to be surprisingly widespread in Zambia, although in most places with low prevalence. The produced maps and the identified environmental correlates of LF infection will provide useful guidance for planning and start-up of geographically targeted and cost-effective LF control in Zambia. PMID:24587466
Mwase, Enala T.; Stensgaard, Anna-Sofie; Nsakashalo-Senkwe, Mutale; Mubila, Likezo; Mwansa, James; Songolo, Peter; Shawa, Sheila T.; Simonsen, Paul E.
An hypothesis that there was an annual emergence of Rift Valley fever virus in Zambia, during or after the seasonal rains, was examined with the aid of sentinel cattle. Serum samples taken during 1974 and 1978 showed evidence of epizootic Rift Valley fever in Zambia, with more than 80% positive. A sentinel herd exposed from 1982 to 1986 showed that some Rift Valley fever occurred each year. This was usually at a low level, with 3-8% of the susceptible cattle seroconverting. In 1985-6 more than 20% of the animals seroconverted, and this greater activity was associated with vegetational changes--which could be detected by remote-sensing satellite imagery--which have also been associated with greater virus activity in Kenya. PMID:1547835
Davies, F G; Kilelu, E; Linthicum, K J; Pegram, R G
As a member of the United Nations, Zambia is committed to the observance of human rights enshrined in the Universal Declaration of Human Rights of 1948. This is evidenced, among others, by the fact that Zambia is a signatory to the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child. Zambia has a…
Decentralization of finances and responsibilities has been one of the most interesting developments in the health systems in developing countries during the last decades. In 1992, Senanga District (Zambia) was involved in a Pilot Project for Financial Decentralization. In order to evaluate the experiences of the health staff, focus group discussions were organized. Although several constraints were faced during the implementation of the project, decentralization was regarded as a valuable and workable concept. Continuation was advocated by all health workers. PMID:7747332
Visschedijk, J H; Liywalii, I M; van Oosterhout, J J
A comprehensive desk review of malaria trends was conducted between 2000-2010 in Zambia to study malaria epidemiology and trends to guide strategies and approaches for effective malaria control. This review considered data from the National Health Information Management System, Malaria Surveys and Programme Review reports and analyzed malaria in-patient cases and deaths in relation to intervention coverage for all ages. Data showed three distinct epidemiological strata after a notable malaria reduction (66%) in in-patient cases and deaths, particularly between 2000-2008. These changes occurred following the (re-)introduction and expansion of indoor residual spraying up to 90% coverage, scale-up of coverage of long-lasting insecticide-treated nets in household from 50% to 70%, and artemisin-based combination therapy nationwide. However, malaria cases and deaths re-surged, increasing in 2009-2010 in the northern-eastern parts of Zambia. Delays in the disbursement of funds affected the implementation of interventions, which resulted in resurgence of cases and deaths. In spite of a decline in malaria disease burden over the past decade in Zambia, a reversal in impact is notable in the year 2009-2010, signifying that control gains are fragile and must be sustained to eliminate malaria. PMID:23593585
This report on the educational system of Zambia contains information for university admissions officers and registrars in the United States on the credentials and other documentation that would be minimally required for student entry from Zambia to specified levels of study in the United States. A section of general information describes that…
collects local and imported pollution, consistent with its location within the southern African gyre. INDEXLusaka, Zambia, during SAFARI-2000: Convergence of local and imported ozone pollution Anne M from trans- boundary recirculation. Starting out over Zambia, Angola, and Namibia, ozone-rich air
This report reviews the "Seers Report," which contained policy guidelines for modern development planning in Zambia, and compares its findings to recent findings during the period 1963-1970. The Seers Report found that Zambia was the most urbanized country in Africa south of the Sahara (excluding South Africa). This report finds that since…
Introduction A rapid assessment of avoidable blindness (RAAB) was conducted in Southern Zambia to establish the prevalence and causes of blindness in order to plan effective services and advocate for support for eye care to achieve the goals of VISION 2020: the right to sight. Methods Cluster randomisation was used to select villages in the survey area. These were further subdivided into segments. One segment was selected randomly and a survey team moved from house to house examining everyone over the age of 50 years. Each individual received a visual acuity assessment and simple ocular examination. Data was recorded on a standard proforma and entered into an established software programme for analysis. Results 2.29% of people over the age of 50 were found to be blind (VA <3/60 in the better eye with available correction). The major cause of blindness was cataract (47.2%) with posterior segment disease being the next main cause (18.8%). 113 eyes had received cataract surgery with 30.1% having a poor outcome (VA <6/60) following surgery. Cataract surgical coverage showed that men (72%) received more surgery than women (65%). Discussion The results from the RAAB survey in Zambia were very similar to the results from a similar survey in Malawi, where the main cause of blindness was cataract but posterior segment disease was also a significant contributor. Blindness in this part of Zambia is mainly avoidable and there is a need for comprehensive eye care services that can address both cataract and posterior segment disease in the population if the aim of VISION 2020 is to be achieved. Services should focus on quality and gender equity of cataract surgery. PMID:22737211
Lindfield, Robert; Griffiths, Ulla; Bozzani, Fiammetta; Mumba, Musonda; Munsanje, Joseph
– \\u000a \\u000a • Plantation forestry in Zambia is based mainly on non-native Eucalyptus and Pinus species and constitutes an important component of the country’s economy. The productivity of these plantations is, however,\\u000a threatened by several factors, including fungal pathogens that reduce timber quality and cause tree mortality.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a • In this paper we present a review of diseases affecting plantation forestry
Donald Chungu; Ambayeba Muimba-Kankolongo; Michael J. Wingfield; Jolanda Roux
a school-level resource that parents find hard to substitute for at home. It is possible that parents do not have the time or skills to teach their children at home. Further, the agency costs of hiring teachers in a market may be high and such costs... presents another source of difference. It is likely that the nature and severity of shocks that teachers experience varies dramatically across the United States and low-income countries. In a country like Zambia, with very high HIV prevalence, shocks due...
Miombo woodlands cover the transition zone between dry open savannas and moist forests in Southern Africa. They cover about 2.7 million km2 in southern Africa and provide many ecosystem services that support rural life, including medical products, wild foods, construction timber and fuel. In Zambia, as in many of its neighbouring countries, miombo woodlands are currently experiencing accelerating degradation and clearing, mostly with charcoal production as the initial driver. Domestic energy needs in the growing urban areas are largely satisfied by charcoal, which is less energy-efficient fuel on a tree-to-table basis than the firewood that is used in rural areas, but has a higher energy density and is thus cheaper to transport. This study uses data from inventories and from eddy covariance measurements of carbon exchange to characterize the impact of charcoal production on miombo woodlands. We address the following questions: (i) how much carbon is lost at local as well as at national scale and (ii) does forest degradation result in the loss of a carbon sink? On the basis of our data we (iii) estimate the per capita emissions through deforestation and forest degradation in Zambia and relate it to fossil fuel emissions. Furthermore, (iv) a rough estimate of the energy that is provided by charcoal production to private households at a national level is calculated and (v) options for alternative energy supply to private households are discussed.
Kutsch, W.; Merbold, L.; Scholes, B.; Mukelabai, M.
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront. PMID:21569490
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront. PMID:21569490
Zambia’s estimated incidence of all forms of human tuberculosis (TB) is 707/100,000. High prevalence of bovine tuberculosis (BTB) – infection with Mycobacterium bovis – in cattle and the Kafue lechwe antelopes (Kobus leche Kafuensis) has been reported in the Kafue basin. Consumption of unpasteurised milk and meat products from infected animals poses a risk of transmitting zoonotic tuberculosis to people living at the human-animal interface. Despite the reported high prevalence of BTB in both livestock and wildlife, information on the proportion of human patients infected with M. bovis is unknown in Zambia. This paper reviews the available information in English on human, livestock and wildlife TB in Zambia with the purpose of assessing the burden of animal infections with M. tuberculosis complex and its public health implications. PMID:23849550
...Responsibilities. The Board will be responsible for overseeing the implementation of...based in Lusaka, Zambia, and will be responsible for managing the day-to-day implementation...Stakeholders Committee(s) will be responsible for continuing the consultative...
studies were conducted to generate information on the current levels of genetic diversity and agronomic performance of both farmer-developed and commercially-bred maize varieties in Zimbabwe, Zambia and Malawi to help in the identification of sources...
BACKGROUND: Like many sub-Saharan African countries, Zambia is dealing with major health issues, including HIV\\/AIDS, family planning, and reproductive health. To address reproductive health problems and the HIV\\/AIDS epidemic in Zambia, several social marketing and health communication programs focusing on reproductive and HIV\\/AIDS prevention programs are being implemented. This paper describes the reach of these programs and assesses their impact
This study utilized in?depth interviewing, participant observation, and student diaries completed by participants to examine the quality of teacher–student relationships at a low?cost private school in the townships of Ndola, Zambia. Amidst economic decline and the HIV\\/AIDS epidemic facing Zambia today, teachers and students developed strong relationships that differed from those found in government secondary schools and were shaped by
This paper explores the interrelationship between maize farming, the discourse of modernity, and the performance of a modern\\u000a farmer in southern Zambia. The post-colonial Zambian government discursively constructed maize as a vehicle for expanding\\u000a economic modernization into rural Zambia and undoing the colonial government’s urban modernization bias. The pressures of\\u000a neo-liberal reform have changed this discursive construction in ways that
Background In line with the Global trend to improve malaria control efforts a major campaign of insecticide treated net distribution was initiated in 1999 and indoor residual spraying with DDT or pyrethroids was reintroduced in 2000 in Zambia. In 2006, these efforts were strengthened by the President's Malaria Initiative. This manuscript reports on the monitoring and evaluation of these activities and the potential impact of emerging insecticide resistance on disease transmission. Methods Mosquitoes were captured daily through a series of 108 window exit traps located at 18 sentinel sites. Specimens were identified to species and analyzed for sporozoites. Adult Anopheles mosquitoes were collected resting indoors and larva collected in breeding sites were reared to F1 and F0 generations in the lab and tested for insecticide resistance following the standard WHO susceptibility assay protocol. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 14 years. Results A total of 619 Anopheles gambiae s.l. and 228 Anopheles funestus s.l. were captured from window exit traps throughout the period, of which 203 were An. gambiae malaria vectors and 14 An. funestus s.s.. In 2010 resistance to DDT and the pyrethroids deltamethrin, lambda-cyhalothrin and permethrin was detected in both An. gambiae s.s. and An. funestus s.s.. No sporozoites were detected in either species. Prevalence of P. falciparum in the sentinel sites remained below 10% throughout the study period. Conclusion Both An. gambiae s.s. and An. funestus s.s. were controlled effectively with the ITN and IRS programme in Zambia, maintaining a reduced disease transmission and burden. However, the discovery of DDT and pyrethroid resistance in the country threatens the sustainability of the vector control programme. PMID:21915314
Background Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. The World Health Organization recommends maintaining a warm chain and skin-to-skin care for thermoprotection of newborn children. Since little is known about practices related to newborn hypothermia in rural Africa, this study's goal was to characterize relevant practices, attitudes, and beliefs in rural Zambia. Methods and Findings We conducted 14 focus group discussions with mothers and grandmothers and 31 in-depth interviews with community leaders and health officers in Lufwanyama District, a rural area in the Copperbelt Province, Zambia, enrolling a total of 171 participants. We analyzed data using domain analysis. In rural Lufwanyama, community members were aware of the danger of neonatal hypothermia. Caregivers' and health workers' knowledge of thermoprotective practices included birthplace warming, drying and wrapping of the newborn, delayed bathing, and immediate and exclusive breastfeeding. However, this warm chain was not consistently maintained in the first hours postpartum, when newborns are at greatest risk. Skin-to-skin care was not practiced in the study area. Having to assume household and agricultural labor responsibilities in the immediate postnatal period was a challenge for mothers to provide continuous thermal care to their newborns. Conclusions Understanding and addressing community-based practices on hypothermia prevention and management might help improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermoprotection for their newborns could facilitate these practices. PMID:24714630
Lunze, Karsten; Yeboah-Antwi, Kojo; Marsh, David R.; Kafwanda, Sarah Ngolofwana; Musso, Austen; Semrau, Katherine; Waltensperger, Karen Z.; Hamer, Davidson H.
Multiple perspectives on the assessment of children's development at the school-community interface in rural areas of Zambia are discussed in the light of several empirical studies conducted between 1974 and 2005. A longitudinal trace study of a cohort of 46 young people born into a rural, Chewa community in Katete District found that girls' scores in early childhood on a battery of ecoculturally grounded cognitive tests correlated less well than they did for boys with two educational outcomes: number of grades of schooling completed, and adult literacy scores. Conversely, ratings of the children on indigenous conceptions of intelligence by adults familiar with the children in the context of their home village lives predicted the same outcomes better for girls than for boys. A separate, linked experiment compared the performance of 76 Katete school children with that of 84 school children in the capital city of Lusaka on the US standardized Draw-a-Person Test (DPT) and the Panga Munthu Test (PMT), an expanded version of one of the tests developed for the Zambian trace study. Analysis of the correlations among scores on these two tests, age, and teacher ratings suggests that aptitudes evident in the home and school domains are less well integrated for rural girls than for urban boys, and that for a low-income, rural population, the PMT taps the domain of home cognition better than school cognition, while the converse is true of the DPT. Implications for educational assessment in Zambia are discussed, and supportive documentation is cited from two ongoing programs of test development. The authors conclude that if educational testing is to support the process of enhancing educational equity across gender, family socioeconomic status, and residential location, its focus should be broadened to include other dimensions of psychological development such as multilingual and personal-social competencies. PMID:22023603
This technical compendium was developed to serve two interrelated purposes: 1.To assist in the development of USAID Zambia’s Feed the Future (FtF) strategy by providing a broad empirical analysis of the current conditions and historical trends shaping Zambia’s agricultural and food sector; and 2. To serve as a technical reference for organizations tasked with designing and implementing programs associated with
Nicholas J. Sitko; Antony Chapoto; Stephen Kabwe; Solomon Tembo; Munguzwe Hichaambwa; Rebecca Lubinda; Harrison Chiwawa; Mebelo Mataa; Simon Heck; Dorothy Nthani
The aim of this study was to determine the provision of learning and teaching materials for pupils with visual impairment in basic and high schools of Zambia. A survey approach utilizing a questionnaire, interviews and a review of the literature was adopted for the study. The findings demonstrated that most schools in Zambia did not provide…
The purpose of this chapter is to explore the extent to which violence can be said to underlie any form of Stae formation in precolonial Africa. This is done by examining the role of violence in State formation in west central Zambia from the 17th century onwards. The chapter shows that State formation in west central Zambia entailed the imposition
In southern Africa, gross disparities in access to water are symptomatic of the overall uneven pattern of development. Despite post-independence egalitarian rhetoric, in countries such as Zambia and Zimbabwe inappropriate models (piped house connections in the urban areas, high technology irrigation schemes in the agricultural sector), combined with weak macro-economies and poorly formulated sectoral policies have actually exacerbated the disparities. Zero or very low tariffs have played a major role in this. Although justified as being consistent with water’s special status, inadequate tariffs in fact serve to undermine any programme of making water accessible to all. This has led to a narrowing of development options, resulting in exclusivist rather than inclusivist development, and stagnation rather than dynamism. A major part of the explanation for perpetuation of such unsatisfactory outcomes is the existence of political interest groups who benefit from the status quo. The first case study in the paper involves urban water consumers in Zambia, where those with piped water connections seek to continue the culture of low tariffs which is by now deeply embedded. The result is that the water supply authorities (in this case the newly formed, but still politically constrained ‘commercialised utilities’) are unable even to maintain adequate supplies to the piped customers, let alone extend service to the peri-urban dwellers, 56% of whom do not have access to safe water. The paper outlines some modest, workable principles to achieve universal, affordable access to water in the urban areas, albeit through a mix of service delivery mechanisms. In a second case study of rural productive water in Zimbabwe, the reasons for only 2% of the rural subsistence farming households being involved in formal small-scale irrigation schemes 20 years after independence are explored. Again, a major part of the explanation lies in government pursuing a water delivery model which is not affordable or sustainable on a wide scale. Its provision, via substantial capital and recurrent subsidies, for a small group has a large opportunity cost for society as a whole. The small-scale irrigators have a vested interest in ensuring that the subsidies are maintained, but in the process continue to absorb a disproportionate amount of resources which could be used for development elsewhere. By choosing simpler, cheaper water technologies, and assisting farmers with growing and marketing high value crops, the resources could instead be used to benefit a much larger proportion of households. With well designed programmes aimed at achieving equity, large numbers of subsistence farmers could improve their incomes and start working their way out of poverty.
Neonatal male circumcision (NMC) is an uncommon procedure in Southern Africa, but is being scaled up in Zambia for long-term HIV prevention. We conducted a cross-sectional survey on NMC with a convenience sample of mothers of newborn boys at two public clinics in Lusaka. Following the survey, mothers received information on availability of NMC, and uptake of the service was tracked. Predictors of uptake were assessed using bivariate and multivariate logistic regression. Of the 1,249 eligible mothers approached, 1000 (80%) agreed to participate. Although 97% of surveyed mothers said they definitely or probably planned to have their newborn son circumcised, only 11% of participants brought their newborn sons for NMC. Significant predictors of uptake in adjusted models included: Older maternal age (AOR 3.77, 95% CI 1.48-9.63 for age 36 and above compared to mothers age 25 and below), having attended antenatal care at an NMC site (AOR 2.13, 95% CI 1.32-3.44), older paternal age (AOR 4.36, 95% CI 1.28-14.91 for age 26-35 compared to fathers age 25 and below), and the infant's father being circumcised (AOR 2.21, 95% CI 1.35-3.62). While acceptability studies in Southern Africa have suggested strong support for MC among parents for having their sons circumcised, this may not translate to high uptake of newly-introduced NMC services. PMID:22968397
A sample of 144 people from the Lundazi District of the Eastern Province of rural Zambia in Central Africa responded to a questionnaire. The first objective of the study was to determine how men and women conceptualize and evaluated appropriate technology for food production, processing, preservation, and storage; second, to investigate if participation in modern institutions (COSISOCHINS) was related to conceptualization of appropriate technology. There were no significant gender differences in how men and women viewed appropriate technology. Participation in modern institutions was not significantly related to how people conceptualized and evaluated appropriate technology. There were significant gender differences in participation in modern institutions; men participated more than women. The findings remained the same when age, education, income and marital status held constant. Sex-role task overlap and exclusiveness in gender division of labor account for lack of significant gender differences. Modern institutions can be useful if they are effectively integrated with the social structure, gender division of labor, and social organization of the production process of the rural communities of the Third World.
Helminths and bot fly larvae were collected from 11 wild ungulate species on a game ranch in the Central Province of Zambia. New host-parasite records are: Calicophoron sp. from defassa waterbuck Kobus ellipsiprymnus defassa and Kafue lechwe Kobus leche kafuensis; Avitellina centripunctata, Gaigeria pachyscelis and Gedoelstia cristata from tsessebe Damaliscus lunatus lunatus; Cooperia rotundispiculum from common reedbuck Redunca arundinum; Dictyocaulus filaria from greater kudu Tragelaphus strepsiceros; Dictyocaulus sp. from tsessebe and defassa waterbuck and Strobiloestrus sp. from sable antelope Hippotragus niger. Most of the other parasites collected are first records for Zambia and thus extend the distribution ranges of several species. PMID:9741058
The study was undertaken to assess the impact of health sector reform from 1993 to 1997 in Zambia in respect of health care service utilization and the shift of caseload from hospitals to health centres. Four key indicators were chosen: general attendance, measles vaccinations, general admissions, and deliveries. Complete sets of district data were analyzed, covering 4.5 million people out of the total population in 1997 of 9.7 million. The results show, on the one hand, a dramatic decrease of about one-third in general attendance for both hospitals and health centres over a 2-year period, followed by a period with a continued but slower decrease. On the other hand, the results also show increases at health centres in measles vaccinations (up 40%), in admissions (up 25%) and in deliveries (up 60%). The study further documents a shift of caseload from hospitals to health centres for some key services. The health centre share increased from 72.2% to 79.8% for measles vaccinations, from 23.9% to 31.0% for general admissions, and from 22.9% to 32.4% for deliveries. However, the intended overall shift in outpatient caseload from hospitals to health centres did not materialize. The main lessons are: utilization patterns can be influenced by policies such as user-payment and decentralization; user payment in poor populations leads to dramatic declines in utilization of services; and decentralization with local control of resources could be an alternative to the traditional vertical disease programme approach for priority interventions. PMID:11772987
In Zambia, ethnopolitical mobilisation is ubiquitous in competitive electoral politics. Mobilisation history, focused on national leadership and guided by the nationalist and power- and status-seeking values of political leaders, has interacted with ethnopolitical group morphology and presidential and plurality institutions to structure political actors' strategic choices to favour broad multiethnic parties. This militates against the emergence and undermines the sustainability
This article synthesizes case studies from Kenya, Zambia, and Ethiopia to assess how differences in the implementation of fertilizer marketing policies have affected the costs and risks borne by marketing actors, the investment response by private traders, and fertilizer consumption.Financial cost accounting techniques indicate that domestic marketing costs account for 50% or more of farm-gate prices. The sum of importer,
This paper is aimed at elucidating the current state of inquiry-based science education (IBSE) in Zambia's high school science curriculum. Therefore, we investigated Zambian teachers' conceptions of inquiry; determined inquiry levels in the national high school science curriculum materials, which include syllabi, textbooks and practical exams; and…
Attitudes toward intimate partner violence (IPV) were compared between Zambian and Kenyan men on sociodemographic, attitudinal, and structural predictors of such attitudes. Data were retrieved from the latest Demographic and Health Surveys in each country. The results showed that many men in Zambia (71%) and Kenya (68%) justified IPV to punish a…
We conducted this cross-sectional study to investigate risk factors of Brucella seropositivity in cattle herds reared in livestock–wildlife interface areas of Blue Lagoon and Lochinvar National Parks in Zambia between August 2003 and September 2004. Sera were collected from cattle aged ?2 years from 124 herds. Data on husbandry practices, grazing strategies, and herd structure (sex and age composition) were
J. B. Muma; K. L. Samui; J. Oloya; M. Munyeme; E. Skjerve
*Management Summary* This report provides information on Zambia on behalf of the implementation of the DECISIONS FOR LIFE project in that country. The DECISIONS FOR LIFE project aims to raise awareness amongst young female workers about their employment opportunities and career possibilities, family building and the work-family balance. This report is part of the Inventories, to be made by the
Maarten Klaveren; Kea Tijdens; Melanie Hughie Williams; Nuria Ramos Martin
Community schools and other approaches to Alternative Primary Education or APE have increased access to primary education for underserved populations in Africa, Asia, and Latin America as a major goal of the Education for All (EFA) movement. In Zambia, a country where an estimated 20 percent of the basic education enrollment now attends community…
This report evaluates the extent of perceived and enacted HIV\\/AIDS-related stigma in a rural setting in Zambia. Stigmatisation is abundant, ranging from subtle actions to the most extreme degradation, rejection and abandonment. Women with HIV and pregnant women assumed to be HIV positive are repeatedly subjected to extensive forms of stigma, particularly once they become sick or if their child
Discussion of two basic organizational models for distance education systems or institutions focuses on the mixed-mode organization at the University of Zambia. Highlights include the development, production, storage, and distribution of teaching materials; communication channels between students and teachers; and the record-keeping system. (11…
The paper presents the observed effects on the streamflow of changing a tropical forest in the high rainfall belt of Zambia to agricultural use based on traditional farming methods. Hydrological observations were carried out on four small catchments under their natural conditions first, and later two of them under agricultural use with accompanying deforestation. Simple linear regression analysis of both
Media stories often speak of a future dominated by large-scale water wars. Rather less attention has been paid to the way water conflicts already play out at local levels and form part of people’s everyday lives. Based on case study studies from Vietnam, Bolivia and Zambia, this paper examines the strategies of poor households in local water conflicts. It is
M. Funder; R. R. Bustamante Zenteno; V. Cossio Rojas; P. T. M. Huong; Koppen van B; C. Mweemba; L. Nyambe; L. T. T. Phuong; T. Skielboe
Two cases of extremely drug-resistant Salmonella enterica serovar Senftenberg isolated from patients in Zambia were investigated by utilizing MIC determinations and whole-genome sequencing. The isolates were resistant to, and harbored genes toward, nine drug classes, including fluoroquinolones and extended-spectrum cephalosporins, contained two plasmid replicons, and differed by 93 single-nucleotide polymorphisms. PMID:23077128
Joensen, Katrine Grimstrup; Lukwesa-Musyani, Chileshe; Kalondaa, Annie; Leekitcharoenphon, Pimlapas; Nakazwe, Ruth; Aarestrup, Frank M.; Hasman, Henrik; Mwansa, James C. L.
The Karoo Supergroup outcropst in the mid-Zambezi Valley, southern Zambia. It is underlain by the Sinakumbe Group of Ordovician to Devonian age. The Lower Karoo Group (Late Carboniferous to Permian age) consists of the basal Siankondobo Sandstone Formation, which comprises three facies, overlain by the Gwembe Coal Formation with its economically important coal deposits, in turn overlain by the Madumabisa
BACKGROUND: Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national
Naawa Sipilanyambe; Jonathon L Simon; Pascalina Chanda; Peter Olumese; Robert W Snow; Davidson H Hamer
This article examines the role of faith-based organizations (FBOs) in delivering HIV\\/AIDS services to the population of Zambia. It outlines the causes of HIV transmission, the development of community initiatives to provide services and education programs to underserved families and orphans affected by the disease, and activities of multinational organizations as they partner with FBOs to strengthen education programs, provide
Inclusive education has become a global trend in the provision of services for students with disabilities. In Zambia and other developing nations, international initiatives from UNESCO and other nongovernmental organisations have contributed to the consensus that all children have a right to a free and appropriate education and that all students…
BACKGROUND: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative
Lonia Mwape; Alice Sikwese; Augustus Kapungwe; Jason Mwanza; Alan Flisher; Crick Lund; Sara Cooper
tributing to the deepening of civil-military relations remains unclear. Despite the existence of many organisations concerned with issues such as human rights, election monitoring, women's rights, peace or policy advocacy, these groups have tended to lack a clear agenda for intervention in matters that affect the military establishment. Perhaps the most important task that civil society in Zambia has taken
This article considers the ways in which educators and learning societies in Zambia and Zimbabwe have had to struggle to create independent, democratic and critical curricula in difficult circumstances over the last 50 years in the context of historical shifts in power, a declining British Empire and the re-emergence of reactionary forces at a…
Lately there has been increasing interest regarding the practice of traditional healers and their use of indigenous plants to treat illnesses. Twenty-three local healers (n’ganga) in Chiawa, rural Zambia, were interviewed about knowledge, practices, and their use of indigenous plants in the diagnosis and treatment of sexually transmitted illnesses (STIs) among male clients. They were also asked about their perceptions
This article identifies information provision services in emergency settings using Zambia as a case study by identifying innovative ways of providing library and information services. The thrust of the article is to analyze information management practices of organizations that work within refugee camps and how they take specific cognizance of the…
BackgroundAnimal and human trypanosomiasis are constraints to both animal and human health in Sub-Saharan Africa, but there is little recent evidence as to how these parasites circulate in wild hosts in natural ecosystems. The Luangwa Valley in Zambia supports high densities of tsetse flies (Glossina species) and is recognised as an historical sleeping sickness focus. The objective of this study
Neil E. Anderson; Joseph Mubanga; Eric M. Fevre; Kim Picozzi; Mark C. Eisler; Robert Thomas; Susan C. Welburn
A new educational environment is emerging within the field of applied music instruction. For the purposes of testing the viability of e-learning through the study of the piano, a unique relationship was established between a teacher in suburban North America and two students (currently ages 10 and 9) in rural Zambia. Synchronous (real time) exchanges were initiated on a weekly
Purpose: To determine whether religious affiliation reduces HIV risk among young women in Zambia, and to examine the effects of religious affiliation on sexual initiation and on condom use during first sexual experience. Methods: Data from a representative probability sample of 5534 women aged 13-20 years was analyzed. The instrument included questions on sexual initiation, condom use during first sex,
Zambia, a central African country of about 10 million people, is currently exposed to the nonsubjective forces of globalization, including institutional weaknesses such as high unemployment rated and chronic levels of poverty that ipso facto problematize its governance and social development priorities. The first part of the article focuses on an…
Background Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006/07 and 2008; quarterly totals from the last quarter of 2005 to the first quarter of 2008 inclusive in Malawi; and annual totals for 2004 to 2007 inclusive in Zambia. Topic-guided interviews were conducted with facility and district managers in both countries, and with health workers in Malawi. Results Facility data confirm significant scale-up in HIV/AIDS service delivery in both countries. In Malawi, this was supported by a large increase in lower trained cadres and only a modest increase in clinical staff numbers. Routine outpatient workload fell in urban facilities, in rural health centres and in facilities not providing antiretroviral treatment (ART), while it increased at district hospitals and in facilities providing ART. In Zambia, total staff and clinical staff numbers stagnated between 2004 and 2007. In rural areas, outpatient workload, which was higher than at urban facilities, increased further. Key informants described the effects of increased workloads in both countries and attributed staff migration from public health facilities to non-government facilities in Zambia to PEPFAR. Conclusions Malawi, which received large levels of GHI funding from only the Global Fund, managed to increase facility staff across all levels of the health system: urban, district and rural health facilities, supported by task-shifting to lower trained staff. The more complex GHI arena in Zambia, where both Global Fund and PEPFAR provided large levels of support, may have undermined a coordinated national workforce response to addressing health worker shortages, leading to a less effective response in rural areas. PMID:20701749
their assignment area. The Peace Corps' fundamental approach to the diffusion of aquaculture in Zambia is centered on the exchange of information between PCVs and rural farmers. Achieving sustainability with the RAP project is essentially based upon the consistency...
No studies have addressed the spatial complexity of Anopheles arabiensis populations in Zambia or the effects of drought on the genetic structure of this species. We genotyped approximately 420 An. arabiensis at 12 microsatellite loci representing 18 collections from the Southern Province of Zambia. Collections spanned three transmission seasons and covered a wet year–drought year–wet year cycle. Anopheles arabiensis within the 2,000 km2 of the Macha study region were panmictic, with high gene flow between Macha and Namwala, Zambia, which are 80 km apart. There was little evidence for genetic structuring among years, with no significant shifts in allele frequency distributions or observed heterozygosity, and no evidence for a genetic bottleneck despite a drastic reduction in mosquito numbers during the drought year. Anopheles arabiensis in southern Zambia has a large deme size, and the regional genetic structure of this species was little affected by an extended drought period. PMID:17690405
Kent, Rebekah J.; Mharakurwa, Sungano; Norris, Douglas E.
Summary objectives To examine the effect of neighbourhood socioeconomic factors on human immunodeficiency virus (HIV) prevalence in young women (aged 15-24 years) in Zambia. methods Re-analysis of a cross-sectional, population-based sero-survey of nearly 2000 adults con- ducted in 1997 ?1998 in Ndola, Zambia. Neighbourhood-level socioeconomic status (SES) was defined using the availability of running water and electricity in addition to
Introduction As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. Methods In 2010, we conducted a qualitative study among adolescents aged 10–19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents’ disclosure of their status to others; and the impact of both forms of disclosure on adolescents. Results Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents’ disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents’ sexual relationships, although it did not always lead to rejection. Conclusions There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process. PMID:24629845
Mburu, Gitau; Hodgson, Ian; Kalibala, Sam; Haamujompa, Choolwe; Cataldo, Fabian; Lowenthal, Elizabeth D; Ross, David
The Kafue Flats is one of the most important wetlands in Zambia. In the early 70's the Kafue Gorge reservoir was built mainly for hydropower production not far downstream the outlet of the Kafue Flats. Only a few years later a dam was constructed upstream the Flats to extend the limited storage of Kafue Gorge. Besides its ecological value the Kafue Flats are also important economically. Around 700 000 people are dependent mainly on fisheries and flood recession agriculture. An increasing number of large irrigation schemes are drawing water from the Kafue river along the wetland. Floodplains in semi-arid and arid areas are often the only source of water supply available throughout the year. They provide numerous economical and ecological services of tremendous value. The ecological uniqueness of many wetlands results largely from a strong seasonality of flooding. As the pressure on water resources grows these natural seasonal patterns are often altered due to water abstractions or the construction of dams. Many efforts have been taken to restore more natural flooding patterns. To assess both, the effects of altered flow regimes and of restoration efforts, a hydrological model reproducing the dynamics of the flooding is required. However, in many cases hydrological modeling of these floodplains is often hampered by the poor availability of data. Data gathering is also limited by the large extent and the limited accessibility of the wetlands. Therefore the application of remote sensing techniques is an attractive approach. The model presented in this study is based on a relatively simple approach which was initially designed for the Okavango Delta. The model is based on the widely used software MODFLOW. However, due to a different environment and technical advances of the software there are some significant differences between the Okavango Delta model and the model presented hereafter. The model is based on MODFLOW 2005 and basically consists of two layers: a subsurface layer, representing the saturated flow in the groundwater, and a surface water layer, representing the flow on the flooded surface. In between these two layers the unsaturated zone is modeled using the kinematic wave approach of the MODFLOW UZF package. To couple the surface water layer and the UZF module, an additional module was developed in order to route excess infiltration water to either the surface layer or a river. Flow in the main river channel of the Kafue is implemented using the stream flow package. Model outputs are calculated on a daily basis. Input data for the model are derived mostly from globally available datasets. Since the purpose of the model is to predict the flooding patterns as accurate as possible, model parameters have to be calibrated against the measured extent of flooding. Images from the ENVISAT ASAR instrument are used to detect flooding patterns. These data provide a good compromise between spatial resolution, spatial coverage and temporal coverage. As additional calibration data measured water levels are available. The calibration is carried out using PEST. This model predictions can serve as a base to provide information on future effects of a changing inflow regime on the ecology as well as on the socio-economic system of the Kafue Flats.
Through an amendment of the Constitution, allowing for a shift from a one-party to a multi-party system, elections were held in Zambia and the ruling United National Independence Party (UNIP) was defeated. A new party, the Movement for Multi-party Democracy (MMD), was ushered into power towards the end of 1991. The new MMD Government lost no time in implementing extensive
Purpose: To: (a) identify risk and protective factors for behaviors that expose Zambian youth to risk of HIV infection and, (b) assess whether research findings from the United States concerning protective factors in “high-risk” environments might apply to other settings.Methods: A community-based sample of 2328 youth ages 10–24 years residing in Lusaka, Zambia was interviewed. Multivariate statistical methods were used
Robert J Magnani; Ali Mehryar Karim; Lisa A Weiss; Katherine C Bond; Musonda Lemba; Gwendolyn T Morgan
HIV services in developing countries are often ill-equipped to address the specific needs of HIV-positive adolescents. Studies suggest a lack of consistent, age-appropriate support regarding sexuality, relationships and transitioning to adulthood. The aims of this study were to explore and document the informational, psychosocial, sexual and reproductive health (SRH) needs of adolescents (aged 10–19 years) living with HIV in Zambia,
Ian Hodgson; Julia Ross; Choolwe Haamujompa; D. Gitau-Mburu
BackgroundIn describing and understanding how the HIV epidemic spreads in African countries, previous studies have not taken into account the detailed periods at risk. This study is based on a micro-simulation model (individual-based) of the spread of the HIV epidemic in the population of Zambia, where women tend to marry early and where divorces are not frequent. The main target
Pauline M. Leclerc; Alan P. Matthews; Michel L. Garenne; Nitika Pant Pai
Lead poisoning can have devastating health consequences, especially for children, with childhood lead exposure estimated to contribute to 600,000 new cases globally of children with intellectual disabilities every year. Lead exposure is entirely preventable, yet is estimated to account for 0.6% of the global burden of disease, with the highest burden in developing regions. Kabwe, the second largest city in Zambia with a population of approximately 203,000, is located in Zambia's Copperbelt. During 1904-1994, lead mining and smelting operations contaminated the soil in residential areas, but no extensive environmental health assessment was completed. In 2003, the World Bank funded the Copperbelt Environmental Project to assist the Government of Zambia in addressing environmental health problems related to the mining sector. Components of the project included removal of mining waste materials, soil remediation, resident evacuation, and treatment of lead-exposed children. During July 22-28, 2014, a team from PureEarth/Blacksmith Institute, the City University of New York School of Public Health, and Green Cross Switzerland conducted extensive surface soil testing and blood lead testing of children in six communities adjacent to the now-closed Kabwe mines and smelters. PMID:25375074
Caravanos, Jack; Fuller, Richard; Robinson, Stephan
Some Bantu languages spoken in southwestern Zambia and neighboring regions of Botswana, Namibia, and Angola are characterized by the presence of click consonants, whereas their closest linguistic relatives lack such clicks. As clicks are a typical feature not of the Bantu language family, but of Khoisan languages, it is highly probable that the Bantu languages in question borrowed the clicks from Khoisan languages. In this paper, we combine complete mitochondrial genome sequences from a representative sample of populations from the Western Province of Zambia speaking Bantu languages with and without clicks, with fine-scaled analyses of Y-chromosomal single nucleotide polymorphisms and short tandem repeats to investigate the prehistoric contact that led to this borrowing of click consonants. Our results reveal complex population-specific histories, with female-biased admixture from Khoisan-speaking groups associated with the incorporation of click sounds in one Bantu-speaking population, while concomitant levels of potential Khoisan admixture did not result in sound change in another. Furthermore, the lack of sequence sharing between the Bantu-speaking groups from southwestern Zambia investigated here and extant Khoisan populations provides an indication that there must have been genetic substructure in the Khoisan-speaking indigenous groups of southern Africa that did not survive until the present or has been substantially reduced. PMID:22929022
Background In Zambia, the presence of bovine tuberculosis in both wild and domestic animals has long been acknowledged and mutual transmission between them has been predicted without any direct evidence. Elucidation of the circulating Mycobacterium bovis strains at wild and domestic animals interphase area in Zambia, where bovine tuberculosis was diagnosed in wildlife seemed to be important. Results A PCR identified 15 and 37 M. bovis isolates from lechwe and cattle, respectively. Spoligotype analysis revealed that M. bovis strains from lechwe and cattle in Kafue basin clustered into a major node SB0120, where isolates outside the Kafue basin clustered into different nodes of SB0131 and SB0948. The comparatively higher variety of strains in cattle compared to lechwe elucidated by Mycobacterial Interspersed Repetitive Units–Variable Number Tandem Repeats analyses are consistent with cattle being the probable source of M. bovis in wild and domestic animals interphase area in Zambia. Conclusions These results provide strong evidence of M. bovis strains transfer between cattle and lechwe, with the latter having developed into a sylvatic reservoir host. PMID:23151267
ABSTRACT Background: In many countries, pregnancy tests are not freely available in family planning clinics. As a result, providers sometimes deny services to non-menstruating clients due to uncertainty about pregnancy. Few clients are actually pregnant, yet denied clients run the risk of becoming pregnant, and those sent to pharmacies pay inflated prices for inexpensive tests. To assess the programmatic effect of free pregnancy testing, we conducted cluster-randomized trials in Ghana and Zambia, assessing clients' uptake of contraception in family planning clinics. Methods: In each country, 5 clinics were randomized to intervention status and 5 to control. Service data from 2,028 new, non-menstruating clients in Zambia and 1,556 in Ghana were collected. Intervention clinics received supplies of pregnancy tests, and staff were instructed to use tests as needed to help exclude pregnancy. Control clinics received no intervention. The primary outcome was the proportion of non-menstruating clients denied an effective contraceptive method. Cost-effectiveness was also evaluated. Results: In Zambia, clients in intervention and control clinics faced a similar risk of service denial at baseline, 15% and 17%, respectively. At follow-up, denial remained unchanged at 17% in control clinics, but decreased significantly to 4% in intervention sites. Clients in Zambia were 4.4 (95% confidence interval [CI]?=?1.3–14.4) times more likely to be denied a method in control sites versus intervention sites (P<.01). Results from Ghana were inconclusive. Cost of a “denial averted” in Zambia was estimated to be US$0.59. Interpretation: Zambia results suggest that availability of free pregnancy testing significantly reduced contraceptive service denial, although results from Ghana preclude an unqualified recommendation. Authors conclude that free pregnancy testing in family planning clinics may make strong public health sense in those developing countries where denial to non-menstruating clients remains a problem. Although pregnancy can usually be excluded with a client history, pregnancy tests are often necessary.
Poor access to health care is one of the greatest impediments to improved health in Africa. In Zambia, user fees are considered to be partly responsible for substantial disparities in access to health care. When the Government introduced user fees in 1993, considerable concern was expressed about the adverse effects on utilisation and access. A national exemption policy was designed to protect the poorest sections of the population. However, this was largely ineffective in reaching the majority of the eligible population. On January 13th, 2006, the President of Zambia announced a policy to abolish user fees at primary health care facilities in designated rural districts. This was a major policy shift from targeted exemptions to free primary health care across the board. This study reviewed the performance of free health care in Zambia, following 15 months of implementation. Using a comprehensive national facility-based dataset, we found that utilisation increased among the rural population aged at least five years by 55%. Importantly, utilisation increases were greatest in the districts with the highest levels of poverty and material deprivation. Further, our patient exit interview survey at facilities in two rural districts reveals that although there is some evidence of a strain on drug supplies, perceptions of quality of health care remain fairly positive. This is in contrast to the experience in other countries that have removed user fees. Our findings strongly suggest that fee removal is more effective than fragmented efforts to target exemptions to certain groups in providing protection against the financial consequences of using health services. PMID:20542363
Background While consensus on malaria vector control policy and strategy has stimulated unprecedented political-will, backed by international funding organizations and donors, vector control interventions are expansively being implemented based on assumptions with unequaled successes. This manuscript reports on the strategies, achievements and challenges of the past and contemporary malaria vector control efforts in Zambia. Case description All available information and accessible archived documentary records on malaria vector control in Zambia were reviewed. Retrospective analysis of routine surveillance data from the Health Management Information System (HMIS), data from population-based household surveys and various operations research reports was conducted to assess the status in implementing policies and strategies. Discussion and evaluation Empirical evidence is critical for informing policy decisions and tailoring interventions to local settings. Thus, the World Health Organization (WHO) encourages the adoption of the integrated vector management (IVM) strategy which is a rational decision making process for optimal use of available resources. One of the key features of IVM is capacity building at the operational level to plan, implement, monitor and evaluate vector control and its epidemiological and entomological impact. In Zambia, great progress has been made in implementing WHO-recommended vector control policies and strategies within the context of the IVM Global Strategic framework with strong adherence to its five key attributes. Conclusions The country has solid, consistent and coordinated policies, strategies and guidelines for malaria vector control. The Zambian experience demonstrates the significance of a coordinated multi-pronged IVM approach effectively operationalized within the context of a national health system. PMID:23298401
Background In describing and understanding how the HIV epidemic spreads in African countries, previous studies have not taken into account the detailed periods at risk. This study is based on a micro-simulation model (individual-based) of the spread of the HIV epidemic in the population of Zambia, where women tend to marry early and where divorces are not frequent. The main target of the model was to fit the HIV seroprevalence profiles by age and sex observed at the Demographic and Health Survey conducted in 2001. Methods and Findings A two-sex micro-simulation model of HIV transmission was developed. Particular attention was paid to precise age-specific estimates of exposure to risk through the modelling of the formation and dissolution of relationships: marriage (stable union), casual partnership, and commercial sex. HIV transmission was exclusively heterosexual for adults or vertical (mother-to-child) for children. Three stages of HIV infection were taken into account. All parameters were derived from empirical population-based data. Results show that basic parameters could not explain the dynamics of the HIV epidemic in Zambia. In order to fit the age and sex patterns, several assumptions were made: differential susceptibility of young women to HIV infection, differential susceptibility or larger number of encounters for male clients of commercial sex workers, and higher transmission rate. The model allowed to quantify the role of each type of relationship in HIV transmission, the proportion of infections occurring at each stage of disease progression, and the net reproduction rate of the epidemic (R0?=?1.95). Conclusions The simulation model reproduced the dynamics of the HIV epidemic in Zambia, and fitted the age and sex pattern of HIV seroprevalence in 2001. The same model could be used to measure the effect of changing behaviour in the future. PMID:19415113
Leclerc, Pauline M.; Matthews, Alan P.; Garenne, Michel L.
Background Malaria is the leading cause of morbidity and the second leading cause of mortality in Zambia. Perceptions of fairness and legitimacy of decisions relating to treatment of malaria cases within public health facilities and distribution of ITNs were assessed in a district in Zambia. The study was conducted within the framework of REsponse to ACcountable priority setting for Trust in health systems (REACT), a north-south collaborative action research study, which evaluates the Accountability for Reasonableness (AFR) approach to priority setting in Zambia, Tanzania and Kenya. Methods This paper is based on baseline in-depth interviews (IDIs) conducted with 38 decision-makers, who were involved in prioritization of malaria services and ITN distribution at district, facility and community levels in Zambia, one Focus Group Discussion (FGD) with District Health Management Team managers and eight FGDs with outpatients' attendees. Perceptions and attitudes of providers and users and practices of providers were systematized according to the four AFR conditions relevance, publicity, appeals and leadership. Results Conflicting criteria for judging fairness were used by decision-makers and patients. Decision-makers argued that there was fairness in delivery of malaria treatment and distribution of ITNs based on alleged excessive supply of free malaria medicines, subsidized ITNs, and presence of a qualified health-provider in every facility. Patients argued that there was unfairness due to differences in waiting time, distances to health facilities, erratic supply of ITNs, no responsive appeal mechanisms, inadequate access to malaria medicines, ITNs and health providers, and uncaring providers. Decision-makers only perceived government bodies and donors/NGOs to be legitimate stakeholders to involve during delivery. Patients found government bodies, patients, indigenous healers, chiefs and politicians to be legitimate stakeholders during both planning and delivery. Conclusion Poor status of the AFR conditions of relevance, publicity, appeals and leadership corresponds well to the differing perceptions of fairness and unfairness among outpatient attendees and decision-makers. This may have been re-enforced by existing disagreements between the two groups regarding who the legitimate stakeholders to involve during service delivery were. Conflicts identified in this study could be resolved by promoting application of approaches such as AFR during priority setting in the district. PMID:21040552
Background The Ministry of Health (MoH) in Zambia is operating with fewer than half of the human resources for health (HRH) necessary to meet basic population health needs. Responding urgently to address this HRH crisis, the MoH plans to double the annual number of health training graduates in the next five years to increase the supply of health workers. The feasibility and costs of achieving this initiative, however, are unclear. Methods We determined the feasibility and costs of doubling training institution output through an individual school assessment framework. Assessment teams, comprised of four staff from the MoH and Clinton Health Access Initiative, visited all of Zambia's 39 public and private health training institutions from 17 April to 19 June 2008. Teams consulted with faculty and managers at each training institution to determine if student enrollment could double within five years; an operational planning exercise carried out with school staff determined the investments and additional operating costs necessary to achieve expansion. Cost assumptions were developed using historical cost data. Results The individual school assessments affirmed the MoH's ability to double the graduate output of Zambia's public health training institutions. Lack of infrastructure was determined as a key bottleneck in achieving this increase while meeting national training quality standards. A total investment of US$ 58.8 million is required to meet expansion infrastructure needs, with US$ 35.0 million (59.5%) allocated to expanding student accommodation and US$ 23.8 million (40.5%) allocated to expanding teaching, studying, office, and dining space. The national number of teaching staff must increase by 363 (111% increase) over the next five years. The additional recurring costs, which include salaries for additional teachers and operating expenses for new students, are estimated at US$ 58.0 million over the five-year scale-up period. Total cost of expansion is estimated at US$ 116.8 million over five years. Conclusions Historic underinvestment in training institutions has crippled Zambia's ability to meet expansion ambitions. There must be significant investments in infrastructure and faculty to meet quality standards while expanding training enrollment. Bottom-up planning can be used to translate national targets into costed implementation plans for expansion at each school. PMID:20860827
Abstract: Background: Among school- attending adolescents, victimization from bullying is associated with anxiety, depression and poor academic performance. There are limited reports on victimization from bullying in Zambia; we therefore conducted this study to determine the prevalence and correlates for victimization from bullying among adolescents in grades 7 to 10 in the country in order to add information on the body of knowledge on victimization from bullying. Methods: The 2004 Zambia Global School-based Health Survey (GSHS) data among adolescents in grades 7 to 10 were obtained from the World Health Organization. We estimated the prevalence of victimization from bullying. We also conducted weighted multivariate logistic regression analysis to determine independent factors associated with victimization from bullying, and report adjusted odds ratios (AOR) and their 95% confidence intervals (CI). Results: Of 2136 students who participated in the 2004 Zambia GSHS, 1559 had information on whether they were bullied or not. Of these, 1559 students, 62.8% (60.0% of male and 65.0% of female) participants reported having been bullied in the previous 30 days to the survey. We found that respondents of age less than 14 years were 7% (AOR=0.93; 95%CI [0.91, 0.95]) less likely to have been bullied compared to those aged 16 years or older. Being a male (AOR=1.07; 95%CI [1.06, 1.09]), lonely (AOR=1.24; 95%CI [1.22, 1.26]), worried (AOR=1.12; 95%CI [1.11, 1.14]), consuming alcohol (AOR=2.59; 95%CI [2.55, 2.64]), missing classes (AOR=1.30; 95%CI [1.28, 1.32]), and considering attempting suicide (AOR=1.20; 95%CI [1.18, 1.22]) were significantly associated with bullying victimization. Conclusions: Victimization from bullying is prevalent among in-school adolescents in grades 7 to 10 in Zambia, and interventions to curtail it should consider the factors that have been identified in this study. PMID:21502789
Siziya, Seter; Rudatsikira, Emmanuel; Muula, Adamson S.
Objective: The purpose of this study was to evaluate the socio-cultural variables that may influence teachers' adoption of classroom-based HIV/AIDS education within the school setting and among school types in Zambia's Lusaka Province. Method: Mixed methods were used to collect original data. Using semi-structured interviews (n=11) and a survey…
Henning, Margaret; Chi, Chunheui; Khanna, Sunil K.
We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10
Alison M. Elliott; Benita Halwiindi; Richard J. Hayes; Nkandu Luo; Alwyn G. Mwinga; George Tembo; Lieve Machiels; Ger Steenbergen; Joseph O. M. Pobee; Paul Nunn; Keith P. W. J. McAdam
Proc. of IEEE Africon'2011, 13-15 Sept., Livingstone, Zambia 1 A Role for Robotics in Sustainable Development? Guido Bugmann Centre for Robotic and Neural Systems University of Plymouth Plymouth, United Kingdom email@example.com Mel Siegel and Rachel Burcin Robotic Institute Carnegie Melon University
This article establishes the level of skills and experience in preservation and conservation management using a case study methodological approach conducted in the 3 university libraries at the University of Zambia. The findings revealed that 20 (57%) of the library staff had not received formal training in preservation and conservation of library…
Urban agriculture has become one of the key survival strategies for the urban poor in the developing world. Yet most cities do not have policy to support it and many actively discourage it. This paper reviews the situation in Zambia's four largest cities. During the 1960s–1970s, the Kaunda government attempted to create a supportive policy environment for urban agriculture, which
This dissertation aims to characterize the relationship between the temporal and information-structuring functions of tense and aspect marking in Totela, an endangered Bantu language of Zambia and Namibia. To that end, I investigate and describe in detail the semantics and pragmatics of selected tense and aspect markers, showing for each that a…
This paper explores the accessibility situation in a developing country such as Zambia. The global view of accessibility for disabled people is provided to examine the accessibility situation in developed and developing countries, highlighting the role of the environment in achieving rights for disabled people. Recognition of disability rights…
Banda-Chalwe, Martha; Nitz, Jennifer C.; de Jonge, Desleigh
BACKGROUND: The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear.
Aaron Tjoa; Margaret Kapihya; Miriam Libetwa; Kate Schroder; Callie Scott; Joanne Lee; Elizabeth McCarthy
This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…
Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.
Zambia is facing a crisis in its human resources for health, with deficits in the number and skill mix of health workers. The University of Zambia School of Medicine (UNZA SOM) was the only medical school in the country for decades, but recently it was joined by three new medical schools--two private and one public. In addition to expanding medical education, the government has also approved several allied health programs, including pharmacy, physiotherapy, biomedical sciences, and environmental health. This expansion has been constrained by insufficient numbers of faculty. Through a grant from the Medical Education Partnership Initiative (MEPI), UNZA SOM has been investing in ways to address faculty recruitment, training, and retention. The MEPI-funded strategy involves directly sponsoring a cohort of faculty at UNZA SOM during the five-year grant, as well as establishing more than a dozen new master's programs, with the goal that all sponsored faculty are locally trained and retained. Because the issue of limited basic science faculty plagues medical schools throughout Sub-Saharan Africa, this strategy of using seed funding to build sustainable local capacity to recruit, train, and retain faculty could be a model for the region. PMID:25072591
Low maternal healthcare service utilization contributes to poor maternal and new born health outcomes in rural Zambia. The purpose of this study was to identify important factors influencing women's intention to use these services in Kalomo, Zambia. An interviewer-administered questionnaire was used to collect data from 1007 women of reproductive age (15-45 years) from 13 rural health centres with the lowest service utilization rates in the district. Questions included measures of (past) healthcare seeking behaviour, psychosocial variables (attitude, perceived social norms, perceived behavioural control), logistical barriers (e.g. distance to the clinic) and sociodemographic variables (e.g. age, income and education level). Overall, our findings showed that most respondents had high intention to use healthcare services. Intention was positively associated with attitude, personal norms, behavioural control, education and income levels. Conversely, intention was negatively related to perceived social norms, age and distance. Multivariate regression analysis showed that, together, these variables accounted for 41.8% of the variance in intention, with perceived behavioural control being the strongest predictor of intention, followed by geographical distance and perceived social norms. These findings suggest that public health programmes mitigating these important factors are likely to motivate pregnant women to use maternal healthcare services. PMID:25274723
Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C
Objectives To identify risk factors for trichomoniasis among young women in Ndola, Zambia. Method The study was a cross-sectional study among adolescent girls aged 13-16 years in Ndola, Zambia. Study participants were recruited from schools in selected administrative areas that represented the different socio-economic strata in town. Consenting participants were interviewed about their socio-demographic characteristics; sexual behaviour; and hygiene practices. Self-administered vaginal swabs were tested for Trichomonas vaginalis. HSV-2 antibodies were determined on serum to validate the self-reported sexual activity. Results A total of 460 girls participated in the study. The overall prevalence of trichomoniasis was 27.1%, 33.9% among girls who reported that they had ever had sex and 24.7% among virgins. In multivariate analysis the only statistically significant risk factor for trichomoniasis was inconsistent use of soap. For the virgins, none of the risk factors was significantly associated with trichomoniasis, but the association with use of soap (not always versus always) and type of toilet used (pit latrine/bush versus flush toilet) was of borderline significance. Conclusion We found a high prevalence of trichomoniasis in girls in Ndola who reported that they had never had sex. We postulate that the high prevalence of trichomoniasis in virgins in Ndola is due to non-sexual transmission of trichomoniasis via shared bathing water and inconsistent use of soap. PMID:21305023
To monitor and evaluate the feasibility of implementing Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) to address trauma and stress-related symptoms in orphans and vulnerable children (OVC) in Zambia as part of ongoing programming within a non-governmental organization (NGO). As part of ongoing programming, voluntary care-workers administered locally validated assessments to identify children who met criteria for moderate to severe trauma symptomatology. Local lay counselors implemented TF-CBT with identified families, while participating in ongoing supervision. Fifty-eight children and adolescents aged 5-18 completed the TF-CBT treatment, with pre- and post-assessments. The mean number of traumas reported by the treatment completers (N=58) was 4.11. Post assessments showed significant reductions in severity of trauma symptoms (p<0.0001), and severity of shame symptoms (p<0.0001). Our results suggest that TF-CBT is a feasible treatment option in Zambia for OVC. A decrease in symptoms suggests that a controlled trial is warranted. Implementation factors monitored suggest that it is feasible to integrate and evaluate evidence-based mental health assessments and intervention into programmatic services run by an NGO in low/middle resource countries. Results also support the effectiveness of implementation strategies such as task shifting, and the Apprenticeship Model of training and supervision. PMID:23768939
Murray, Laura K; Familiar, Itziar; Skavenski, Stephanie; Jere, Elizabeth; Cohen, Judy; Imasiku, Mwiya; Mayeya, John; Bass, Judith K; Bolton, Paul
A small scale, forced convection, indirect solar food drier was designed, built and tested in Zambia. The drier consisted of five modules: a solar collector, a drying cabinet, a fan housing, a heat storage and a control unit. The construction methods and materials used were selected so as to match the level of technological development in the denser populated areas of Zambia. Practically all the materials were acquired locally. The drier could be run in three main operating modes (straight-through, heat storage, heat recovery) and a number of air recycling submodes by means of manipulating simple slide valves. The food was dried indirectly. A set of eight experiments was first carried out to determine the energy collection and heat transfer characteristics of the equipment in its various operating modes and submodes. Okra, cabbage and beef were then dried. Although the experiments were done during the Zambian 'winter', these foods could be dried to below 15% moisture in two or three operating days.
This study examines the status of biomass energy in Zambia. In its current usage, the concept of biomass energy often implies woodfuel because woodfuel is the main biomass energy. This study develops an econometric model of household woodfuel demand and also evaluates the supply of woodfuel in Zambia. The study finds that there are significant sectoral differences in woodfuel demand between the rural and urban sectors. In the rural sector, inflation is by far the most significant determinant of household woodfuel demand. The coefficients on inflation are statistically significant at better than the one percent level and also have expected positive signs. In the urban sector, inflation is again by far the most significant determinant of woodfuel demand. However, in the urban sector, household income and woodfuel price are also significant determinants of demand. The coefficients on inflation, household income, and woodfuel price are all significant at better than the one percent level and have expected signs. The income elasticity of woodfuel demand is positive, suggesting that in the short-run, woodfuel is a normal good. However, the elasticity of woodfuel demand with respect to growth in investment is negative, indicating that long-run structural change in the economy reduces woodfuel demand.
Schistosoma mansoni disease is endemic in most parts of rural Zambia, and associated complications are common. We conducted a cross-sectional study among 754 people in rural communities of Kaoma District, western Zambia to determine the burden of S. mansoni infection and associated morbidity. Parasitology and ultrasonography assessments were conducted on consenting participants. The overall prevalence of S. mansoni infection and geometric mean egg count (GMEC) were 42.4% (304) and 86.6 eggs per gram (95% confidence interval = 75.6-99.6), respectively. Prevalence was highest in the age group of 15-19 years old (adjusted prevalence ratio = 1.70, P = 0.017). S. mansoni-related portal fibrosis was detected in 26% of the participants screened. Participants above 39 years old were 2.93 times more likely to have fibrosis than the 7-9 years old age group (P = 0.004). The study highlights the high burden of S. mansoni disease in this area and calls for immediate interventions to avert complications associated with the disease. PMID:25246696
Mutengo, Mable M; Mwansa, James C L; Mduluza, Takafira; Sianongo, Sandie; Chipeta, James
In August and September, throughout south central Africa, seasonal clearing of dry vegetation and other fire-related activities lead to intense smoke haze and ozone formation. The first ozone soundings in the heart of the southern African burning region were taken at Lusaka, Zambia (155 deg S, 28 deg E) in early September 2000. Over 90 ppbv ozone was recorded at the surface (1.3 km elevation) and column tropospheric ozone was greater than 50 DU during a stagnant period. These values are much higher than concurrent measurements over Nairobi (1 deg S, 38 deg E) and Irene (25 deg S, 28 deg E, near Pretoria). The heaviest ozone pollution layer (800-500 hPa) over Lusaka is due to recirculated trans-boundary ozone. Starting out over Zambia, Angola, and Namibia, ozone heads east to the Indian Ocean, before turning back over Mozambique and Zimbabwe, heading toward Lusaka. Thus, Lusaka is a collection point for pollution, consistent with a picture of absolutely stable layers recirculating in a gyre over southern Africa.
Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tal; Phahlane, N. Agnes; Coetzee, G. J. R.; Bhartia, P. K. (Technical Monitor)
Kaposi sarcoma-associated herpesvirus (KSHV) is the etiologic agent for Kaposi Sarcoma (KS), the most common cancer diagnosed in HIV- infected patients. The role of neutralizing antibodies in KS pathogenesis and in KSHV infected individuals is not clearly understood. The goal of this study was to investigate and compare the prevalence and titers of neutralizing antibodies in plasma samples from KS patients and KSHV infected asymptomatic individuals from Zambia, a KS endemic region in sub-Saharan Africa. Plasma samples (N?=?267) consisting of KS patients (group 1) and asymptomatic individuals (group 2) were collected from Lusaka, Zambia. A flow cytometry based quantitative neutralization assay utilizing recombinant KSHV expressing GFP was used to detect KSHV neutralizing antibodies. Our results show that the overall prevalence of neutralizing antibodies in KS patients (group 1) was 66.7% which was significantly higher than the prevalence of 6.5% present in KSHV infected asymptomatic individuals (group 2). Total antibody titers as well as neutralizing antibodies titers were found to be significantly higher among KS patients. It is likely that higher neutralizing antibodies prevalence and titers in KS patients result from higher levels of antigenic stimulation over time. This study is first to compare prevalence and titers of neutralizing antibodies in participants with and without disease from a KSHV endemic region. PMID:23967174
Kumar, Pankaj; Kuwa, Nithal Y; Minhas, Veenu; Marimo, Clemence; Shea, Danielle M; Kankasa, Chipepo; Wood, Charles
Relationship quality and partner dynamics provide important insights into understanding sexual behavior within HIV sero-positive and -discordant couples. Individuals in long-term partnerships may be vulnerable to HIV/STI infection within their relationships due to misperceptions of their partners risk behaviors and potential concurrent (e.g., extramarital, non-primary) sexual partnerships. This study sought to examine relationship quality among HIV sero-positive and – discordant couples in Zambia, and its association with safer sex behavior. This study utilized data drawn from an ongoing translational study, The Partnership II Project – a couples based sexual risk reduction intervention in Lusaka, Zambia. Couples (n = 240) were assessed on demographics, relationship quality, and sexual risk behavior. Overall, couples perceiving their relationships more positively engaged in less risky sexual behavior (i.e., more condom use (b = .011, t = 3.14, p = .002) and fewer partners (?2 = 11.4, p = .003). Within the dyad, condom use was “actor driven,” indicating that the association between relationship quality and condom use did not depend on the partner’s evaluation of the relationship. Safer sex behavior was positively influenced by communication about condoms. Results support the paradigm shift from prevention strategies with HIV positive and at-risk individuals to concentrated efforts addressing male-female dyads, and suggest that interventions to address the role of couples’ relationship quality, a modifiable target for decreasing sexual risk behavior, are needed. PMID:23336258
Vamos, Szonja; Cook, Ryan; Chitalu, Ndashi; Mumbi, Miriam; Weiss, Stephen M.; Jones, Deborah
HIV and AIDS still pose a major public health problem to most countries in sub-Saharan Africa, Zambia included. The objective of the paper is to determine changes in selected sexual behaviour and practice and HIV prevalence indicators between 2001–2002 and 2007. We used the Demographic and Health Survey Indicators Database for the computation of the selected indicators. We further used STATA 10.0 to compute significance tests to test for statistical difference in the indicators. The results indicate some changes in sexual behaviour, as indicated by an increase in abstinence, use of condoms and the decrease in multiple partnerships. The overall percentage of abstinence among never-married young men and women aged 15–24 years in Zambia increased significantly by 15.2% (p = .000) and 5.9% (p = .001) respectively, between 2001–2002 and 2007. A statistically significant increase of 6.6% (p = .029) was observed in the percentage of young women who reported having used a condom during the last time they had had premarital sex. A statistically significant decrease of 11.0% (p = .000) and 1.4% (p = .000) was observed among young men and women, respectively, who reported having multiple partners in the preceding 12 months. The factorial decomposition using multivariate analysis reveals that the indicators which contributed to the statistically significant 2.6% decline in HIV prevalence among young women aged 15–24 years in Zambia include proportion reporting condom use during premarital sex (+6.6%), abstinence (+5.9%), sex before age 15 (– 4.5%), premarital sex (– 2.6%), sex before age 18 (– 2.4%) and proportion reporting multiple partnerships (– 1.4%). Remarkable strides have been achieved towards promoting responsible sexual behaviour and practice among young people in Zambia. Further research focusing on factors that predispose young women in Zambia to higher risk of infection from HIV is required. The results from this paper should be useful in the design of programmes to control the spread of HIV and AIDS, particularly among young people in Zambia and other sub-Saharan countries. PMID:24702245
HIV and AIDS still pose a major public health problem to most countries in sub-Saharan Africa, Zambia included. The objective of the paper is to determine changes in selected sexual behaviour and practice and HIV prevalence indicators between 2001-2002 and 2007. We used the Demographic and Health Survey Indicators Database for the computation of the selected indicators. We further used STATA 10.0 to compute significance tests to test for statistical difference in the indicators. The results indicate some changes in sexual behaviour, as indicated by an increase in abstinence, use of condoms and the decrease in multiple partnerships. The overall percentage of abstinence among never-married young men and women aged 15-24 years in Zambia increased significantly by 15.2% (p=.000) and 5.9% (p=.001) respectively, between 2001-2002 and 2007. A statistically significant increase of 6.6% (p=.029) was observed in the percentage of young women who reported having used a condom during the last time they had had premarital sex. A statistically significant decrease of 11.0% (p=.000) and 1.4% (p=.000) was observed among young men and women, respectively, who reported having multiple partners in the preceding 12 months. The factorial decomposition using multivariate analysis reveals that the indicators which contributed to the statistically significant 2.6% decline in HIV prevalence among young women aged 15-24 years in Zambia include proportion reporting condom use during premarital sex (+6.6%), abstinence (+5.9%), sex before age 15 (-4.5%), premarital sex (-2.6%), sex before age 18 (-2.4%) and proportion reporting multiple partnerships (-1.4%). Remarkable strides have been achieved towards promoting responsible sexual behaviour and practice among young people in Zambia. Further research focusing on factors that predispose young women in Zambia to higher risk of infection from HIV is required. The results from this paper should be useful in the design of programmes to control the spread of HIV and AIDS, particularly among young people in Zambia and other sub-Saharan countries. PMID:24702245
Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas. PMID:20849626
In Zambia, the burden of HIV-related diseases such as tuberculosis has received substantial international attention. Zambians experience and participate in a range of globally produced programs to manage TB and cure TB sufferers. Guided by the WHO’s Directly Observed Treatment, Short-course (DOTS) protocol, TB treatment regimens now emphasize adherence to medications as the primary way to achieve cure. This article aims to understand how adherence models enter into the daily lives of children who live with and care for adult TB patients in an area disproportionately affected by the disease. I suggest that children domesticate adherence models, using them as strategies to safeguard identities, relationships, livelihoods, and futures that are increasingly under threat in the age of HIV. They draw on TB treatment and the hope and agency it affords to hold onto a version of childhood in which they are cared for by adults who will advocate for their wellbeing. PMID:23804398
Effective household water treatment can improve drinking water quality and prevent disease if used correctly and consistently over time. One year after completion of a randomized controlled study of water filters among households in Zambia with children < 2 years old and mothers who were human immunodeficiency virus (HIV)-positive, we conducted a follow-up study to assess use and performance of new filters distributed at the conclusion of the study; 90% of participating households met the criteria for current users, and 75% of participating households had stored water with lower levels of fecal contamination than source water. Microbiologically, the filters continued to perform well, removing an average of 99.0% of fecal indicator bacteria. Although this study provides some encouraging evidence about the potential to maintain high uptake and filter performance, even in the absence of regular household visits, additional research is necessary to assess whether these results can be achieved over longer periods and with larger populations. PMID:24100635
Penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) were detected in nine out of 27 (3.2%) treatment failures in 310 cases of acute gonococcal urethritis in men in Lusaka, Zambia. Minimum inhibitory concentrations of penicillin for 17.2% of 233 gonococcal isolates were less than or equal to 0.05 microgram/ml, for 38.2% between 0.125 and 0.25 microgram/ml, and for 46.6% greater than or equal to 0.5 microgram/ml. At present the prevalence of PPNG in African countries is not known but is likely to increase rapidly unless simplified control schemes are adopted within the existing health care programmes. Endemic pockets of PPNG in a few countries can threaten worldwide efforts to control gonorrhoea. PMID:6799144
Trypomastogotes of Trypanosoma brucei were detected from 4 asymptomatic kudus (Tragelaphus strepsiceros) on a game ranch located approximately 45 km north east of Lusaka, Zambia. Blood smears examined from 14 wildlife species comprising of the impala (Aepyceros melampus), Kafue lechwe (kobus leche kafuensis), sable antelope (Hippotragus niger), tsessebe (Damaliscus lunatus), warthog (Phacochoerus aethiopicus), puku (Kobus vardoni), zebra (Equus burchelli), waterbuck (Kobus ellipsiprymnus), bushbuck (Tragelaphus scriptus), reedbuck (Redunca arundinum), wilderbeest (Connochaetes taurinus), hartebeest (Alcephelus lichtensteini), African buffalo (Syncerus caffer), and kudu (Tragelaphus strepsiceros) showed that only the kudu had T. brucei. Although game ranching has emerged to be a successful ex-situ conservation strategy aimed at saving the declining wildlife population in the National Parks, our findings suggest that it has the potential of aiding the re-distribution of animal diseases. Hence, there is a need for augmenting wildlife conservation with disease control strategies aimed at reducing the risk of disease transmission between wildlife and domestic animals. PMID:20333288
Trypomastogotes of Trypanosoma brucei were detected from 4 asymptomatic kudus (Tragelaphus strepsiceros) on a game ranch located approximately 45 km north east of Lusaka, Zambia. Blood smears examined from 14 wildlife species comprising of the impala (Aepyceros melampus), Kafue lechwe (kobus leche kafuensis), sable antelope (Hippotragus niger), tsessebe (Damaliscus lunatus), warthog (Phacochoerus aethiopicus), puku (Kobus vardoni), zebra (Equus burchelli), waterbuck (Kobus ellipsiprymnus), bushbuck (Tragelaphus scriptus), reedbuck (Redunca arundinum), wilderbeest (Connochaetes taurinus), hartebeest (Alcephelus lichtensteini), African buffalo (Syncerus caffer), and kudu (Tragelaphus strepsiceros) showed that only the kudu had T. brucei. Although game ranching has emerged to be a successful ex-situ conservation strategy aimed at saving the declining wildlife population in the National Parks, our findings suggest that it has the potential of aiding the re-distribution of animal diseases. Hence, there is a need for augmenting wildlife conservation with disease control strategies aimed at reducing the risk of disease transmission between wildlife and domestic animals. PMID:20333288
The largest health discrepancy in the world is maternal mortality with most deaths occurring around the labor, delivery and postpartum period. The presence of skilled birth attendants such as qualified midwives is a leading factor in averting death and disability. This study evaluated the use of simulation with midwifery students in Zambia using a pre and post test quasi experimental design measuring confidence, satisfaction with learning, and knowledge between students who experienced simulation and those who had traditional instruction. A total of 34 students participated in the study. There were no statistical differences between mean scores on knowledge or confidence measures. Students who participated in simulation were more satisfied with learning than those who did not (p = .03). This pilot study provided data on the process of implementing simulation with midwifery students in a low resourced setting and area's for improvement for it to be an effective teaching method. PMID:22947661
Tyer-Viola, Lynda; Zulu, Beatrice; Maimbolwa, Margaret; Guarino, Anthony
Objectives To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. Methods 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. Results The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). Conclusions Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population. PMID:24069309
Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia. PMID:20653981
We investigate heavy-metal contamination of irrigation water used for urban agriculture and subsequent contamination of food crops in Chunga, NW Lusaka, the capital of Zambia. Inhabitants of the Chunga area rely on urban agriculture as both a major source of income and food. From August 2004 to July 2005, monthly samples of irrigation water used and edible portions of food crops were taken from a farmer's plot at Chunga. The food crops (cabbage, Chinese cabbage, pumpkin leaves, rape, sweet potato leaves and tomatoes) are grown using irrigation throughout the year. Irrigation water samples and digested food crop samples were analysed using ICP-MS at the Department of Geology, Colgate University, USA for Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Cd, Ba, Hg, Tl, Pb, and U. We find heavy-metal concentrations present in both irrigation water and food crop samples. Zambian sample concentrations were compared to Zambian and international legislative and guideline limits for concentrations of heavy metals in industrial effluent, heavy metals in irrigation water and heavy metals in foods. In irrigation water samples recommended national and/or international legislative limits for Al, Cr, Mn, Fe, Cu, Hg, Pb and U were exceeded. Limits for Hg were exceeded by up to 130 times. There were heavy-metal concentrations above recommended limits in food crops for Cr, Fe, Ni, Cu, Zn, Cd, Hg and Pb throughout the different food crops grown and throughout the year. In all 14 samples recommended limits for Cr, Fe and Hg were exceeded. Zambian legislated limits for food crops were exceeded by up to 16 times for Pb and 58 times for Hg. The results of this study show that heavy metal contamination is present in irrigation water used and food crops grown in urban agriculture in Chunga, Lusaka, Zambia. Recommended maximum limits for heavy metals in irrigation water and food are exceeded in some samples indicating there may be a risk to health.
Holden, J. A.; Malamud, B. D.; Chishala, B. H.; Kapungwe, E.; Volk, J.; Harpp, K. S.
Transmission of Plasmodium falciparum is hyperendemic in southern Zambia. However, no data on the entomologic aspects of malaria transmission have been published from Zambia in more than 25 years. We evaluated seasonal malaria transmission by Anopheles arabiensis and An. funestus s.s. and characterized the blood feeding behavior of An. arabiensis in two village areas. Transmission during the 2004–2005 rainy season was nearly zero because of widespread drought. During 2005–2006, the estimated entomologic inoculation rate values were 1.6 and 18.3 infective bites per person per transmission season in each of the two village areas, respectively. Finally, with a human blood index of 0.923, An. arabiensis was substantially more anthropophilic in our study area than comparable samples of indoor-resting An. arabiensis throughout Africa and was the primary vector responsible for transmission of P. falciparum. PMID:17297034
Thuma, Philip E.; Mharakurwa, Sungano; Norris, Douglas E.
Although ART is increasingly accessible and eases some stresses, it creates other challenges including the importance of food security to enhance ART-effectiveness. This paper explores the role livelihood strategies play in achieving food security and maintaining nutritional status among ART patients in Kenya and Zambia. Ongoing quantitative studies exploring adherence to ART in Mombasa, Kenya (n=118) and in Lusaka, Zambia (n=375) were used to identify the relationship between BMI and adherence; an additional set of in-depth interviews with people on ART (n=32) and members of their livelihood networks (n=64) were undertaken. Existing frameworks and scales for measuring food security and a positive deviance approach was used to analyse data. Findings show the majority of people on ART in Zambia are food insecure; similarly most respondents in both countries report missing meals. Snacking is important for dietary intake, especially in Kenya. Most food is purchased in both countries. Having assets is key for achieving livelihood security in both Kenya and Zambia. Food supplementation is critical to survival and for developing social capital since most is shared amongst family members and others. Whilst family and friends are key to an individual's livelihood network, often more significant for daily survival is proximity to people and the ability to act immediately, characteristics most often found amongst neighbours and tenants. In both countries findings show that with ART health has rebounded but livelihoods lag. Similarly, in both countries respondents with high adherence and high BMI are more self-reliant, have multiple income sources and assets; those with low adherence and low BMI have more tenuous livelihoods and were less likely to have farms/gardens. Food supplementation is, therefore, not a long-term solution. Building on existing livelihood strategies represents an alternative for programme managers and policy-makers as do other strategies including supporting skills and asset accumulation. PMID:21574075
BackgroundPatients starting antiretroviral therapy (ART) for acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa have high rates of mortality in the initial weeks of treatment. We assessed the association of serum phosphate with early mortality among HIV-infected adults with severe malnutrition and\\/or advanced immunosuppression.Methodology\\/Principal FindingsAn observational cohort of 142 HIV-infected adults initiating ART in Lusaka, Zambia with body mass index (BMI)
Douglas C. Heimburger; John R. Koethe; Christopher Nyirenda; Claire Bosire; Janelle M. Chiasera; Meridith Blevins; Andres Julian Munoz; Bryan E. Shepherd; Dara Potter; Isaac Zulu; Angela Chisembele-Taylor; Benjamin H. Chi; Jeffrey S. A. Stringer; Edmond K. Kabagambe; Robert J. Wilkinson
BackgroundMany HIV-infected children in sub-Saharan Africa reside in rural areas, yet most research on treatment outcomes has been conducted in urban centers. Rural clinics and residents may face unique barriers to care and treatment.MethodsA prospective cohort study of HIV-infected children was conducted between September 2007 and September 2010 at the rural HIV clinic in Macha, Zambia. HIV-infected children younger than
Janneke H. van Dijk; Catherine G. Sutcliffe; Bornface Munsanje; Pamela Sinywimaanzi; Francis Hamangaba; Philip E. Thuma; William J. Moss; Landon Myer
Objective: To determine the population effectiveness of a city-wide perinatal HIV prevention program. Design: An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP). Methods: All 10 public-sector delivery centers in Lusaka, Zambia participated. All mother-infant pairs delivering during the 12-week surveillance period at the partici- pating centers and who received antenatal care at a public-sector facility
Jeffrey S. A. Stringer; Moses Sinkala; Courtney C. Maclean; Jens Levy; Chipepo Kankasa; Alain DeGroot; Elizabeth M Stringer; Edward P Acosta; Robert L Goldenberg; Sten H Vermund
The view that widows and their dependents face greater livelihood risks in the era of HIV\\/AIDS is indeed supported by nationally-representative survey results from Zambia. Efforts to safeguard widows’ rights to land through land tenure innovations involving community authorities may be an important component of social protection, poverty alleviation, and HIV\\/AIDS mitigation strategies. Several of the findings reported show the
Using comprehensive rural farm household longitudinal data from Zambia, this paper measures the impacts of prime-age (PA) adult morbidity and mortality on crop production and cropping patterns, household size, livestock and non-farm income. The paper adopts and extends the counterfactual (difference-in-difference) approach by controlling for initial (pre-death) household conditions that may influence the severity of the impacts of adult mortality.
Babesia spp. were detected from 4 asymptomatic pukus captured on a game ranch in central Zambia in October 2008. Blood smears were examined in 4 species of aymptomatic free-ranging antelopes, namely the puku (Kobus vordanii), reedbuck (Redunca arundinum), bushbuck (Tragelaphus sylvaticus), and kudu (Tragelaphus strepsiceros), and showed the presence of Babesia parasites only in the puku. In the puku, the prevalence of babesiosis was estimated at 33.3% (n=12), while the overall prevalence in all examined animals was 8.5% (n=47). The parasites showed morphological characteristics of paired ring-like stages with the length varying between 1.61 µm and 3.02 µm (mean=2.12 µm, n=27; SD=0.76 µm). Both the infected and non-infected pukus showed good body condition scores (BCS), while the dominant tick species detected from all animals were Rhipicephalus appendiculatus, Rhipicephalus spp., and Boophilus spp. To our knowledge this is the first report of Babesia spp. infection in pukus in Zambia. These findings suggest that wildlife could play an important role in the epidemiology of babesiosis in Zambia. PMID:22355215
Munyeme, Musso; Nambota, Andrew Mubila; Nalubamba, King Shimumbo; Siamudaala, Victor M.
Babesia spp. were detected from 4 asymptomatic pukus captured on a game ranch in central Zambia in October 2008. Blood smears were examined in 4 species of aymptomatic free-ranging antelopes, namely the puku (Kobus vordanii), reedbuck (Redunca arundinum), bushbuck (Tragelaphus sylvaticus), and kudu (Tragelaphus strepsiceros), and showed the presence of Babesia parasites only in the puku. In the puku, the prevalence of babesiosis was estimated at 33.3% (n = 12), while the overall prevalence in all examined animals was 8.5% (n = 47). The parasites showed morphological characteristics of paired ring-like stages with the length varying between 1.61 µm and 3.02 µm (mean = 2.12 µm, n = 27; SD = 0.76 µm). Both the infected and non-infected pukus showed good body condition scores (BCS), while the dominant tick species detected from all animals were Rhipicephalus appendiculatus, Rhipicephalus spp., and Boophilus spp. To our knowledge this is the first report of Babesia spp. infection in pukus in Zambia. These findings suggest that wildlife could play an important role in the epidemiology of babesiosis in Zambia. PMID:22355215
Munang'andu, Hetron Mweemba; Munyeme, Musso; Nambota, Andrew Mubila; Nalubamba, King Shimumbo; Siamudaala, Victor M
Zambia has been experiencing low livestock productivity as well as trade restrictions owing to the occurrence of foot and mouth disease (FMD), but little is known about the epidemiology of the disease in these endemic settings. The fundamental questions relate to the spatio-temporal distribution of FMD cases and what determines their occurrence. A retrospective review of FMD cases in Zambia from 1981 to 2012 was conducted using geographical information systems and the SaTScan software package. Information was collected from peer-reviewed journal articles, conference proceedings, laboratory reports, unpublished scientific reports and grey literature. A space-time permutation probability model using a varying time window of one year was used to scan for areas with high infection rates. The spatial scan statistic detected a significant purely spatial cluster around the Mbala-Isoka area between 2009 and 2012, with secondary clusters in Sesheke-Kazungula in 2007 and 2008, the Kafue flats in 2004 and 2005 and Livingstone in 2012. This study provides evidence of the existence of statistically significant FMD clusters and an increase in occurrence in Zambia between 2004 and 2012. The identified clusters agree with areas known to be at high risk of FMD. The FMD virus transmission dynamics and the heterogeneous variability in risk within these locations may need further investigation. PMID:25005590
Sinkala, Yona; Simuunza, Martin; Muma, John B; Pfeiffer, Dirk U; Kasanga, Christopher J; Mweene, Aaron
... View Larger Image Heavy rainfall in southern Africa between December 2003 and April 2004 provided ... with floodwaters needed to support the diverse uses of water within the Kafue Flats region. The Kafue Flats are home to about one ...
Introduction Current health policy directions in Zambia are formulated in the National Health Strategic Plan. The Plan focuses on national health priorities, which include the human resources (HR) crisis. In this paper we describe the way the HRH establishment is distributed in the different provinces of Zambia, with a view to assess the dimension of shortages and of imbalances in the distribution of health workers by province and by level of care. Population and methods We used secondary data from the "March 2008 payroll data base", which lists all the public servants on the payroll of the Ministry of Health and of the National Health Service facilities. We computed rates and ratios and compared them. Results The highest relative concentration of all categories of workers was observed in Northern, Eastern, Lusaka, Western and Luapula provinces (in decreasing order of number of health workers). The ratio of clinical officers (mid-level clinical practitioners) to general medical officer (doctors with university training) varied from 3.77 in the Lusaka to 19.33 in the Northwestern provinces. For registered nurses (3 to 4 years of mid-level training), the ratio went from 3.54 in the Western to 15.00 in Eastern provinces and for enrolled nurses (two years of basic training) from 4.91 in the Luapula to 36.18 in the Southern provinces. This unequal distribution was reflected in the ratio of population per cadre. The provincial distribution of personnel showed a skewed staff distribution in favour of urbanized provinces, e.g. in Lusaka's doctor: population ratio was 1: 6,247 compared to Northern Province's ratio of 1: 65,763. In the whole country, the data set showed only 109 staff in health posts: 1 clinical officer, 3 environmental health technologists, 2 registered nurses, 12 enrolled midwives, 32 enrolled nurses, and 59 other. The vacancy rates for level 3 facilities(central hospitals, national level) varied from 5% in Lusaka to 38% in Copperbelt Province; for level 2 facilities (provincial level hospitals), from 30% for Western to 70% for Copperbelt Province; for level 1 facilities (district level hospitals), from 54% for the Southern to 80% for the Western provinces; for rural health centres, vacancies varied from 15% to 63% (for Lusaka and Luapula provinces respectively); for urban health centres the observed vacancy rates varied from 13% for the Lusaka to 96% for the Western provinces. We observed significant shortages in most staff categories, except for support staff, which had a significant surplus. Discussion and Conclusions This case study documents how a peaceful, politically stable African country with a longstanding tradition of strategic management of the health sector and with a track record of innovative approaches dealt with its HRH problems, but still remains with a major absolute and relative shortage of health workers. The case of Zambia reinforces the idea that training more staff is necessary to address the human resources crisis, but it is not sufficient and has to be completed with measures to mitigate attrition and to increase productivity. PMID:22182366
Background Non-communicable lifestyle diseases are a growing public health concern globally. Obesity is a risk factor for premature mortality from cardiovascular diseases and diabetes as well as all-cause mortality. The objective of the study was to estimate the prevalence and associated factors for obesity among Zambian adults in Lusaka district. Methods A community-based study was done among adults in Zambia. Descriptive and co-relational analyses were conducted to estimate the prevalence of being obese as well as identify associated factors. Results A total of 1,928 individuals participated in the survey, of which 33.0% were males. About half of the participants were aged 25–34?years (53.2%), and about two-thirds had attended at least secondary level of education (63.9%). Overall, 14.2% of the participants (5.1% of males, and 18.6% of females) were obese. Significant factors associated with obesity were sex, age, education, cigarette smoking and blood pressure. Male participants were 55% (AOR?=?0.45; 95% CI [0.29, 0.69]) less likely to be obese compared to female participants. Compared to participants who were of age 45?years or older, participants of age 25–34?years were 61% (AOR?=?0.39 (95% CI [0.23, 0.67]) less likely to be obese. Compared to participants who attained college or university level of education, participants who had no formal education were 63% (AOR?=?0.37; 95% CI [0.15, 0.91]) less likely to be obese; and participants who had attained secondary level of education were 2.22 (95% CI [1.21, 4.07]) times more likely to be obese. Participants who smoked cigarettes were 67% (AOR?=?0.33; 95% CI [0.12, 0.95]) less likely to be obese compared to participants who did not smoke cigarettes. Compared to participants who had severe hypertension, participants who had moderate hypertension were 3.46 (95% CI [1.34, 8.95]) times more likely to be obese. Conclusions The findings from this study indicate that Zambian women are more at risk of being obese. Prevention and control measures are needed to address high prevalence and gender inequalities in risks for non-communicable diseases in Zambia. Such measures should include policies that support gender specific approaches for the promotion of health behavior changes. PMID:22551418
Background In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process. Methodology Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed. Results The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers. Conclusions This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors’ power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform. PMID:23870454
Background Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia. Methods This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15–24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners). Results HIV prevalence among young women aged 15–24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women. Conclusion The findings suggested structural effects on HIV prevalence. Future research should include more detailed mapping of neighbourhood factors of relevance to HIV transmission as part of the effort to better understand the causal mechanisms involved. PMID:19706189
Background Human resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo. Methods The health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district’s health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies. Results The primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient’s medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment. Conclusions Although active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country’s ability to align the training, management, and deployment of its health workforce to meet the needs of its people. PMID:25080074
Background Cervical cancer kills more women in low-income nations than any other malignancy. A variety of research and demonstration efforts have proven the efficacy and effectiveness of low-cost cervical cancer prevention methods but none in routine program implementation settings of the developing world, particularly in HIV-infected women. Methods In our public sector cervical cancer prevention program in Zambia, nurses conduct screening using visual inspection with acetic acid aided by digital cervicography. Women with visible lesions are offered same-visit cryotherapy or referred for histologic evaluation and clinical management. We analyzed clinical outcomes and modeled program effectiveness among HIV-infected women by estimating the total number of cervical cancer deaths prevented through screening and treatment. Results Between 2006 and 2008, 6572 HIV-infected women were screened, 53.6% (3523) had visible lesions, 58.5% (2062) were eligible for cryotherapy and 41.5% (1461) were referred for histologic evaluation. A total of 75% (1095 out of 1462) of patients who were referred for evaluation complied. Pathology results from 65% (715 out of 1095) of women revealed benign abnormalities in 21% (151), cervical intraepithelial neoplasia (CIN) I in 30% (214), CIN 2/3 in 33% (235) and invasive cervical cancer in 16.1% (115, of which 69% were early stage). Using a conditional probability model, we estimated that our program prevented 142 cervical cancer deaths (high/low range: 238–96) among the 6572 HIV-infected women screened, or one cervical cancer death prevented per 46 (corresponding range: 28–68) HIV-infected women screened. Conclusion Our prevention efforts using setting-appropriate human resources and technology have reduced morbidity and mortality from cervical cancer among HIV-infected women in Zambia. Financial support for implementing cervical cancer prevention programs integrated within HIV/AIDS care programs is warranted. Our prevention model can serve as the implementation platform for future low-cost HPV-based screening methods, and our results may provide the basis for comparison of programmatic effectiveness of future prevention efforts. PMID:25419240
Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Sahasrabuddhe, Vikrant V; Westfall, Andrew O; King, Kristin E; Chibwesha, Carla; Pfaendler, Krista S; Mkumba, Gracilia; Mudenda, Victor; Kapambwe, Sharon; Vermund, Sten H; Hicks, Michael L; Stringer, Jeffrey SA; Chi, Benjamin H
Background National malaria control programmes and their partners must document progress associated with investments in malaria control. While documentation has been achieved through population-based surveys for most interventions, measuring changes in malaria case management has been challenging because the increasing use of diagnostic tests reduces the denominator of febrile children who should receive anti-malarial treatment. Thus the widely used indicator, “proportion of children under five with fever in the last two weeks who received anti-malarial treatment according to national policy within 24 hours from onset of fever” is no longer relevant. Methods An alternative sequence of indicators using a systems effectiveness approach was examined using data from nationally representative surveys in Zambia: the 2012 population-based Malaria Indictor Survey (MIS) and the 2011 Health Facility Survey (HFS). The MIS measured fever treatment-seeking behaviour among 972 children under five years (CU5) and 1,848 people age five years and above. The HFS assessed management of 435 CU5 and 429 people age five and above with fever/history of fever seeking care at 149 health facilities. Consultation observation and exit interviews measured use of diagnostic tests, artemisinin combination therapy (ACT) prescription, and patient comprehension of prescribed regimens. Results Systems effectiveness for malaria case management among CU5 was estimated as follows: [100% ACT efficacy] x [55% fever treatment-seeking from an appropriate provider (MIS)] x [71% malaria blood testing (HFS)] x [86% ACT prescription for positive cases (HFS)] x [73% patient comprehension of prescribed ACT drug regimens (HFS)]?=?25%. Systems effectiveness for malaria case management among people age five and above was estimated at 15%. Conclusions Tracking progress in malaria case management coverage can no longer rely solely on population-based surveys; the way forward likely entails household surveys to track trends in fever treatment-seeking behaviour, and facility/provider data to track appropriate management of febrile patients. Applying health facility and population-based data to the systems effectiveness framework provides a cogent and feasible approach to documenting malaria case management coverage and identifying gaps to direct program action. In Zambia, this approach identified treatment-seeking behaviour as the largest contributor to reduction in systems effectiveness for malaria case management. PMID:24160186
Background In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children. Methods We enrolled 958 HIV-infected women and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months. Results In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P = 0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P = 0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P = 0.007). Conclusions Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants. (ClinicalTrials.gov number, NCT00310726.) PMID:18525036
Kuhn, Louise; Aldrovandi, Grace M.; Sinkala, Moses; Kankasa, Chipepo; Semrau, Katherine; Mwiya, Mwiya; Kasonde, Prisca; Scott, Nancy; Vwalika, Cheswa; Walter, Jan; Bulterys, Marc; Tsai, Wei-Yann; Thea, Donald M.
Botswana must close the gap between knowledge and practice if population growth is to be decreased. Community-based efforts have been partially successful, but obstacles are posed by cultural attitudes, misinformation and fear, teenage mistrust of family planning (FP) clinics, and slow FP service due to skilled labor shortages. The growth rate has declined from 3.5 in 1980 to 2.8, but population may still increase from 1.3 million in 1991 to 2.3 million by 2011. About 60% of the population is aged under 30 years. The increased population is expected to strain resources for social services, exacerbate employment absorption, and contribute to environmental degradation. Although fertility was still very high at 5.0 in 1991, the total fertility rate 10 years ago was 7.1. In 1988, 90% of women knew of a modern method, and contraceptive usage of a modern method increased to 33%. The government aimed to increase contraceptive prevalence to 40% between 1991 and 1997. Botswana, compared to the same-sized Zambia, has been able to rapidly reduce its fertility with only 33% of Zambia's arable land and lesser urbanization. The difference in these two countries may be in Botswana's work force, 33% of which is made up of women, and in the high female school enrollment. Government officials acted without an official population policy before voluntary FP associations were involved to encourage parents to space their children and use modern methods. The integration of maternal and child health and FP was responsible for much of the fertility decline. Family life education was initiated in school curriculums in the early 1980s. Male contraceptive use and parent education in communication with youth have received the attention of nongovernmental groups. 86% of the population lives within 15 km of a health center, and 73% lives within 8 km. Improvements are still needed in training health service staff to be sensitive to client concerns and to shorten waiting times. In 1987, the government approved dispensing of contraceptives to adolescents, who still fear clinics and reprisal from parents discovering their sexual activity or their contraceptive use. PMID:12345836
Background Malaria control was strengthened in Zambia over the past decade. The two primary interventions for vector control are indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs). Using passive malaria surveillance data collected from 2006 to 2011 through the Zambian District Health Information System, the associations between increased coverage with LLINs and IRS and the burden of malaria in Zambia were evaluated. Methods National passive malaria surveillance data from 2006 to 2011 were analysed. A district-level, random-effects model with Poisson regression was used to explore the association between malaria cases and coverage with LLINs and IRS. Malaria cases and LLINs and IRS coverage were mapped to visualize spatiotemporal variation in malaria for each year. Results From 2006–2011, 24.6 million LLINs were distributed and 6.4 million houses were sprayed with insecticide. Coverage with LLINs was not uniformly distributed over the study period and IRS was targeted to central and southern districts where malaria transmission was low. LLIN coverage was associated with a reduction in malaria cases, although an increase in the number of malaria cases was reported in some districts over the study period. A high burden of malaria persisted in north-eastern Zambia, whereas a reduction in the number of reported malaria cases was observed in western and southern Zambia. Conclusion Enhanced and targeted interventions in north-eastern Zambia where the burden of malaria remains high, as well as efforts to sustain low malaria transmission in the south-west, will be necessary for Zambia to achieve the national goal of being malaria free by 2030. PMID:24289177
Biochar amendment to soil is a potential technology for carbon storage and climate change mitigation. It may, in addition, be a valuable soil fertility enhancer for agricultural purposes in sandy and/or weathered soils. A life cycle assessment including ecological, health and resource impacts has been conducted for field sites in Zambia to evaluate the overall impacts of biochar for agricultural use. The life cycle impacts from conservation farming using cultivation growth basins and precision fertilization with and without biochar addition were in the present study compared to conventional agricultural methods. Three different biochar production methods were evaluated: traditional earth-mound kilns, improved retort kilns, and micro top-lit updraft (TLUD) gasifier stoves. The results confirm that the use of biochar in conservation farming is beneficial for climate change mitigation purposes. However, when including health impacts from particle emissions originating from biochar production, conservation farming plus biochar from earth-mound kilns generally results in a larger negative effect over the whole life cycle than conservation farming without biochar addition. The use of cleaner technologies such as retort kilns or TLUDs can overcome this problem, mainly because fewer particles and less volatile organic compounds, methane and carbon monoxide are emitted. These results emphasize the need for a holistic view on biochar use in agricultural systems. Of special importance is the biochar production technique which has to be evaluated from both environmental/climate, health and social perspectives. PMID:23272937
Patients' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients' and health care professionals' perceived barriers and facilitators to patients' adherence to ART. Based on data from individual interviews and focus group interviews with a total of 60 patients and 12 health care professionals, we identified barriers and facilitators related to patients' beliefs and behaviours, the health service, and socio-economic and cultural factors. Among the barriers we identified were lack of communication and information about ART, inadequate time during consultations, lack of follow-up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, and lack of nutritional support. Feeling better, prospects of living longer, family support, information about ART, support for income-generating activities, disclosure of HIV status, prayers and transport support were among the facilitators. Our study suggests that several issues need to be considered when providing ART. Further research is needed to study interactions between patients and their health care providers. Our findings can inform interventions to improve adherence to ART. PMID:18979047
During July 1993 to June 1994, in Zambia, 32 pregnant women aged 15-46 years suffered from uterine rupture at Mansa General Hospital, a referral center for Luapula province. Adolescent women were significantly more likely to have had a uterine rupture than all women delivering (38% vs. 17%; p 0.01). Nulliparity was more common among the uterine rupture cases than among all women giving birth (44% vs. 27%; p 0.05). Multiparity was just as common. 63% of uterine rupture cases had had no prenatal care. In 94% of cases the rupture occurred during labor. Some identified contributing factors for uterine rupture were cephalopelvic disproportion (24 cases), previous cesarean section (3), and oxytocic stimulation and assisted breech delivery with undiagnosed mild hydrocephalus (2). 44% of the women died postoperatively. Sepsis was the leading cause of death (79%). Mortality was associated with nulliparity (79%), adolescence (71%), and anemia, sepsis, and shock on admission (64%). Sepsis and maternal death increased with time since rupture and distance between patient's home or referring center and hospital. Prenatal care did not affect maternal death. All the babies died. These findings emphasize the need for health education of rural residents, training and supervision of traditional birth attendants, and available transportation. In cases of uterine rupture, later marriage, family planning use, and obstetric care may improve maternal prognosis. PMID:8634565
Many applications in the areas of agricultural, hydrological and environmental resource management require data over very large areas and with a high imaging frequency - monitoring crop growth, water stress, seasonal wetland flooding and natural vegetation development. This precludes the use of fine resolution data (Landsat, Spot) on the grounds of cost, accessibility and low imaging frequency. Meteorological satellites have the potential to fill this need, given their very wide spatial coverage, and high repeat imaging. The Remote Sensing Unit (RSU) at the Zambia Meteorological Department routinely receives, processes and archives imagery from both Meteosat and NOAA AVHRR satellites. Here I wish to present some examples of applications of these data sets that arise from the RSU work - relationships between rainfall and vegetation development as assessed by satellite, derived information and seasonal patterns of flooding in the Barotse floodplain and the Kafue flats. I also wish to outline ways in which a more widespread use of this data by the Zambian institutions can be achieved.
Heterosexual HIV transmission remains the leading cause of HIV incidence in adult men and women in sub-Saharan Africa. This study assessed whether an HIV risk-reduction intervention would be more likely to increase sexual barrier acceptability and decrease risk behavior when delivered to couples in gender concordant groups or in an individual format. This study also examined the mutual impact of couple members as a source of influence on acceptability, and assessed whether product acceptability, intimate partner violence (IPV), and/or partner communication predicted sexual barrier use. HIV seroconcordant and serodiscordant couples (n=216) were recruited in Lusaka, Zambia, and randomized to a four session gender-concordant intervention. Participants were assessed at baseline, 6, and 12 months. Willingness to use barriers (p=0.012), acceptability (p<0.001), and barrier use (p<0.001) increased over time in both conditions, and were influenced by gender preferences. IPV decreased (p=0.040) and positive communication increased (p<0.001) in both conditions. Individual and gender concordant group sessions achieved similar increases in sexual barrier use following the intervention. Results highlight the influence of partners as well as product acceptability as predictors of sexual barrier use among couples in sub-Saharan Africa. Future prevention studies should consider both product acceptability and partner influence to achieve optimal sexual risk behavior outcomes. PMID:24983201
Land and water for agriculture are scarce natural resources hence the promotion of good land management has taken center stage in Zambia. This study attempts to measure the factors that could be associated with the adoption of conservation farming practices considering that farmers have multiple practices to choose from and may adopt a given technology package in pieces. Based on a 1999/2000 national representative sample, the study suggests that farmers may be using intercropping to manage risk in low rainfall areas whereas pot holing does not yet appear to be considered as a risk reduction option. The thrust of this study is that policy makers should strive to build human capital, while at the same time retain skilled farmers through reduced adult mortalities. Provision of extension services should concentrate in areas with relevant physiographical factors while infrastructure should be improved to minimize costs of delivering extension services and agricultural inputs. DEDICATION This thesis is dedicated to my wife Doreen and my little daughter Chomba. The patience they showed and the support they provided during the time I was studying up to the very end of writing this thesis was wonderful. iii ACKNOWLEDGEMENTS Many thanks and appreciation goes to the following institutions and individuals whom without their help and support, the successful completion of my study would not have been possible:
Objective To characterize prenatal and delivery care in an urban African setting. Methods The Zambia Electronic Perinatal Record System (ZEPRS) was implemented to record demographic characteristics, past medical and obstetric history, prenatal care, and delivery and newborn care for pregnant women across 25 facilities in the Lusaka public health sector. Results From June 1, 2007, to January 31, 2010, 115 552 pregnant women had prenatal and delivery information recorded in ZEPRS. Median gestation age at first prenatal visit was 23 weeks (interquartile range [IQR] 19–26). Syphilis screening was documented in 95 663 (83%) pregnancies: 2449 (2.6%) women tested positive, of whom 1589 (64.9%) were treated appropriately. 111 108 (96%) women agreed to HIV testing, of whom 22% were diagnosed with HIV. Overall, 112 813 (98%) of recorded pregnancies resulted in a live birth, and 2739 (2%) in a stillbirth. The median gestational age was 38 weeks (IQR 35–40) at delivery; the median birth weight of newborns was 3000 g (IQR 2700–3300 g). Conclusion The results demonstrate the feasibility of using a comprehensive electronic medical record in an urban African setting, and highlight its important role in ongoing efforts to improve clinical care. PMID:21315347
Chi, Benjamin H.; Vwalika, Bellington; Killam, William P.; Wamalume, Chibesa; Giganti, Mark J.; Mbewe, Reuben; Stringer, Elizabeth M.; Chintu, Namwinga T.; Putta, Nande B.; Liu, Katherine C.; Chibwesha, Carla J.; Rouse, Dwight J.; Stringer, Jeffrey S.A.
Objective To describe predictors of contraceptive method discontinuation and switching behaviors among HIV positive couples receiving couples' voluntary HIV counseling and testing services in Lusaka, Zambia. Design Couples were randomized in a factorial design to two family planning educational intervention videos, received comprehensive family planning services, and were assessed every 3-months for contraceptive initiation, discontinuation and switching. Methods We modeled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models. Results Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods, and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping. Conclusions We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long acting reversible contraceptive (LARC) methods, and that fertility-goal based, LARC-focused family planning be offered as an integral part of HIV prevention services. PMID:24088689
Background. The mechanisms of severe malarial anemia and cerebral malaria, which are extreme manifestations of Plasmodium falciparum malaria, are not fully understood. Methods. Children aged <6 years from southern Zambia presenting to the hospital with severe malarial anemia (n = 72), cerebral malaria (n = 28), or uncomplicated malaria (n = 66) were studied prospectively. Children with overlapping severe anemia and cerebral malaria were excluded. Results. Low interleukin 10 concentrations had the strongest association with severe anemia (standard ? = .61; P < .001) followed by high tumor necrosis factor ? and sFas concentrations, low weight-for-age z scores, presence of stool parasites, and splenomegaly (standard ? = .15–.25; P ? .031); most of these factors were also associated with lower reticulocytes. Greater parasitemia was associated with higher interleukin 10 and tumor necrosis factor ? concentrations, whereas sulfadoxizole/pyrimethamine therapy and lower weight-for-age z scores were associated with lower interleukin 10 levels. Thrombocytopenia and elevated tissue plasminogen activator inhibitor 1 levels had the strongest associations with cerebral malaria (standard ? = .37 or .36; P < .0001), followed by exposure to traditional herbal medicine and hemoglobinuria (standard ? = .21–.31; P ? .006). Conclusions. Predictors of severe malarial anemia (altered immune responses, poor nutrition, intestinal parasites, and impaired erythropoiesis) differed from those of cerebral malaria (thrombocytopenia, herbal medicine, and intravascular hemolysis). Improved preventive and therapeutic measures may need to consider these differences. PMID:21288821
Thuma, Philip E.; van Dijk, Janneke; Bucala, Rick; Debebe, Zufan; Nekhai, Sergei; Kuddo, Thea; Nouraie, Mehdi; Weiss, Gunter
New ideas about conserving wildlife are emerging to compete with conventional national park policies. But methods of analyzing wildlife conservation problems in Africa are inadequate for the analysis of complex issues of policy. Much of the analysis of conservation policy attempts to be ‘apolitical’ on issues charged with social conflict. Analyses are too often ahistorical when history can say a great deal about the origins of present-day ecological problems. Further-more, problems are commonly analyzed within narrow discilinary frameworks which predetermine the nature of conclusions and lead to professionally biased proposals. This case study of the Luangwa Valley, Zambia, is used to demonstrate a method which attempts to remedy these weaknesses, In the first part of the article we examine the role of the Luangwa National Parks in the context of the Zambian political economy, and identify social groups which compete for the resources of the national parks. Next we trace the historical origins of present-day ecological changes. These analyses lead toward a model of the Parks and some of their relationships with the national economy. We end with a proposal for communal use of wildlife which attempts to resolve some of the contradictions inherent in current policy.
Background Epilepsy-associated stigma contributes substantially to the social, medical, and economic burden of disease for people with epilepsy (PWE), but little is known about its impact on caregivers of PWE. Methods To better understand stigma experienced by caregivers of PWE, factors that influence caregiver stigma, and the effect of stigma on a caregiver's psychologic well being, we interviewed 100 caregivers of children with epilepsy in Zambia. Questions assessed maternal knowledge, attitudes, and practices related to epilepsy, maternal stigma, mother's proxy report of child stigma, and maternal psychiatric morbidity. Results Of 100 mothers, 39 (39%) indicated that their child was stigmatized because of his or her epilepsy. Maternal proxy report of child stigma was highly correlated with maternal stigma (OR: 5.4, p=0.04), seizure frequency (p=0.03) and seizure severity (p=0.01). One in five of 100 mothers (20%) reported feeling stigmatized because of their child's epilepsy. Higher maternal stigma was associated with lower familial and community support (ORs: 65.2 and 34.7, respectively; both p<0.0001) as well as higher psychiatric morbidity (OR: 1.2; p=0.002). Formal education and epilepsy knowledge were associated with decreased maternal stigma (ORs: 0.8 and 0.7, respectively; both p<0.001). Conclusions One in five mothers of PWE feel stigmatized because of their child's epilepsy. As maternal stigma is associated with psychiatric morbidity, educating caregivers about epilepsy and screening for anxiety and depression are warranted. PMID:24214528
Intensive agricultural practices are recognized as significant sources of metal pollution in soils and pasture. This study investigated metal contamination in cattle offal from an agricultural area in Zambia, where inorganic fertilizers, agricultural lime, and pesticides are routinely applied. The highest median values (mg/kg, wet weight) of Cu (40.9), Zn (35.2), Cr (1.35) and Ni (0.594) were recorded in the liver, whereas the highest median values of Pb (0.061) and Cd (0.049) were found in kidneys. Maximum levels of Hg, As and Co were under 0.2 mg/kg in both organs. Pb and Cd did not exceed the benchmark values in cattle offal for human consumption and did not pose immediate health risks. Concentrations of Ni and Cr could present a public health concern. Monitoring of metal accumulations in offal of cattle, not only from well-known polluted environments but also agricultural areas, should be done regularly for the health of human consumers. PMID:22672843
Yabe, John; Nakayama, Shouta M M; Ikenaka, Yoshinori; Muzandu, Kaampwe; Ishizuka, Mayumi; Umemura, Takashi
Developmental changes in river basins in Africa have become a reality. Many wetland ecosystems have been impacted by dams and other hydrological interventions resulting in both foreseen and unexpected consequences. The Kafue Flats in southern Zambia is an extensive floodplain system that lies within the middle Kafue river basin. The floodplain is about 255 km long and 60 km wide, covering an area of approximately 6,500 km 2. It is currently sandwiched between two large dams which are approximately 270 km apart. These dams have completely altered the hydrological regime of the system. Backwater from the downstream dam and releases from upstream have created a permanently flooded area within the floodplain that was not present in the past. Elsewhere, flooding has been reduced. The ecological consequences of these changes for the floodplain, which hosts two national parks (both Ramsar sites), have been extensive. Hydrological and vegetation changes have impacted the habitat for important wildlife communities including the endemic antelope, Kobus leche kafuensis. The most dramatic change in vegetation is associated with the colonisation of parts of the floodplain by the invasive alien plant, Mimosa pigra. This paper discusses these changes and their potential consequences.
This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR?=?2.48 95% CI?=?1.00–6.19); tolerance to gender-based violence (OR?=?2.10 95% CI?=?1.05–4.32) and fear of social rejection (OR?=?1.48 95% CI?=?1.23–1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families. PMID:23991005
Gari, Sara; Malungo, Jacob R. S.; Martin-Hilber, Adriane; Musheke, Maurice; Schindler, Christian; Merten, Sonja
The relationship between education and socioeconomic status has been demonstrated in studies of the developed and the developing world, yet there are communities in which schooling is either not available to all children or not a preferred activity for all children. In this study, we investigated the differences between children in-school and out-of-school in rural and peri-urban communities of Zambia. As expected, we found that the children in-school performed higher in domains of adaptive behavior and on assessments of academic achievement (i.e., mathematics, reading). Somewhat unexpectedly, however, when controlling for socioeconomic status, home responsibilities (i.e., chores, work) were a positive predictor for the performance of the children out-of-school, but a negative predictor for the children in-school. The relationship between home responsibilities and academic performance may be bidirectional and differential; for example, our findings allow for the hypothesis that for in-school children chores take time away from the studies, but for out-of-school children they provide some limited mathematics exposure. PMID:24347996
Reich, Jodi; Hein, Sascha; Krivulskaya, Suzanna; Hart, Lesley; Gumkowski, Nina; Grigorenko, Elena L.
Understanding the nature of water conflict and cooperation is a crucial element in water governance within Integrated Water Resources Management (IWRM). Much of the recent attention to the issue has however focused on transboundary aspects, while we know rather less about the nature and dynamics of local water conflict and cooperation. Drawing on the work of the collaborative Competing for Water Research Programme, this article presents selected findings from a quantitative and qualitative mapping and exploration of water conflict and cooperation events in Namwala District of Zambia. It is found that local water competition situations often involve both conflictive and cooperative events in a dynamic succession of each other, but also that the majority of events are conflictive, and that they primarily take place between different types of water uses, and less frequently among the same types of uses. There is a distinct tendency for both conflictive and cooperative events to originate in the dry season, and many events are associated with water infrastructure development, particularly boreholes. The study found that most conflictive and cooperative events took place within individual communities, and only to a lesser extent between two or more communities or between districts. While third parties are involved in some events, these are primarily local village institutions such as Headmen. The article concludes by discussing the implications of these findings for local water governance, including the need to ensure that the very localized nature of such conflict and cooperation events is taken into consideration in the institutional development of IWRM.
Zambia introduced a sector-wide approach (SWAp) in the health sector in 1993. The goal was to improve efficiency in the use of domestic funds and externally sourced development assistance by integrating these into a joint sectoral framework. Over a decade into its existence, however, the SWAp remains largely unevaluated. This study explores whether the envisaged improvements have been achieved by studying developments in administrative, technical and allocative efficiency in the Zambian health sector from 1990-2006. A case study was conducted using interviews and analysis of secondary data. Respondents represented a cross-section of stakeholders in the Zambian health sector. Secondary data from 1990-2006 were collected for six indicators related to administrative, technical and allocative efficiency. The results showed small improvements in administrative efficiency. Transaction costs still appeared to be high despite the introduction of the SWAp. Indicators for technical efficiency showed a drop in hospital bed utilization rates and government share of funding for drugs. As for allocative efficiency, budget execution did not improve with the SWAp, although there were large variations between both donors and year. Funding levels had apparently improved at district level but declined for hospitals. Finally, the SWAp had not succeeded in bringing all external assistance together under a common framework. Despite strong commitment to implement the SWAp in Zambia, the envisaged efficiency improvements do not seem to have been attained. Possible explanations could be that the SWAp has not been fully developed or that not all parties have completely embraced it. SWAp is not ruled out as a coordination model, but the current setup in Zambia has not proved to be fully effective. PMID:18562459
Poverty and food security are endemic issues in much of sub-Saharan Africa. To eradicate extreme poverty and hunger in the region remains a key Millennium Development Goal. Many African governments have pursued economic reforms and agricultural policy interventions in order to accelerate economic growth that reduces poverty faster. Agricultural policy regimes in Zambia in the last 50 years (1964–2008) are examined here to better understand their likely impact on food security and poverty, with an emphasis on the political economy of maize subsidy policies. The empirical work draws on secondary sources and an evaluation of farm household data from three villages in the Kasama District of Zambia from 1986/87 and 1992/93 to estimate a two-period econometric model to examine the impact on household welfare in a pre- and post-reform period. The analysis shows that past interventions had mixed effects on enhancing the production of food crops such as maize. While such reforms were politically popular, it did not necessarily translate into household-level productivity or welfare gains in the short term. The political economy of reforms needs to respond to the inherent diversity among the poor rural and urban households. The potential of agriculture to generate a more pro-poor growth process depends on the creation of new market opportunities that most benefit the rural poor. The state should encourage private sector investments for addressing infrastructure constraints to improve market access and accelerate more pro-poor growth through renewed investments in agriculture, rural infrastructure, gender inclusion, smarter subsidies and regional food trade. However, the financing of such investments poses significant challenges. There is a need to address impediments to the effective participation of public private investors to generate more effective poverty reduction and hunger eradication programmes. This article also explores the opportunities for new public–private investments through South–South cooperation and Asia-driven growth for reducing poverty in Zambia. PMID:22213879
The objective of this research was to explore the context of abortion stigma in Ghana and Zambia through qualitative research, and develop a quantitative instrument to measure stigmatizing attitudes and beliefs about abortion. Ultimately, we aimed to develop a scale to measure abortion stigma at the individual and community level that can also be used in the evaluation of stigma reduction interventions. Focus group discussions were conducted in both countries to provide information around attitudes and beliefs about abortion. A 57-item instrument was created from these data, pre-tested, and then administered to 531 individuals (n = 250 in Ghana and n = 281 in Zambia). Exploratory factor analyses were conducted on 33 of the original 57 items to identify a statistically and conceptually relevant scale. Items with factor loadings >0.39 were retained. All analyses were completed using Stata IC/11.2. Exploratory factor analysis resulted in a three-factor solution that explained 53% of the variance in an 18-item instrument. The three identified subscales are: (i) negative stereotypes (eight items), (ii) discrimination and exclusion (seven items), and (iii) potential contagion (three items). Coefficient alphas of 0.85, 0.80, and 0.80 for the three subscales, and 0.90 for the full 18-item instrument provide evidence of internal consistency reliability. Our Stigmatizing Attitudes, Beliefs, and Actions scale captures three important dimensions of abortion stigma: negative stereotypes about men and women who are associated with abortion, discrimination/exclusion of women who have abortions, and fear of contagion as a result of coming in contact with a woman who has had an abortion. The development of this scale provides a validated tool for measuring stigmatizing attitudes and beliefs about abortion in Ghana and Zambia. Additionally, the scale has the potential to be applicable in other country settings. It represents an important contribution to the fields of reproductive health, abortion, and stigma. PMID:25074064
Shellenberg, Kristen M; Hessini, Leila; Levandowski, Brooke A
Background Malaria control interventions have been scaled-up in Zambia in conjunction with a malaria surveillance system. Although substantial progress has been achieved in reducing morbidity and mortality, national and local information demonstrated marked heterogeneity in the impact of malaria control across the country. This study reports the high burden of malaria in Nchelenge District, Luapula Province, Zambia from 2006 to 2012 after seven years of control measures. Methods Yearly aggregated information on cases of malaria, malaria deaths, use of malaria diagnostics, and malaria control interventions from 2006 to 2012 were obtained from the Nchelenge District Health Office. Trends in the number of malaria cases, methods of diagnosis, malaria positivity rate among pregnant women, and intervention coverage were analysed using descriptive statistics. Results Malaria prevalence remained high, increasing from 38% in 2006 to 53% in 2012. Increasing numbers of cases of severe malaria were reported until 2010. Intense seasonal malaria transmission was observed with seasonal declines in the number of cases between April and August, although malaria transmission continued throughout the year. Clinical diagnosis without accompanying confirmation declined from 95% in 2006 to 35% in 2012. Intervention coverage with long-lasting insecticide-treated nets and indoor residual spraying increased from 2006 to 2012. Conclusions Despite high coverage with vector control interventions, the burden of malaria in Nchelenge District, Zambia remained high. The high parasite prevalence could accurately reflect the true burden, perhaps in part as a consequence of population movement, or improved access to care and case reporting. Quality information at fine spatial scales will be critical for targeting effective interventions and measurement of progress. PMID:24755108
Background A low body mass index (BMI) at antiretroviral therapy (ART) initiation is a strong predictor of mortality among HIV-infected\\u000a adults in resource-constrained settings. The relationship between nutrition and inflammation-related serum biomarkers and\\u000a early treatment outcomes (e.g., less than 90 days) in this population is not well described.\\u000a \\u000a \\u000a \\u000a \\u000a Methods An observational cohort of 142 HIV-infected adults in Lusaka, Zambia, with BMI under
John R Koethe; Meridith Blevins; Christopher Nyirenda; Edmond K Kabagambe; Bryan E Shepherd; C William Wester; Isaac Zulu; Janelle M Chiasera; Lloyd B Mulenga; Albert Mwango; Douglas C Heimburger
The Kafue River is the longest river in Zambia and is a major tributary of the Zambezi River. It is a vital source of fish, transportation, drinking water, and hydropower for much of Zambia's population, over half of whom live in the Kafue River basin. Like many important water bodies in developing countries the Kafue and its ecosystems face pollution from industrial, mining, agricultural, and domestic/sewage discharge. The Kafue River forms a wide and shallow wetland (the Kafue Flats) during the rainy season (Nov. - Apr.) which serves as habitat for diverse groups of birds and mammals. In recent years the unprecedented emergence of invasive aquatic vegetation such as the water hyacinth (Eichhornia crassipes) and Salvinia molesta have choked the river, degrading its ability to provide adequate habitat to promote biodiversity, ecosystem services, and hydropower. In addition, these plants provide additional habitat for mosquitoes (vectors for malaria) and aquatic snails (vectors of schistosomiasis). Nutrient-rich effluents are widely believed to contribute to the proliferation and explosive growth of this floating aquatic vegetation. The general methods for managing these aquatic weeds have included mechanical and physical removal, herbicides, and bio-control agents which have had very little impact. However, as in neighboring Lake Victoria, total weed coverage has fluctuated dramatically from year to year making evaluation of the efficacy of management programs difficult. The objectives of this study were to (1) generate the first record of aquatic plant coverage for a section of the Kafue River which is immediately downstream of a sugar plantation (a major source of nitrogen and phosphorus to the river) and (2) determine if plant coverage is correlated with any major climatic (ENSO, temperature, rainfall) or management (introduction of bio-control agents) indices. We utilized remote sensing techniques in conjunction with Landsat 4-5 TM and Landsat 7 ETM imagery for the time range 1990 to 2013 to identify the extent of aquatic vegetation in the dry season for all years available within the time range using spectral data. We derived rainfall for the time period from TRMM data and temperature from MODIS LST data. Overall weed coverage tended to increase from 1990 to 2013. There was no significant correlation between rainfall (as measured by TRMM) and water hyacinth coverage. However there was a significant positive correlation between minimum October temperatures (the warmest month of the year) and weed coverage (exponential fit, R2 = 0.81). There was no indication that the release of bio-control agents reduced weed coverage. Water hyacinth is known to be sensitive to temperature, with cooler temperatures retarding growth. In the Kafue River, aquatic plant coverage varies mainly with October low temperatures indicating an overall control of temperature on weed coverage. Increasing low temperatures in the region would be expected to exacerbate problems associated with aquatic weeds.
Mischler, J. A.; Abdalati, W.; Hussein, K.; Townsend, A. R.
Until a few years ago, a limited number of epidemiologists or public health experts mentioned the words "diabetes." As new lifestyles, imported dietary practices, and globalization take roots in the developing world, as Africa is, today, diabetes and its complications are considered an epidemic in Africa, compelling African governments to start paying more attention to its impact as thousands of Africans run the risk of dying young. The potential severity of diabetes is such that some epidemiologists predict that its economic impact and death toll will surpass the ravages of HIV and AIDS in the near future. On the African sub-continent, present literature and the work of the World Diabetes Foundation have highlighted three countries, namely, Mali, Mozambique, and Zambia. However, the conditions in South Africa, Kenya, and Nigeria, some of the most developed areas of the continent, provide a clue to how people are coping and how governments are responding to diabetes and its full impact. This study is, therefore, a meta-summary of the incidence and prevalence of today's emerging silent killer or diabetes in Sub-Saharan Africa. The theme is that time is running out for Africa and that, as was for HIV/AIDS, by the time the governments wake up and stop denying the catastrophic potential of the epidemic, diabetes will simply overwhelm the continent's resources, and the world will witness the death of millions of Africans. The last section is a call for action against diabetes in terms of advocacy, promotion of awareness, and public health policies that empower people to diabetes self-management. PMID:20165596
Flake based assemblages (Mode 1) comprise the earliest stone technologies known, with well-dated Oldowan sites occurring in eastern Africa between ??? 2.6-1.7 Ma, and in less securely dated contexts in central, southern and northern Africa. Our understanding of the spread and local development of this technology outside East Africa remains hampered by the lack of reliable numerical dating techniques applicable to non-volcanic deposits. This study applied the still relatively new technique of cosmogenic nuclide burial dating (10Be/26Al) to calculate burial ages for fluvial gravels containing Mode 1 artefacts in the Luangwa Valley, Zambia. The Manzi River, a tributary of the Luangwa River, has exposed a 4.7 m deep section of fluvial sands with discontinuous but stratified gravel layers bearing Mode 1, possibly Oldowan, artefacts in the basal layers. An unconformity divides the Manzi section, separating Mode 1 deposits from overlying gravels containing Mode 3 (Middle Stone Age) artefacts. No diagnostic Mode 2 (Acheulean) artefacts were found. Cosmogenic nuclide burial dating was attempted for the basal gravels as well as exposure ages for the upper Mode 3 gravels, but was unsuccessful. The complex depositional history of the site prevented the calculation of reliable age models. A relative chronology for the full Manzi sequence was constructed, however, from the magnetostratigraphy of the deposit (N>R>N sequence). Isothermal thermoluminescence (ITL) dating of the upper Mode 3 layers also provided consistent results (???78 ka). A coarse but chronologically coherent sequence now exists for the Manzi section with the unconformity separating probable mid- or early Pleistocene deposits below from late Pleistocene deposits above. The results suggest Mode 1 technology in the Luangwa Valley may post-date the Oldowan in eastern and southern Africa. The dating programme has contributed to a clearer understanding of the geomorphological processes that have shaped the valley and structured its archaeological record. ?? 2010 Elsevier Ltd.
As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand. Improving clinic efficiencies and introducing time-saving procedures and advance scheduling options should be considered. PMID:25375790
Price, Jessica E.; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C.; Topp, Stephanie M.; Shiliya, Nicholas; Hatzold, Karin
Boiling is the most common method of disinfecting water in the home and the benchmark against which other point-of-use water treatment is measured. In a six-week study in peri-urban Zambia, we assessed the microbiological effectiveness and potential cost of boiling among 49 households without a water connection who reported "always" or "almost always" boiling their water before drinking it. Source and household drinking water samples were compared weekly for thermotolerant coliforms (TTC), an indicator of fecal contamination. Demographics, costs, and other information were collected through surveys and structured observations. Drinking water samples taken at the household (geometric mean 7.2 TTC/100 mL, 95% CI, 5.4-9.7) were actually worse in microbiological quality than source water (geometric mean 4.0 TTC/100 mL, 95% CI, 3.1-5.1) (p < 0.001), although both are relatively low levels of contamination. Only 60% of drinking water samples were reported to have actually been boiled at the time of collection from the home, suggesting over-reporting and inconsistent compliance. However, these samples were of no higher microbiological quality. Evidence suggests that water quality deteriorated after boiling due to lack of residual protection and unsafe storage and handling. The potential cost of fuel or electricity for boiling was estimated at 5% and 7% of income, respectively. In this setting where microbiological water quality was relatively good at the source, safe-storage practices that minimize recontamination may be more effective in managing the risk of disease from drinking water at a fraction of the cost of boiling. PMID:21650207
Psutka, Rebecca; Peletz, Rachel; Michelo, Sandford; Kelly, Paul; Clasen, Thomas
Background Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme. Methods This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents. Results We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027). Conclusions There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome. PMID:21138565
Background There exist significant challenges to the receipt of comprehensive oncologic treatment for children diagnosed with cancer in sub-Saharan Africa. To better define those challenges, we investigated treatment outcomes and risk factors for treatment abandonment in a cohort of children diagnosed with cancer at the University Teaching Hospital (UTH), the site of the only pediatric oncology ward in Zambia. Methods Using an established database, a retrospective cohort study was conducted of children aged 0–15 years admitted to the pediatric oncology ward between July 2008 and June 2010 with suspected cancer. Diagnosis, mode of diagnosis, treatment outcome, and risk factors for abandonment of treatment were abstracted from this database and clinical medical records. Results Among 162 children treated at the UTH during the study time period that met inclusion criteria, only 8.0% completed a treatment regimen with most of the patients dying during treatment or abandoning care. In multivariable analysis, shorter distance from home to the UTH was associated with a lower risk of treatment abandonment (Adjusted Odds Ratio [aOR]?=?0.48 (95% confidence interval [CI] 0.23–0.97). Conversely maternal education less than secondary school was associated with increased risk for abandonment (aOR?=?1.65; 95% CI 1.05–2.58). Conclusions Despite availability of dedicated pediatric oncology treatment, treatment completion rates are poor, due in part to the logistical challenges faced by families, low educational status, and significant distance from the hospital. Alternative treatment delivery strategies are required to bring effective pediatric oncology care to the patients in need, as their ability to come to and remain at a central tertiary care facility for treatment is limited. We suggest that the extensive system now in place in most of sub-Saharan Africa that sustains life-long antiretroviral therapy for children with human immunodeficiency virus (HIV) infection be adapted for pediatric cancer treatment to improve outcome. PMID:24586527
Slone, Jeremy S.; Chunda-Liyoka, Catherine; Perez, Marta; Mutalima, Nora; Newton, Robert; Chintu, Chifumbe; Kankasa, Chipepo; Chipeta, James; Heimburger, Douglas C.; Vermund, Sten H.; Friedman, Debra L.
Background VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. The objective of this study was to undertake a situation analysis of the Zambian eye health system and assess VISION 2020 process indicators on human resources, equipment and infrastructure. Methods All eye health care providers were surveyed to determine location, financing sources, human resources and equipment. Key informants were interviewed regarding levels of service provision, management and leadership in the sector. Policy papers were reviewed. A health system dynamics framework was used to analyse findings. Results During 2011, 74 facilities provided eye care in Zambia; 39% were public, 37% private for-profit and 24% owned by Non-Governmental Organizations. Private facilities were solely located in major cities. A total of 191 people worked in eye care; 18 of these were ophthalmologists and eight cataract surgeons, equivalent to 0.34 and 0.15 per 250,000 population, respectively. VISION 2020 targets for inpatient beds and surgical theatres were met in six out of nine provinces, but human resources and spectacles manufacturing workshops were below target in every province. Inequalities in service provision between urban and rural areas were substantial. Conclusion Shortage and maldistribution of human resources, lack of routine monitoring and inadequate financing mechanisms are the root causes of underperformance in the Zambian eye health system, which hinder the ability to achieve the VISION 2020 goals. We recommend that all VISION 2020 process indicators are evaluated simultaneously as these are not individually useful for monitoring progress. PMID:24575919
ABSTRACT Background: The Zambia Defence Force (ZDF) has applied the Standards-Based Management and Recognition (SBM-R®) approach, which uses detailed performance standards, at some health facilities to improve HIV-related services offered to military personnel and surrounding civilian communities. This study examines the effectiveness of the SBM-R approach in improving facility readiness and provider performance at ZDF facilities. Methods: We collected data on facility readiness and provider performance before and after the 2010–2012 intervention at 4 intervention sites selected for their relatively poor performance and 4 comparison sites. Assessors observed whether each facility met 16 readiness standards and whether providers met 9 performance standards during consultations with 354 returning antiretroviral therapy (ART) clients. We then calculated the percentages of criteria achieved for each readiness and performance standard and conducted bivariate and multivariate analyses of provider performance data. Results: Facilities' ART readiness scores exceeded 80% before the intervention at both intervention and comparison sites. At endline, scores improved on 4 facility readiness standards in the intervention group but on only 1 standard in the comparison group. Multivariate analysis found that the overall provider performance score increased significantly in the intervention group (from 58% to 84%; P<.01) but not in the comparison group (from 62% to 70%). The before-and-after improvement in scores was significantly greater among intervention sites than among comparison sites for 2 standards—initial assessment of the client's condition and nutrition counseling. Conclusion: The standards-based approach, which involved intensive and mutually reinforcing intervention activities, showed modest improvements in some aspects of providers' performance during ART consultations. Further research is needed to determine whether improvements in provider performance affect client outcomes such as adherence to ART.
Kim, Young Mi; Banda, Joseph; Kanjipite, Webby; Sarkar, Supriya; Bazant, Eva; Hiner, Cyndi; Tholandi, Maya; Reinhardt, Stephanie; Njobvu, Panganani Dalisani; Kols, Adrienne; Benavides, Bruno
For the first time a Bayesian geostatistical version of the Moran Curve, a logarithmic form of the Ricker stock recruitment curve, is proposed that is able to give an estimate of net change in population demographic rates considering components such as fertility and density dependent and density independent mortalities. The method is applied to spatio-temporally referenced count data of tsetse flies obtained from fly-rounds. The model is a linear regression with three components: population rate of change estimated from the Moran curve, an explicit spatio-temporal covariance, and the observation error optimised within a Bayesian framework. The model was applied to the three main climate seasons of Zambia (rainy--January to April, cold-dry--May to August, and hot-dry--September to December) taking into account land surface temperature and (seasonally changing) cattle distribution. The model shows a maximum positive net change during the hot-dry season and a minimum between the rainy and cold-dry seasons. Density independent losses are correlated positively with day-time land surface temperature and negatively with night-time land surface temperature and cattle distribution. The inclusion of density dependent mortality increases considerably the goodness of fit of the model. Cross validation with an independent dataset taken from the same area resulted in a very accurate estimate of tsetse catches. In general, the overall framework provides an important tool for vector control and eradication by identifying vector population concentrations and local vector demographic rates. It can also be applied to the case of sustainable harvesting of natural populations. PMID:24755848
Sedda, Luigi; Mweempwa, Cornelius; Ducheyne, Els; De Pus, Claudia; Hendrickx, Guy; Rogers, David J
For the first time a Bayesian geostatistical version of the Moran Curve, a logarithmic form of the Ricker stock recruitment curve, is proposed that is able to give an estimate of net change in population demographic rates considering components such as fertility and density dependent and density independent mortalities. The method is applied to spatio-temporally referenced count data of tsetse flies obtained from fly-rounds. The model is a linear regression with three components: population rate of change estimated from the Moran curve, an explicit spatio-temporal covariance, and the observation error optimised within a Bayesian framework. The model was applied to the three main climate seasons of Zambia (rainy – January to April, cold-dry – May to August, and hot-dry – September to December) taking into account land surface temperature and (seasonally changing) cattle distribution. The model shows a maximum positive net change during the hot-dry season and a minimum between the rainy and cold-dry seasons. Density independent losses are correlated positively with day-time land surface temperature and negatively with night-time land surface temperature and cattle distribution. The inclusion of density dependent mortality increases considerably the goodness of fit of the model. Cross validation with an independent dataset taken from the same area resulted in a very accurate estimate of tsetse catches. In general, the overall framework provides an important tool for vector control and eradication by identifying vector population concentrations and local vector demographic rates. It can also be applied to the case of sustainable harvesting of natural populations. PMID:24755848
Sedda, Luigi; Mweempwa, Cornelius; Ducheyne, Els; De Pus, Claudia; Hendrickx, Guy; Rogers, David J.
Background: Pregnant women and infants are particularly vulnerable to malaria. National malaria in pregnancy (MIP) programs in Malawi, Senegal, and Zambia were reviewed to identify promising strategies that have helped these countries achieve relatively high coverage of MIP interventions as well as ongoing challenges that have inhibited further progress. Methods: We used a systematic case study methodology to assess health system strengths and challenges in the 3 countries, including desk reviews of available reports and literature and key informant interviews with national stakeholders. Data were collected between 2009 and 2011 and analyzed across 8 MIP health systems components: (1) integration of programs and services, (2) policy, (3) commodities, (4) quality assurance, (5) capacity building, (6) community involvement, (7) monitoring and evaluation, and (8) financing. Within each program area, we ranked degree of scale up across 4 stages and synthesized the findings in a MIP table of analysis to reveal common themes related to better practices, remaining bottlenecks, and opportunities to accelerate MIP coverage, strengthen MIP programs, and improve results. Findings: Each of the 3 countries has malaria policies in place that reflect current MIP guidance from the World Health Organization. The 3 countries successfully integrated MIP interventions into a platform of antenatal care services, but coordination at the national level was disjointed. All 3 countries recognized the importance of having a MIP focal person to ensure collaboration and planning at the national level, but only Malawi had appointed one. Commodity stockouts were frequent due to problems at all levels of the logistics system, from quantification to distribution. Lack of support for quality assurance and weak monitoring and evaluation mechanisms across all 3 countries affected optimal coverage. Conclusions: MIP programs should address all 8 interconnected MIP health systems areas holistically, in the context of a health systems approach to building successful programs. The MIP table of analysis can be a useful tool for other malaria-endemic countries to review their programs and improve MIP outcomes. PMID:25276563
Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach. Total CHW costs were estimated to be US$5.7 million per round. Measles accounted for 57%, deworming 22% and vitamin A 21% of total costs. The cost per child was US$0.46. The additional supplies and personnel required to include measles increased total costs by 42%, but reduced the average costs of providing vitamin A and deworming alone, manifesting economies of scope. The average costs of covering larger, more urban populations was less than the cost of covering smaller, more dispersed populations. Provincial-level costs per child served were determined primarily by the number of service sites, not the number of children treated. Reliance on volunteers to provide 60% of CHW manpower enables expanding coverage, shortening the duration of CHWs and reduces costs by one-third. With costs of $1093 per life saved and $45 per disability-adjusted life-year saved, WHO criteria classify Zambia's CHWs as 'very cost-effective'. The continued need for CHWs is discussed. PMID:23242696
Fiedler, John L; Mubanga, Freddie; Siamusantu, Ward; Musonda, Mofu; Kabwe, Kabaso F; Zulu, Charles
The Lukanga Swamp in central Zambia has previously been proposed as the site of a large (52 km diameter) impact structure on the basis of alleged observation of shock-diagnostic planar deformation features (PDFs) in quartz of breccia from the southern margin of the swamp. The southern margin of the swamp, marked by the Nyama Dislocation Zone, consists of quartzite and
Crispin Katongo; Christian Koeberl; Wolf Uwe Reimold; Singute Mubu
As universal testing moves onto the HIV agenda, there is a need for more understanding of the relatively low uptake of HIV testing and the dynamics of disclosure in Sub-Saharan Africa. Despite the expanding provision of anti-retroviral therapy in Zambia since 2004, disclosure of HIV status – beyond a closed network – remains limited. Drawing on 20 years of living
The Lufilian Belt is of geological significance and economic importance due to rich Cu?Co mineralisation in the Katanga Province of the Democratic Republic of Congo and the Copperbelt of Zambia. Though thorough exploration has yielded much information on the mines districts, the understanding of the belt as a whole appears, to some extent, historically charged and confused. In the first
A study conducted in 1988 assessed the effectiveness of the multigrade system in providing a primary education at four pilot schools in sparsely populated, rural areas of Zambia. In an attempt to alleviate the problems of financial strain and low enrollment in rural schools, this system combines two or more grade levels into one class taught by…
Since sexual cleansing (kusalazya) and the intertwined ritual of levirate marriage or widow and widower inheritance (kunjilila mung’anda) have come to be implicated in the transmission of HIV\\/AIDS, alternative rituals to sexual cleansing have emerged. Using both quantitative and qualitative data obtained from Zambia in the second half of 1998, this study reveals that the alternative rituals to sexual cleansing
Since the roll out of no cost antiretroviral drugs (ARVs) in health centers in Zambia in 2004, the number of Zambians receiving treatment has substantially increased. While research has addressed adult responses to ARVs in Zambia and elsewhere, there is little known about how children experience and respond to the presence of treatment in their communities and households. The increasing acknowledgement that children provide care and treatment support to people with HIV in their households demands a better understanding of children’s knowledge of HIV and ARVs. To examine children’s ARV knowledge, this article focuses on three children’s workshops carried out with 38 children ages 8 to 12, who participated in a yearlong ethnographic study in 2007 and 2008. All children lived in a low-income and heavily HIV-affected residential area in Lusaka, and many children lived with parents or guardians who had HIV. Findings suggest that when the children discussed ARVs, they made two intersecting points: 1) local conditions make living with HIV, even while on ART, difficult; and 2) children face particular challenges, concerns, and insecurities when caring for and living with the ill. Children’s discussions about ARVs offer a deeper understanding of experiences of HIV and childhood in a disproportionately HIV-affected and low resource area. Such insights might productively inform future programming and research aimed at assisting children and adults. PMID:23256500
Phenobarbital remains one of the most widely used antiepileptic drugs worldwide, yet there are limited data regarding side effects associated with its use in routine clinical care settings in low-income countries. Available data suggests that phenobarbital is as effective as other first-line drugs for treating tonic-clonic seizures, but side effect reports differ widely between high and low-income settings. A better understanding of phenobarbital side effect profile and severity in low-income settings is warranted given its role in efforts to decrease the epilepsy treatment gap. We used the Liverpool adverse events profile (LEAP) to assess side effects in consecutive patients with epilepsy on phenobarbital seeking care in rural Zambia. Data regarding age, gender, medication dose, and medication adherence were also collected. T-tests and Spearman's correlation coefficient were used to assess predictors of LEAP score and medication adherence. Thirty-five patients receiving a mean dose of 2.1mg/kg/day (SD: 2.78mg/kg/day) of phenobarbital were assessed. All participants reported at least one side effect in the previous four weeks with a median of 6 symptoms (IQR: 4-8) and a mean side effects score of 28/76 (SD: 5.38). Over half reported sleepiness and dizziness. Memory problems and depression were also common (both 46%). Total LAEP score was not associated with age (p=0.88), gender (p=0.17), or phenobarbital dose (p=0.13). Medication adherence was not associated with side effects total score (p=0.56). Rural Zambian adults taking phenobarbital at doses recommended by the World Health Organization report a significant number of side effects. The most common side effects reported were similar to those reported in high-income countries. The significant burden of phenobarbital-associated side effects in this African cohort is in contrast to data from non-randomized clinical trials in China that reported phenobarbital to be well-tolerated with few side effects. Additional investigations regarding phenobarbital side effects during routine care in low income settings is warranted. PMID:25219354
Elafros, Melissa A; Bui, Esther; Birbeck, Gretchen L
Background Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level. Methods Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9. Results The 95% one-sided confidence interval for Cronbach’s alpha was between 0.69 and 0.74 for the 16 items. The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies. Conclusions The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach’s alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations. PMID:23927531
The Lumwana Cu (± Co ± U) deposits of NW Zambia are large, tabular, disseminated ore bodies, hosted within the Mwombezhi Dome of the Lufilian Arc. The host rocks to the Lumwana deposits are two mineralogically similar but texturally distinct gneisses, a granitic to pegmatitic gneiss and a banded to augen gneiss which both comprise quartz-feldspar ± biotite ± muscovite ± haematite ± amphibole and intervening quartz-feldspar ± biotite schist. The sulphide ore horizons are typically developed within a biotite-muscovite-quartz-kyanite schist, although mineralization locally occurs within internal gneiss units. Contacts between the ore and host rocks are transitional and characterized by a loss of feldspar. Kinematic indicators, such as S-C fabrics and pressure shadows on porphyroblasts, suggest a top to the north shear sense. The sulphides are deformed by a strong shear fabric, enclosed within kyanite or concentrated into low strain zones and pressure shadows around kyanite porphyroblasts. This suggests that the copper mineralization was introduced either syn- or pre-peak metamorphism. In addition to Cu and Co, the ores are also characterized by enrichments in U, V, Ni, Ba and S and small, discrete zones of uranium mineralization, occur adjacent to the hanging wall and footwall of the copper ore bodies or in the immediate footwall to the copper mineralization. Unlike typical Copperbelt mineralization, unmineralized units show very low background copper values. Whole rock geochemical analyses of the interlayered schist and ore schist, compared to the gneiss, show depletions in Ca, Na and Sr and enrichments in Mg and K, consistent with replacement of feldspar by biotite. The mineral chemistry of muscovite, biotite and chlorite reflect changes in the bulk rock chemistry and show consistent increases in X Mg as the schists develop. ?34S for copper sulphides range from +2.3 ‰ to +18.5 ‰, with pyrite typically restricted to values between +3.9 ‰ and +6.2 ‰. These values are atypical of sulphides precipitated by bacteriogenic sulphate reduction. ?34S data for Chimiwungo (Cu + Co) show a broader range and increased ?34S values compared to the Malundwe (Cu) mineralization. The Lumwana deposits show many characteristics which distinguish them from classical Copperbelt mineralization and which suggests that they are formed by metasomatic alteration, mineralization and shearing of pre-Katangan basement. Although this style of mineralization is reported elsewhere in the Copperbelt, sometimes associated with the more widely reported stratiform ores of the Lower Roan, none of the previously reported occurrences have so far developed the tonnages of ore reported at Lumwana.
Background In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. Methods A phenomenological approach was used to examine CHAs’ experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach. Results Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs’ ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs’ ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA’s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs’ ability to deliver services. Conclusions Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare. PMID:24886146
Background Many public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive. This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production. Methods Qualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial. Results A prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition. The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings. Conclusions Employing strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims. PMID:20849580
Designing a methodology for mapping and studying soils in a quick and inexpensive way is critical especially in developing countries which lack detailed soil surveys. The main aim of this research was to explore the potential of Landsat ETM data combined with various forms of ancillary data in mapping soils in Chongwe, a semi arid region in Zambia. The study also examines how spectral maps produced by digital analysis of Landsat ETM data compare with field observation data. The study area, covering 54 000 ha, is located about 45 km to the east of the capital city, Lusaka, Zambia. It encompasses five main landscapes: hilland, piedmont, plateau, alluvial plain and valley dambos (seasonally waterlogged depressions). Geospatial tools were applied in four related chapters, (1) a review and discussion on the application of geospatial tools to aid soil mapping, (2) identification and characterization of soils in different landscapes in the Chongwe region of Zambia, (3) digital analysis of Landsat ETM data and its application to soil mapping, and (4) summary of the results, conclusions and suggestions for future research. This research has shown that visual interpretation and digital analysis of Landsat images have the capacity to map soils with reasonable accuracy. It demonstrates the utility of Landsat data to delineate soil patterns, especially when acquired during the dry season when there are long periods of cloud free skies, low soil moisture and minimal vegetation cover. When the accuracy of the Landsat ETM image was tested the agreement between Landsat ETM data and field reference data was 72%, indicating a definite relationship between Landsat imagery and soils types. Furthermore, the study revealed that overall, upland areas have a better agreement with Landsat spectral data compared to lowland areas, probably due to diverse origin of sediments and low spatial extent of most geomorphic units in lowland areas. In terms of soilscape boundary delineation, the Landsat derived map was better than the conventional soil map. Landsat data delineated more areas within the conventional soil map polygons. Examining the spectral responses in different bands, it was found that spectral bands, 3, 5, and 7 provide images of optimum contrast for the delineation of soilscapes.
Background Plasmodium falciparum transmission has decreased significantly in Zambia in the last decade. The malaria transmission is influenced by environmental variables. Incorporation of environmental variables in models of malaria transmission likely improves model fit and predicts probable trends in malaria disease. This work is based on the hypothesis that remotely-sensed environmental factors, including nocturnal dew point, are associated with malaria transmission and sustain foci of transmission during the low transmission season in the Southern Province of Zambia. Methods Thirty-eight rural health centres in Southern Province, Zambia were divided into three zones based on transmission patterns. Correlations between weekly malaria cases and remotely-sensed nocturnal dew point, nocturnal land surface temperature as well as vegetation indices and rainfall were evaluated in time-series analyses from 2012 week 19 to 2013 week 36. Zonal as well as clinic-based, multivariate, autoregressive, integrated, moving average (ARIMAX) models implementing environmental variables were developed to model transmission in 2011 week 19 to 2012 week 18 and forecast transmission in 2013 week 37 to week 41. Results During the dry, low transmission season significantly higher vegetation indices, nocturnal land surface temperature and nocturnal dew point were associated with the areas of higher transmission. Environmental variables improved ARIMAX models. Dew point and normalized differentiated vegetation index were significant predictors and improved all zonal transmission models. In the high-transmission zone, this was also seen for land surface temperature. Clinic models were improved by adding dew point and land surface temperature as well as normalized differentiated vegetation index. The mean average error of prediction for ARIMAX models ranged from 0.7 to 33.5%. Forecasts of malaria incidence were valid for three out of five rural health centres; however, with poor results at the zonal level. Conclusions In this study, the fit of ARIMAX models improves when environmental variables are included. There is a significant association of remotely-sensed nocturnal dew point with malaria transmission. Interestingly, dew point might be one of the factors sustaining malaria transmission in areas of general aridity during the dry season. PMID:24927747
The composition of the rumen ciliate fauna in 76 Kafue lechwe inhabiting a limited area in Zambia was surveyed and five genera containing 24 species with 16 formae belonging to the family Ophryoscolecidae were identified. Four new species belonging to Diplodiniinae were recognized and described as Diplodinium lochinvarense n. sp., Diplodinium leche n. sp., Diplodinium zambiense n. sp., and Metadinium ossiculi n. sp. In addition, Ostracodinium gracile form fissilaminatum Dogiel, 1932 was found for the second time and described as Metadinium fissilaminatum n. comb. The species composition was fairly unusual. Seven of the species have been found only in African wild antelopes and these species were found more frequently than cosmopolitan species. There was no evidence of isotrichid species. The average density of ciliates per 1 ml of the rumen fluid was 25.7 x 10(4), and the number of ciliate species per head of host was 10.8. PMID:1522538
Anopheles arabiensis is a major vector of Plasmodium falciparum in southern Zambia. This study aimed to determine the rate of multiple human blood meals taken by An. arabiensis to more accurately estimate entomologic inoculation rates (EIRs). Mosquitoes were collected in four village areas over two seasons. DNA from human blood meals was extracted and amplified at four microsatellite loci. Using the three-allele method, which counts ? 3 alleles at any microsatellite locus as a multiple blood meal, we determined that the overall frequency of multiple blood meals was 18.9%, which was higher than rates reported for An. gambiae in Kenya and An. funestus in Tanzania. Computer simulations showed that the three-allele method underestimates the true multiple blood meal proportion by 3–5%. Although P. falciparum infection status was not shown to influence the frequency of multiple blood feeding, the high multiple feeding rate found in this study increased predicted malaria risk by increasing EIR. PMID:20595474
Norris, Laura C.; Fornadel, Christen M.; Hung, Wei-Chien; Pineda, Fernando J.; Norris, Douglas E.
A total of 7 stocks of Trypanosoma brucei subspecies, isolated from naturally infected game animals in the Luangwa Valley, Eastern Province, Zambia were examined using a modified version of the Blood Incubation Infectivity Test (BIIT). One stock giving consistent BIIT responses typical of T.b. rhodesiense, was obtained from warthog (Phacochoerus aethiopicus). Four other stocks, 2 from hyaena (Crocuta crocuta), 1 from a waterbuck (Kobus ellipsiprymnus) and 1 from a lion (Panthera leo) responded like T.b. brucei. One stock from a waterbuck and 1 from a giraffe (Giraffa camelopardalis) failed to infect mice after incubation in human serum for 30 min at 37 degrees C when first tested, but after 5 or 6 further serial passages in mice and even with serum incubation time increased to 5 h, they retained infectivity. PMID:44098
Background Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices. Methods and Findings This study consisted of 36 focus group discussions with breastfeeding mothers, grandmothers, and traditional birth attendants, and 42 in-depth interviews with key community informants. Semi-structured field guides were used to lead discussions and interviews at urban and rural sites. A wide variation in knowledge, beliefs, and practices surrounding cord care was discovered. For home deliveries, cords were cut with non-sterile razor blades or local grass. Cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g., Vaseline, cooking oil, used motor oil) and agents intended for medicinal/protective purposes (e.g., breast milk, cow dung, chicken feces). Concerns regarding the length of time until cord detachment were universally expressed. Blood clots in the umbilical cord, bulongo-longo, were perceived to foreshadow neonatal illness. Management of bulongo-longo or infected umbilical cords included multiple traditional remedies and treatment at government health centers. Conclusion Umbilical cord care practices and beliefs were diverse. Dry cord care, as recommended by the World Health Organization at the time of the study, is not widely practiced in Southern Province, Zambia. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions. PMID:24244447
Faecal samples were collected from the rectum of 540 domestic dogs from four districts (Lusaka, Katete, Petauke and Luangwa) in Zambia between 2005 and 2006 and prevalences of canine alimentary tract parasites were determined by coprological examination. Thirteen different ova and parasites including strongyle (43.3%), Spirocerca lupi (18.7%), taeniid (13.1%), Toxocara canis (7.6%), Sarcocystis sp.* (7.5%), Isospora sp.* (5.7%), Physaloptera sp.* (4.6%), Capillaria sp.* (2.8%), Dipylidium caninum (2.2%), Mesocestoides sp.* (2.0%), Ascaris sp.* (1.7%), Trichuris vulpis* (0.4%) and Schistosoma mansoni* (0.4%) were detected, Ascaris and Schistosoma probably originating from coprophagy. The species with asterisks and later-described Taenia multiceps are for the first time reported from dogs in Zambia. A coproantigen enzyme-linked immunosorbent assay (CoproAg-ELISA) developed for Echinococcus spp. revealed 43 positive dogs and 37 of these harboured taeniid eggs. From 63 of the 71 taeniid egg-positive samples, eggs and DNA thereof were isolated and subjected to a multiplex polymerase chain reaction for differentiating E. granulosus sensu lato, E. multilocularis and Taenia spp. Amplicons indicative for Taenia spp. were obtained from 60 samples. Sequencing of amplicons spanning part of the mitochondrial cytochrome c oxidase subunit 1 gene, which was possible with 38 samples, revealed 35 infections with T. hydatigena and 3 with T. multiceps. Therefore, the CoproAg-ELISA showed some positives, but concrete evidence for the existence of canine E. granulosus infection could not be established. Comparison of the results of the CoproAg-ELISA and Taenia species identification indicated that the CoproAg-ELISA cross-reacts with patent infections of T. hydatigena (57%) and T. multiceps (33%). PMID:22185947
Nonaka, N; Nakamura, S; Inoue, T; Oku, Y; Katakura, K; Matsumoto, J; Mathis, A; Chembesofu, M; Phiri, I G K
Black lechwe (Kobus leche smithemani) is a semi-aquatic medium sized antelope currently enlisted on the IUCN red list of endangered species and is only endemic to the Bangweulu basin of Zambia. Its population has significantly decreased due to floods that took place during the period 1930-1940 from over 250 000-15000 leading the Zambian government to gazette all habitats of Black lechwe into state protected areas, and to establish urgent management strategies needed to save the remaining population from extinction. Using retrospective data, our findings show that the population has increased from 15000 animals in 1954 to 55 632 in 2009. The current population is estimated at 34.77% (55 632/160 000) of the carrying capacity of the Bangweulu basin. Although the Black lechwe is one of the 42 species offered for consumptive utilization by the Zambia Wildlife Authority (ZAWA), only 0.12% and 0.08% of the current stock was offered for safari and resident hunting annually for the period 2005-2009, respectively. Annual quota utilization were estimated at 67% (n=37) and 81% (n=37) for safari and resident hunting, respectively. Hence, overall income obtained from utilization of Black lechwe is very low accounting for only 2.1% of the total revenue earned from wildlife utilization. Although the current population trend is showing a unit increase of 639 animals per year, it is still far below levels ideal for the lucrative utilization. In this study, we demonstrate that adverse ecological changes on wildlife species, can lead to their vulnerability and danger of extinction, and that their recovery to full carrying capacity may demand a considerable amount of time. PMID:23342517
Siamudaala, Victor M; Munyeme, Musso; Matandiko, Wigganson; Muma, John B; Munang'andu, Hetron M
Background There are few published estimates of the cost of pediatric antiretroviral therapy (ART) in Africa. Our objective was to estimate the outpatient cost of providing ART to children remaining in care at six public sector clinics in Zambia during the first three years after ART initiation, stratified by service delivery site and time on treatment. Methods Data on resource utilization (drugs, diagnostics, outpatient visits, fixed costs) and treatment outcomes (in care, died, lost to follow up) were extracted from medical records for 1,334 children at six sites who initiated ART at <15 years of age between 2006 and 2011. Fixed and variable unit costs (reported in 2011 USD) were estimated from the provider’s perspective using site level data. Results Median age at ART initiation was 4.0 years; median CD4 percentage was 14%. One year after ART initiation, 73% of patients remained in care, ranging from 60% to 91% depending on site. The average annual outpatient cost per patient remaining in care was $209 (95% CI, $199–$219), ranging from $116 (95% CI, $107–$126) to $516 (95% CI, $499–$533) depending on site. Average annual costs decreased as time on treatment increased. Antiretroviral drugs were the largest component of all outpatient costs (>50%) at four sites. At the two remaining sites, outpatient visits and fixed costs together accounted for >50% of outpatient costs. The distribution of costs is slightly skewed, with median costs 3% to 13% lower than average costs during the first year after ART initiation depending on site. Conclusions Outpatient costs for children initiating ART in Zambia are low and comparable to reported outpatient costs for adults. Outpatient costs and retention in care vary widely by site, suggesting opportunities for efficiency gains. Taking advantage of such opportunities will help ensure that targets for pediatric treatment coverage can be met. PMID:23840788
The informed consent (IC) process for voluntary medical male circumcision (VMMC) was evaluated in Zambia and Swaziland as VMMC programs scaled up. In-depth interviews (IDIs) were conducted with clients 1 week after surgery to explore understanding of IC and gauge how expectations of MC surgery compared to actual experiences. In Zambia, key opinion leaders (KOLs) were also interviewed. Some clients equated written IC with releasing the clinic from liability. Most clients felt well prepared for the procedure, although many were surprised by the level of pain experienced during anesthesia and postsurgery. Clients were highly motivated to adhere to wound care, but some were overwhelmed by extensive instructions. Adolescents described barriers to accessing follow-up care and the need for support in overcoming adult gatekeepers. KOLs indicated that IC is not well understood in poorly educated communities. Results led to concrete programmatic changes, including revised patient education materials and more effective anesthesia for longer-lasting pain relief. PMID:24694330
Schenk, Katie D; Friedland, Barbara A; Sheehy, Meredith; Apicella, Louis; Hewett, Paul C
Prevalence, incidence and seasonal variation of Cryptosporidium and Giardia duodenalis were studied over a 12-month period in 100 children from four pre-schools in Kafue, Zambia. Questionnaire data and a single stool sample were collected monthly from each child. Samples were processed using a commercial kit (Meridian Diagnostics Inc., USA) and oo(cysts) visualised by immunofluorescence microscopy. Cryptosporidium was detected in 30.7%
Joyce Siwila; Isaac G. K. Phiri; Heidi Larsen Enemark; Mbiko Nchito; Annette Olsen
Many scholars claim that open access due to the effective absence of state control is the major reason for the overuse of\\u000a common-pool resources such as fisheries. Based on data from the Kafue Flats fisheries in Zambia, we argue that the main problem\\u000a in open-access situations is the paradox of a state that is simultaneously absent and present: present in
A detailed study of the soil chemical and physical properties in seven-year-old alley cropping trial containingLeucaena leucocephala andFlemingia congesta in Northern Zambia is described. There was a strong correlation between the maize yield and the total amount of nitrogen applied, both from prunings and fertiliser, suggesting that a major reason for the observed benefit from alley cropping, particularly withLeucaena, was
A. Dalland; P. I. Vĺje; R. B. Matthews; B. R. Singh
U–Pb SHRIMP zircon age data, together with geochemical analyses, from the basement to the Katanga Supergroup in the Central African Copperbelt reveal the existence of a widespread Palaeoproterozoic magmatic arc terrane. The Lufubu schists represent a long-lived calc-alkaline volcanic arc sequence and, where dated in both Zambia and the Democratic Republic of Congo (DRC), yield ages of 1980±7, 1968±9, 1964±12
C. Rainaud; S. Master; R. A. Armstrong; L. J. Robb
BACKGROUND: Since the beginning of the 21st century, development assistance for HIV\\/AIDS has increasingly been provided through Global Health Initiatives, specifically the United States Presidential Emergency Plan for AIDS Relief, the Global Fund to Fight HIV, TB and Malaria and the World Bank Multi-country AIDS Programme. Zambia, like many of the countries heavily affected by HIV\\/AIDS in southern Africa, also
Comprehension is fundamental for informed consent--an individual's right to choose a medical procedure, such as male circumcision (MC). Because optimal benefits depend on post-surgical behaviors, comprehension is particularly critical for MC programs. We evaluated clients' comprehension of MC's risks and benefits, wound care instructions, and risk reduction post-MC using a true/false test (n = 1181) and 92 semi-structured interviews (SSIs) in Zambia and Swaziland. Most participants (89% Zambia, 93% Swaziland) passed the true/false test, although adolescents scored lower (significantly so in Swaziland) than adults and one-third (including nearly half of adolescents in Zambia) said MC has no risks. SSIs indicated confusion between "risk" of adverse surgical outcomes and reduced "risk" of HIV; most respondents acknowledged the 6 week abstinence period post-MC, yet few said resuming sex early increases HIV risk. Providers should distinguish between surgical "risks" and reduced HIV "risk," and emphasize that HIV risk increases with sex before complete healing. PMID:23392912
Friedland, Barbara A; Apicella, Louis; Schenk, Katie D; Sheehy, Meredith; Hewett, Paul C
This study compared the prevalence of self-reported childhood physical abuse and neglect and the associated psychopathological sequelae among Kenyan, Zambian, and Dutch university students. In addition, we sought to find out the differentiated role of posttraumatic stress symptoms (PTSS) in mediating the associations between childhood maltreatment experiences and psychopathology symptoms. The sample consisted of 862 university students from Kenya (n?=?375), Zambia (n?=?182), and The Netherlands (n?=?305) who completed the Personal and Relationships Profile (PRP). Results showed that physical abuse was highly prevalent in Kenya (59%) and Zambia (40%), and that neglect was even more prevalent than physical abuse in Zambia and The Netherlands at 59%, 54%, and 42% for the Kenyan, Zambian, and Dutch samples respectively. Neglect was associated with psychopathological symptoms in all three samples, whereas physical abuse was associated with psychopathological sequelae in the Kenyan and Zambian samples only. PTSS mediated the association between neglect and psychopathology symptoms in the Dutch sample and between physical abuse and psychopathology symptoms in the Dutch and Kenyan samples. We conclude that physical abuse and neglect are associated with psychopathology symptoms independently of country and cultural context. However, the pathways through which physical abuse and neglect may lead to psychopathological sequelae may be dependent on perceptions of specific parental behavior in different sociocultural contexts. PMID:23597009
Mbagaya, Catherine; Oburu, Paul; Bakermans-Kranenburg, Marian J
Background Malaria, caused by the parasite Plasmodium falciparum, is a significant source of morbidity and mortality in southern Zambia. In the Mapanza Chiefdom, where transmission is seasonal, Anopheles arabiensis is the dominant malaria vector. The ability to predict larval habitats can help focus control measures. Methods A survey was conducted in March-April 2007, at the end of the rainy season, to identify and map locations of water pooling and the occurrence anopheline larval habitats; this was repeated in October 2007 at the end of the dry season and in March-April 2008 during the next rainy season. Logistic regression and generalized linear mixed modeling were applied to assess the predictive value of terrain-based landscape indices along with LandSat imagery to identify aquatic habitats and, especially, those with anopheline mosquito larvae. Results Approximately two hundred aquatic habitat sites were identified with 69 percent positive for anopheline mosquitoes. Nine species of anopheline mosquitoes were identified, of which, 19% were An. arabiensis. Terrain-based landscape indices combined with LandSat predicted sites with water, sites with anopheline mosquitoes and sites specifically with An. arabiensis. These models were especially successful at ruling out potential locations, but had limited ability in predicting which anopheline species inhabited aquatic sites. Terrain indices derived from 90 meter Shuttle Radar Topography Mission (SRTM) digital elevation data (DEM) were better at predicting water drainage patterns and characterizing the landscape than those derived from 30 m Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) DEM. Conclusions The low number of aquatic habitats available and the ability to locate the limited number of aquatic habitat locations for surveillance, especially those containing anopheline larvae, suggest that larval control maybe a cost-effective control measure in the fight against malaria in Zambia and other regions with seasonal transmission. This work shows that, in areas of seasonal malaria transmission, incorporating terrain-based landscape models to the planning stages of vector control allows for the exclusion of significant portions of landscape that would be unsuitable for water to accumulate and for mosquito larvae occupation. With increasing free availability of satellite imagery such as SRTM and LandSat, the development of satellite imagery-based prediction models is becoming more accessible to vector management coordinators. PMID:21050496
Background Malaria elimination will require that both symptomatic- and asymptomatic-infected persons be identified and treated. However, well-characterized, individual-level risk factors for malaria may not be valid in regions with declining malaria transmission. Changes in individual-level correlates of malaria infection were evaluated over three years in a region of declining malaria transmission in southern Zambia. Methods Malaria surveys were conducted in two study areas within the catchment area of Macha Hospital, Zambia in 2007 and 2008/2009. A random sample of households was identified from a digitized satellite image of the study areas. Cross-sectional surveys were conducted approximately five times throughout the year in each of the two study areas. During study visits, adults and caretakers of children were administered questionnaires and a blood sample was obtained for a rapid diagnostic test (RDT) for malaria. Results In the 2007 study area, 330 individuals were surveyed. 40.9% of participants lived in a household with at least one insecticide-treated bed net (ITN); however, only 45.2% reported sleeping under the ITN. 23.9% of participants were RDT positive. Correlates of RDT positivity included younger age, the presence of symptoms, testing during the rainy season, using an open water source, and not sleeping under an ITN. In the 2008 study area, 435 individuals were surveyed. 77.0% of participants lived in a household with at least one ITN; however, only 56.4% reported sleeping under the ITN. 8.1% of participants were RDT positive. RDT positivity was negatively correlated with the presence of symptoms within the last two weeks but positively correlated with documented fever. In 2009, 716 individuals were surveyed in the same area as 2008. 63.7% of participants lived in a household with at least one ITN; however, only 57.7% reported sleeping under the ITN. 1.5% of participants were RDT positive. Only self-reported fever was significantly correlated with RDT positivity. Conclusions With declining malaria prevalence, few individual-level characteristics were correlated with RDT positivity. This lack of correlation with individual characteristics hampers identification of individuals infected with malaria. Strategies based on ecological or environmental risk factors may be needed to target control efforts and achieve further reductions and elimination. PMID:22039751
Background Of the estimated 800,000 adults living with HIV in Zambia in 2011, roughly half were receiving antiretroviral therapy (ART). As treatment scale up continues, information on the care provided to patients after initiating ART can help guide decision-making. We estimated retention in care, the quantity of resources utilized, and costs for a retrospective cohort of adults initiating ART under routine clinical conditions in Zambia. Methods Data on resource utilization (antiretroviral [ARV] and non-ARV drugs, laboratory tests, outpatient clinic visits, and fixed resources) and retention in care were extracted from medical records for 846 patients who initiated ART at ?15 years of age at six treatment sites between July 2007 and October 2008. Unit costs were estimated from the provider’s perspective using site- and country-level data and are reported in 2011 USD. Results Patients initiated ART at a median CD4 cell count of 145 cells/?L. Fifty-nine percent of patients initiated on a tenofovir-containing regimen, ranging from 15% to 86% depending on site. One year after ART initiation, 75% of patients were retained in care. The average cost per patient retained in care one year after ART initiation was $243 (95% CI, $194-$293), ranging from $184 (95% CI, $172-$195) to $304 (95% CI, $290-$319) depending on site. Patients retained in care one year after ART initiation received, on average, 11.4 months’ worth of ARV drugs, 1.5 CD4 tests, 1.3 blood chemistry tests, 1.4 full blood count tests, and 6.5 clinic visits with a doctor or clinical officer. At all sites, ARV drugs were the largest cost component, ranging from 38% to 84% of total costs, depending on site. Conclusions Patients initiate ART late in the course of disease progression and a large proportion drop out of care after initiation. The quantity of resources utilized and costs vary widely by site, and patients utilize a different mix of resources under routine clinical conditions than if they were receiving fully guideline-concordant care. Improving retention in care and guideline concordance, including increasing the use of tenofovir in first-line ART regimens, may lead to increases in overall treatment costs. PMID:24684772
Background Linkage of healthcare services for tuberculosis (TB) and human immunodeficiency virus (HIV) remains a major challenge in resource-limited settings. Our operational research aimed to evaluate the linkage between TB and HIV services in a rural area of Zambia, and to explore factors associated with the enrolment of TB/HIV co-infected patients in HIV care services. Methods All TB patients newly diagnosed as HIV-positive in Chongwe district, Zambia between 2009 and 2010 were included. Data from TB registers and medical records were reviewed. Patient referral to HIV services and provision of antiretroviral therapy (ART) were further examined through HIV registers and records. Results Of 621 patients (median age 33.0 years, female 42.4%) who started anti-TB treatment, clinic records indicated that 297 patients were newly diagnosed as HIV-positive, and 176 (59.3%) of these were referred to an ART clinic. Analysis of records at the ART clinic found that only 85 (28.6%) of TB/HIV patients had actually been enrolled in HIV care, of whom only 58 (68.2%) had commenced ART. Logistic regression analyses demonstrated the following factors associated with lower enrolment: “male” sex (aOR, 0.45; 95% CI 0.26-0.78), “previous TB treatment” (aOR, 0.29; 95% CI, 0.11-0.75), “registration at sites that did not provide ART services (non-ART site)” (aOR, 0.10; 95% CI, 0.01-0.77) and “death on TB treatment outcome (aOR, 0.20; 95% CI, 0.06-0.65). However, patient registration at TB clinics in 2010 was associated with markedly higher enrolment in HIV care as compared to registration in 2009 (aOR, 2.80; 95% CI, 1.53-5.12). Conclusions HIV testing for TB patients has been successfully scaled up. However referrals of co-infected patients still remain a challenge due to poor linkage between TB and HIV healthcare services. Committed healthcare workers, a well-organized health services system and patient education are urgently required to ensure a higher rate of referral of TB/HIV co-infected patients for appropriate care. PMID:24103082
A prospective cohort study was conducted in two villages in Zambia to compare the efficacy of praziquantel in the treatment of schistosomiasis haematobium in people with and without concomitant infection with human immunodeficiency virus (HIV). Five hundred seven individuals with infected with Schistosoma haematobium were enrolled and followed-up for as long as 12 months after treatment with a single dose of praziquantel. Seventy-three were coinfected with HIV. The study demonstrated that praziquantel is still very effective in the treatment and control of S. haematobium even when there is coinfection with HIV (without symptoms and signs of acquired immunodeficiency syndrome [AIDS]/HIV disease). Resistance to reinfection with S. haematobium is not altered in subjects coinfected with HIV (without symptoms and signs of AIDS/HIV disease). Individuals with coinfection excreted fewer eggs and complained less of hematuria than those without HIV infection, and the sensitivity and positive predictive value of reported hematuria as an indication of heavy infection were lower in the group coinfected with HIV. This observation may have implications for the use of hematuria as an indicator for rapid diagnosis of schistosomiasis in areas where HIV is prevalent. PMID:14640503
This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age (15-45 years), who gave birth within the last year; in-depth interviews comprised traditional leaders, mothers, fathers, community health workers and nurse-midwives. Perspectives on maternal health complications, health-seeking behaviour and barriers to utilization of maternal healthcare were explored. Most women showed insight into maternal health complications. Nevertheless, they started antenatal care visits late and did not complete the recommended schedule. Moreover, most women gave birth at home and did not use postnatal care. The main reasons for the low utilization were the low perceived quality of maternal healthcare services in clinics (negative attitude), negative opinion of important referents (subjective norms), physical and economic barriers such as long distances, high transport and indirect costs including money for baby clothes and other requirements. To improve, our findings suggest need for an integrated intervention to mitigate these barriers. Our findings also suggest need for further research to measure the elicited beliefs and determine their relevance and changeability. PMID:24663431
Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C
Culex quinquefasciatus , an arboviral and filarial vector, is present in high numbers throughout sub-Saharan Africa, and insecticide-resistant populations have been reported worldwide. In order to determine the insecticide resistance status of Cx. quinquefasciatus in Macha, Zambia, adult mosquitoes reared from eggs collected from oviposition traps were tested by bioassay. High levels of resistance to DDT, pyrethroids, malathion, and deltamethrin-treated net material were detected, and molecular assays revealed that the knockdown resistance (kdr) allele was frequent in the Cx. quinquefasciatus population, with 7.0% homozygous for the kdr L1014 allele and 38.5% heterozygous (0.263 kdr frequency). The kdr frequency was significantly higher in mosquitoes that had successfully fed on human hosts, and screening archived specimens revealed that kdr was present at lower frequency prior to the introduction of ITNs, indicating that ITNs might be a selective force in this population. Additionally, metabolic detoxification enzyme activity assays showed upregulated glutathione S-transferases, ?-esterases, and ?-esterases. Continued monitoring and assessment of the Cx. quinquefasciatus population is necessary to determine levels of resistance. PMID:22129413
Background HIV discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods – intrauterine devices (IUDs) and hormonal implants – among HIV discordant couples in Rwanda and Zambia. Study Design Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ?3 years were counseled on LARC methods and offered an IUD and implant on-site. Results Among 409 fertile Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman’s younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms. Conclusions Integrated fertility-goal based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities. PMID:23153896
KHU, Naw H.; VWALIKA, Bellington; KARITA, Etienne; KILEMBE, William; BAYINGANA, Roger A.; SITRIN, Deborah; ROEBER-RICE, Heidi; LEARNER, Emily; TICHACEK, Amanda C.; HADDAD, Lisa B.; WALL, Kristin M.; CHOMBA, Elwyn N.; ALLEN, Susan A.
A rights-based approach in HIV service delivery for adults is increasingly taking root in sub-Saharan Africa in the context of greater availability of antiretroviral therapy. Yet there has been comparatively little progress in strengthening a rights-based approach to adolescent HIV services, which we learned during a qualitative study in 2010 among 111 adolescents living with HIV, 21 parents and 38 health providers in three districts in Zambia. Adolescents in the study expressed a range of information and support needs and wanted locally relevant interventions to meet those needs. They wanted greater access to HIV, sexual and reproductive health information, information on how to protect themselves, privacy and confidentiality in service sites, skills training so as to be able to earn money, and better control over disclosure of their HIV status to others. Both health workers and parents acknowledged that information and services needed to be improved to meet those needs far better. This paper provides examples of successful programmes in Zimbabwe, Uganda, Tanzania, Botswana and South Africa and calls for adolescent services to be linked to both paediatric and adult services, peer networks to be established to increase adolescents' ability to collectively voice their concerns and support each other, interventions supporting adolescents' control over self-disclosure, and lastly that adolescent health should become a training specialty in sub-Saharan Africa. PMID:23684200
In early September, throughout south central Africa, seasonal clearing of dry vegetation and the production of charcoal for cooking leads to intense smoke haze and ozone formation. Ozone soundings made over Lusaka in early September 2000 recorded layers of high ozone (greater than 125 ppbv at 5 km) during two stagnant periods, broken by a frontal passage that reduced boundary layer ozone by 30%. During the 6-day measurement period, surface ozone concentrations ranged from 50-95 ppbv and integrated tropospheric ozone from the soundings was 39-54 Dobson Units (note 1.3 km elevation at the launch site). A stable layer of high ozone at 2-5 km was advected from rural burning regions in western Zambia and neighboring countries, making Lusaka a collection point for transboundary pollution. This is confirmed by trajectories that show ozone leaving Angola, Namibia, Botswana and South Africa before heading toward the Indian Ocean and returning to Lusaka via Mozambique and Zimbabwe. Ozone in the mixed layer at Lusaka is heavily influenced by local sources.
Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tai; Phalane, N. Agnes; Coetzee, Gert J. R.
In early September, throughout south central Africa, seasonal clearing of dry vegetation and the production of charcoal for cooking leads to intense smoke haze and ozone formation. Ozone soundings made over Lusaka during a six-day period in early September 2000 recorded layers of high ozone (greater than 125 ppbv at 5 km) during two stagnant periods, interspersed by a frontal passage that reduced boundary layer ozone by 30 percent. Smoke aerosol column variations aloft and total ozone were monitored by a sun photometer. During the 6-day measurement period, surface ozone concentrations ranged from 50-95 ppbv and integrated tropospheric ozone from the soundings was 39- 54 Dobson Units (note 1.3 km elevation at the launch site). High ozone concentrations above the mixed and inversion layers were advected from rural burning regions in western Zambia where SAFARI aircraft and ground-based instruments observed intense biomass fires and elevated aerosol and trace gas amounts. TOMS tropospheric ozone and smoke aerosols products show the distribution of biomass burning and associated pollution throughout southern Africa in September 2000. Animations of satellite images and trajectories confirm pollutant recirculation over south central African fires, exit of ozone from Mozambique and Tanzania to the Indian Ocean and the characteristic buildup of tropospheric ozone over the Atlantic from western African outflow.
Thompson, Anne M.; Herman, J. R.; Witte, J. C.; Phahlane, A.; Coetzee, G. J. R.; Mukula, C.; Hudson, R. D.; Frolov, A. D.; Bhartia, P. K. (Technical Monitor)
Since the advent of community-based natural resource management (CBNRM) in the mid-1980s, scholars and practitioners have sought to explain the uneven performance of CBNRM programs. Most CBNRM assessments examine the underlying principles of community-based conservation, the local social and ecological contexts, and connections with larger political and historical patterns. In this article, I argue that analysis of the potential and pitfalls of CBNRM also requires an understanding of the institutional history and internal dynamics of projects that implement CBNRM reforms. Drawing upon theory and methods from development ethnography and public policy, I examine the rise and fall of CONASA, a second-generation CBNRM project in Zambia that operated from 2001 to 2004. CONASA was constituted from a merger of organizations and discourses to provide continuity with previous projects. Its ambitious suite of activities included support for household livelihoods, community-based resource management, policy analysis, advocacy, and conservation enterprises at local, national, and transboundary levels. While individual activities were largely successful, CONASA's hybrid origins and logframe-centric management created fissures between its holistic design and operational logics, and hindered its ability to develop a broader narrative and maintain key alliances. This case study illustrates the importance of understanding the interplay between project design and operational context to fully appreciate the possibilities and limitations of project-mode conservation.
In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control. PMID:24889956
Theileriosis or East Coast Fever (ECF) is an important livestock disease widespread in Zambia except for some provinces such as Luapula. This freedom status has been achieved due to strict livestock movement regulations that only authorise cattle imports from commercial farms implementing strict ECF control regimens. Recent increases in both the demand and price of beef in Zambia are stimulating a policy change towards a more inclusive inter-provincial trade in live cattle. This may also encourage the introduction of breeding cattle from high production pastoral sectors such as Central Province to stimulate the beef industry in disease free low production areas such as the Luapula Province. To estimate and compare the risks linked with those potential introductions of cattle from the traditional or commercial production sectors of the Central Province, a quantitative risk assessment model was developed. This risk comparison was necessary because the traditional livestock production sector accounts for over 79% of breeding cattle trade in Central Province but is characterised by minimalistic tick-borne disease control and a higher prevalence of ECF. We estimate that should the importation of breeding cattle from Central into Luapula Province be permitted, we could expect to import ECF by the introduction of infected animals at a median rate (5th and 95th percentiles) of every 0.44 years (0.12, 2.60), from the traditional sector compared to every 3.57 years (0.37, 103.6) from the commercial sector. Infected ticks would be expected to enter every 3.46 (0.66, 43.8) years via traditional cattle imports. These risks are strongly influenced by the prevalence of infection, performance of pre-transport screening tests, and the effectiveness of pre-transport tick cleansing. This assessment is expected to provide a model for tick borne disease risk assessments in similar settings, as well as inform ECF control, cattle trade, and stock movement policies in Zambia. PMID:24974081
Background There are limited data on the prevalence and associated factors of truancy in southern Africa. Yet truancy should attract the attention of public health professionals, educators and policy makers as it may be associated with adolescent problem behaviours. The objectives of the study were to estimate the prevalence and determine correlates of school truancy among pupils in Zambia. Findings We used data collected in 2004 in the Zambia Global School-based Health Survey. Logistic regression analysis was conducted to identify factors associated with truancy. A total of 2257 pupils participated in the survey of whom 53.9% were male. Overall 58.8% of the participants (58.1% of males and 58.4% of females) reported being truant in the past 30 days. Factors associated with truancy were having been bullied (AOR = 1.34, 95% CI [1.32, 1.36]), current alcohol use (AOR = 2.19, 95% CI [2.16, 2.23]), perception that other students were kind and helpful (AOR = 1.12, 95% CI [1.10, 1.14]), being male and being from the lowest school grade. Pupils whose parents or guardians checked their homework (AOR = 0.91 95% CI, [0.89, 0.92]) and those who reported parental supervision (AOR = 0.94, 95% CI [0.92-0.95]) were less likely to report being truant. Conclusions We found a high prevalence of truancy among pupils in grades 7-10 in Zambia. Interventions aimed to reduce truancy should be designed and implemented with due consideration of the associated factors. PMID:22260248
Introduction Zambia’s under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level. Description of implementation The project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia’s Lusaka Province. We have deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. We also engage community health workers to actively refer and follow up patients. Evaluation design Project implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. Three annual household surveys will determine population estimates of age-standardized mortality and under-5 mortality in each community before, during, and after implementation. Surveys will also provide measures of childhood vaccine coverage, pregnancy care utilization, and general adult health. Health facility surveys will assess coverage of primary health interventions and measures of health system effectiveness. Discussion The patient-provider interaction is an important interface where the community and the health system meet. Our project aims to reduce population mortality by substantially improving this interaction. Our success will hinge upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognize their value and begin to utilize them. PMID:23819614
Background Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. Methods The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level. Results The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV. Conclusion The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling. PMID:25012796
Objective We describe rates of unintended pregnancy among HIV positive couples in Lusaka, Zambia. We also identify factors associated with unintended pregnancy among oral contraceptive pill (OCP) using couples in this cohort. Design Data were analyzed from couples randomized in a factorial design to two family planning intervention videos. Methods Rates of unintended pregnancy were stratified by contraceptive method used at time of pregnancy. Predictors of time to unintended pregnancy among OCP users were determined via multivariate Cox modeling. Results The highest rates of unintended pregnancy were observed among couples requesting condoms only (26.4/100CY) or OCPs (20.7/100CY); these rates were not significantly different. OCP users accounted for 37% of the couple-years (CY) observed and 87% of unintended pregnancies. Rates of unintended pregnancy for injectable (0.7/100CY) and intrauterine device (1.6/100CY) users were significantly lower relative to condom only users. No pregnancies occurred among contraceptive implant users or after tubal ligation. Factors associated (p<0.05) with time to unintended pregnancy among OCP users in multivariate analysis included the man wanting more children, the woman being HIV negative versus having stage IV HIV disease, and the woman reporting: younger age, no previous OCP use, missed OCPs, or sex without a condom. Conclusions Long-acting reversible contraceptive methods were effective in the context of integrated couples HIV prevention and contraceptive services. Injectable methods were also effective in this context. Given the high user failure rate of OCPs, family planning efforts should promote longer-acting methods among OCP users wishing to avoid pregnancy. Where other methods are not available or acceptable, OCP adherence counseling is needed, especially among younger and new OCP users. Trial registration ClinicalTrials.gov NCT00067522 PMID:24098692
This study examined Zambian counselors, children, and caregivers' perceptions of an evidence-based treatment (EBT) for trauma (Trauma-Focused Cognitive Behavioral Therapy [TF-CBT]) utilized in Zambia to address mental health problems in children. Semistructured interviews were conducted with local counselors trained in TF-CBT (N = 19; 90% of those trained; 12 female) and children/caregivers who had received TF-CBT in a small feasibility study (N = 18; 86% of the children and N = 16; 76% of the caregivers) who completed TF-CBT (total completed; N = 21). Each client was asked six open-ended questions, and domain analysis was used to explore the data. Counselors were positive about the program, liked the structure and flexibility, reported positive changes in their clients, and discussed the cultural adaptation around activities and language. Counselors stated the training was too short, and the supervision was necessary. Challenges included client engagement and attendance, availability of location, funding, and a lack of community understanding of "therapy." Children and caregivers stated multiple positive changes they attributed to TF-CBT, such as better family communication, reduction of problem behaviors, and ability to speak about the trauma. They recommended continuing the program. This study brings a critical examination of providers' and clients' perspectives of the implementation of an EBT for children in a low-resource setting. Clinical implications include changing implementation methods based on responses. Research implications include future study directions such as an effectiveness trial of TF-CBT and an examination of implementation factors. PMID:24400677
Murray, Laura K; Skavenski, Stephanie; Michalopoulos, Lynn M; Bolton, Paul A; Bass, Judith K; Familiar, Itziar; Imasiku, Mwiya; Cohen, Judith
One of the diseases of veterinary and public health importance affecting the Kafue lechwe (Kobus leche kafuensis) on the Kafue flats is brucellosis, for which only scant information is available. During the 2003 (October), 2004 (December), and 2008 (July-December) hunting seasons in the Kafue flats, we conducted a study to determine the seroprevalence of Brucella spp. in the Kafue lechwe and to evaluate serologic tests for detection of Brucella spp. antibodies in lechwe. The Rose Bengal Test (RBT), competitive enzyme-linked immunosorbent assay (cELISA), and fluorescence polarization assay (FPA) were used. A total of 121 Kafue lechwe were hunted for disease investigations in 2003, 2004, and 2008 in the Kafue Flat Game Management Area. Of these, 21.6%, (95% confidence interval [CI]: 14.2-29.1%) had detectable antibodies to Brucella spp. The Kafue lechwe in Lochnivar National Park had higher antibody results than those in Blue Lagoon National Park (odds ratio=3.0; 95% CI: 0.94-9.4). Infection levels were similar in females (21.6%) and males (21.7%). Results were similar among RBT, FPA, cELISA tests, suggesting that these could effectively be used in diagnosing brucellosis in the Kafue lechwe. Our study demonstrates the presence of Brucella infections in the Kafue lechwe in two national parks located in the Kafue flats and further highlights the suitability of serologic assays for testing the Kafue lechwe. Because the Kafue lechwe is the most hunted wildlife species in Zambia, hunters need to be informed of the public health risk of Brucella spp. infection. PMID:20966257
Muma, John Bwalya; Lund, Arve; Siamudaala, Victor M; Munang'andu, Hetron Mweemba; Munyeme, Musso; Matope, Gift; Nielsen, Klaus; DJřnne, Berit; Godfroid, Jacques; Tryland, Morten; Skjerve, Eystein
Background To assess progress in the scale-up of rapid diagnostic tests and artemisinin-based combination therapies (ACTs) across Africa, malaria control programs have increasingly relied on standardized national household surveys to determine the proportion of children with a fever in the past 2 wk who received an effective antimalarial within 1–2 d of the onset of fever. Here, the validity of caregiver recall for measuring the primary coverage indicators for malaria diagnosis and treatment of children <5 y old is assessed. Methods and Findings A cross-sectional study was conducted in five public clinics in Kaoma District, Western Provence, Zambia, to estimate the sensitivity, specificity, and accuracy of caregivers' recall of malaria testing, diagnosis, and treatment, compared to a gold standard of direct observation at the health clinics. Compared to the gold standard of clinic observation, for recall for children with fever in the past 2 wk, the sensitivity for recalling that a finger/heel stick was done was 61.9%, with a specificity of 90.0%. The sensitivity and specificity of caregivers' recalling a positive malaria test result were 62.4% and 90.7%, respectively. The sensitivity and specificity of recalling that the child was given a malaria diagnosis, irrespective of whether a laboratory test was actually done, were 76.8% and 75.9%, respectively. The sensitivity and specificity for recalling that an ACT was given were 81.0% and 91.5%, respectively. Conclusions Based on these findings, results from household surveys should continue to be used for ascertaining the coverage of children with a fever in the past 2 wk that received an ACT. However, as recall of a malaria diagnosis remains suboptimal, its use in defining malaria treatment coverage is not recommended. Please see later in the article for the Editors' Summary PMID:23667337
Eisele, Thomas P.; Silumbe, Kafula; Yukich, Josh; Hamainza, Busiku; Keating, Joseph; Bennett, Adam; Miller, John M.
A SURVEY WAS MADE IN 1966 TO FIND OUT REASONS WHY ENROLLED PART- TIME STUDENTS IN THE GENERAL CERTIFICATE OF EDUCATION COURSES (G.C.E.) AT THE EVELYN HONE COLLEGE IN LUSAKA, ZAMBIA, DROPPED OUT OR DID NOT START EVENING CLASSES. DATA FROM THE STUDENT ENROLLMENT FORMS AND CLASS REGISTERS WERE ANALYZED AND COMPARED FOR ATTENDANCE PATTERNS, SUBJECT…
Ex-situ conservancies are expanding alternatives to livestock production in Zambia albeit the lack of information on circulating infectious parasites from wildlife. Therefore, 12 wildlife species were examined on a game ranch were all species were found to be infected by Rhipecephalus spp. Haemoparasite infections were estimated at 7.37% (n = 95) with Babesia spp. detected in bushbuck (Tragelaphus scriptus); Anaplasma marginale in impala (Aepyceros melampus) and puku (Kobus vardonii) for the first time in Zambia. The majority of worm species isolated from bovids were not detected in equids and, vice versa. Our findings intimate ecological and behavioural patterns of some animals as deterministic to exposure. Kafue lechwe (Kobus leche kafuensis) had the widest range of worm species with more infected organs than other animals suggesting their semi aquatic nature contributory to prolonged worm exposure compared to other animals. On the other hand, Kafue lechwe had the least tick infections attributable more to shorter attachment periods as they spend prolonged periods submerged in water. Our findings indicate the vital role that wildlife plays in the epidemiology of parasitic diseases. To reduce the infection burden, control measures should be focused on reducing transmission to highly susceptible animal species as described herein. PMID:22701163
Munang'andu, Hetron Mweemba; Siamudaala, Victor M.; Munyeme, Musso; Nalubamba, King Shimumbo
The selection of insecticide resistance in malaria vectors has the potential to compromise any insecticide-based vector control programme. To ensure that the insecticides used for indoor residual spraying and insecticide-treated nets in Zambia remain effective and their choice is evidence based, insecticide resistance surveillance and monitoring are essential. This study assessed and compared the residual efficacy of etofenprox (Vectron 20?WP), an ether pyrethroid, at 0.1?g/m(2) with pyrethroids: bifenthrin (Bistar 10?WP) and lambda-cyhalothrin (Icon 10 CS) at 25?mg/m(2) for indoor residual spraying. We also assessed the resistance status of etofenprox to local malaria vectors, An. funestus s.s and An. gambiae s.s, using World Health Organization standard protocols. The residual efficacy of Vectron 20?WP on cement, rendered walls of houses lasted for four months with 100% mortality. By the eighth month, the killing effect had reduced to 73.8% compared to 63.3% for bifenthrin and 77.0% for lambda-cyhalothrin. Susceptibility tests using standard World Health Organization assays on An. gambiae s.s showed susceptibility to etofenprox (0.1%) but some resistance was detected to Anopheles funestus s.s. The product is recommended as an ideal insecticide for indoor residual spraying for malaria control in Zambia as part of a resistance management programme in selected areas of the country. PMID:24967135
Background Malaria is receding in many endemic countries with intervention scale -up against the disease. However, this resilient scourge may persist in low-grade submicroscopic infections among semi-immune members of the population, and be poised for possible resurgence, creating challenges for detection and assessment of intervention impact. Parasite genotyping methods, such as the molecular barcode, can identify specific malaria parasite types being transmitted and allow tracking and evaluation of parasite population structure changes as interventions are applied. This current study demonstrates application of pre-amplification methods for successful detection and genotyping of residual Plasmodium falciparum infections during a dramatic malarial decline. Methods The study was a prospective cross-sectional design and based on a 2,000 sq km vicinity of Macha Mission Hospital in southern Zambia. Willing and predominantly asymptomatic residents of all ages were screened for malaria by microscopy during the 2005 and 2008 transmission seasons, with simultaneous collection of dried blood spots (DBS) on filter paper, and extraction of Plasmodium falciparum DNA was performed. Plasmodium falciparum infections were genotyped using a 24 SNP-based molecular barcode assay using real-time PCR. Submicroscopic parasitaemia samples were subjected to pre-amplification using TaqMan PreAmp Master Mix following the manufacturer’s instructions before SNP barcode analysis. Results There was a dramatic decline of malaria between 2005 and 2008, and the geometric mean parasite density (95% CI) fell from 704/?L (390–1,271) in 2005 to 39/?L (23–68) in 2008, culminating in a large proportion of submicroscopic infections of which 90% failed to yield ample DNA for standard molecular characterization among 2008 samples. Pre-amplification enabled successful detection and genotyping of 74% of these low-grade reservoir infections, overall, compared to 54% that were detectable before pre-amplification (p <0.0005, n = 84). Furthermore, nine samples negative for parasites by microscopy and standard quantitative PCR amplification were positive after pre-amplification. Conclusions Pre-amplification allows analysis of an otherwise undetectable parasite population and may be instrumental for parasites identification, tracking and assessing the impact of interventions on parasite populations during malaria control and elimination programmes when parasitaemia is expected to decline to submicroscopic levels. PMID:24618119
Introduction HIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics. Methods Integration involved three key modifications: i) amalgamation of space and patient flow; ii) standardization of medical records and iii) introduction of routine provider initiated testing and counseling (PITC). Assessment of feasibility included monitoring rates of HIV case-finding and referral to care, measuring median waiting and consultation times and assessing adherence to clinical care protocols for HIV and non-HIV outpatients. Qualitative data on patient/provider perceptions was also collected. Findings Provider and patient interviews at both sites indicated broad acceptability of the model and highlighted a perceived reduction in stigma associated with integrated HIV services. Over six months in Clinic 1, PITC was provided to 2760 patients; 1485 (53%) accepted testing, 192 (13%) were HIV positive and 80 (42%) enrolled. Median OPD patient-provider contact time increased 55% (6.9 vs. 10.7 minutes; p<0.001) and decreased 1% for ART patients (27.9 vs. 27.7 minutes; p?=?0.94). Median waiting times increased by 36 (p<0.001) and 23 minutes (p<0.001) for ART and OPD patients respectively. In Clinic 2, PITC was offered to 1510 patients, with 882 (58%) accepting testing, 208 (24%) HIV positive and 121 (58%) enrolled. Median OPD patient-provider contact time increased 110% (6.1 vs. 12.8 minutes; p<0.001) and decreased for ART patients by 23% (23 vs. 17.7 minutes; p<0.001). Median waiting times increased by 47 (p<0.001) and 34 minutes (p<0.001) for ART and OPD patients, respectively. Conclusions Integrating vertical ART and OPD services is feasible in the low-resource and high HIV-prevalence setting of Lusaka, Zambia. Integration enabled shared use of space and staffing that resulted in increased HIV case finding, a reduction in stigma associated with vertical ART services but resulted in an overall increase in patient waiting times. Further research is urgently required to assess long-term clinical outcomes and cost effectiveness in order to evaluate scalability and generalizability. PMID:20644629
Topp, Stephanie M.; Chipukuma, Julien M.; Giganti, Mark; Mwango, Linah K.; Chiko, Like M.; Tambatamba-Chapula, Bushimbwa; Wamulume, Chibesa S.; Reid, Stewart
Background Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). Methods and Findings Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14–0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19–8.94). There were two deaths in the intervention and one in the control arm. Conclusions The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia. Trial registration ClinicalTrials.gov NCT00513500 Please see later in the article for the Editors' Summary PMID:20877714
Yeboah-Antwi, Kojo; Pilingana, Portipher; Macleod, William B.; Semrau, Katherine; Siazeele, Kazungu; Kalesha, Penelope; Hamainza, Busiku; Seidenberg, Phil; Mazimba, Arthur; Sabin, Lora; Kamholz, Karen; Thea, Donald M.; Hamer, Davidson H.
Background Zambia’s fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia. Methods This paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15–49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables. Results Two thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively. Conclusion Joint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor determining use of these methods. As such, family planning programmes directed at increasing use of LAPMs ought to not only encourage spousal communication but should also consider rolling out interventions that incorporate economic empowerment. PMID:24993034
Diagnosis for intestinal Schistosoma mansoni lacks sensitivity and is arduous to conduct. The standard diagnostic tests, Kato-Katz (KK) and circulating cathodic antigen (CCA) both lack sensitivity and with KK, require obtaining, transporting, and examining fresh stool. We compared diagnostic efficacy of KK, CCA, and polymerase chain reaction (PCR) to detect S. mansoni infection (species-specific DNA) from 89 filtered urine samples collected in Zambia. The PCR was the strongest indicator of positive cases with sensitivity and specificity of 100% in comparison to CCA (67% and 60%) and KK (50% and 100%). High positive and negative predictive values (100%) were also indicative of robustness of PCR. The same pattern was observed when stratified for sex and age group-specific analysis. Diagnosis of S. mansoni from filtered urine samples by PCR is an effective means to detect low intensity infection and would enhance the effectiveness of surveillance and control programs of schistosomiasis. PMID:23716406
Lodh, Nilanjan; Mwansa, James C. L.; Mutengo, Mable M.; Shiff, Clive J.
Generally accepted as universal, the construct of adaptive behavior differs in its manifestations across different cultures and settings. The Vineland-II (Sparrow et al. in Vineland Adaptive Behavior Scales, Second edn. AGS Publishing, Circle Pines, MN, 2005) was translated into Chitonga and adapted to the setting of rural Southern Province, Zambia. This version was administered to the parents/caregivers of 114 children (grades 3-7, mean age = 12.94, SD = 2.34). The relationships between these children's adaptive behavior, academic achievement and cognitive ability indicators are compared to those usually observed in US samples. Results reflect no association between adaptive behavior and cognitive ability indicators, but a strong relationship between high adaptive behavior and reading-related measures. Six case studies of children with high and low scores on the Vineland-II are presented to illustrate the possible factors affecting these outcomes. PMID:22391811
Tan, Mei; Reich, Jodi; Hart, Lesley; Thuma, Philip E; Grigorenko, Elena L
There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with < 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions. PMID:24218409
Comfort, Alison B; van Dijk, Janneke H; Mharakurwa, Sungano; Stillman, Kathryn; Gabert, Rose; Korde, Sonali; Nachbar, Nancy; Derriennic, Yann; Musau, Stephen; Hamazakaza, Petan; Zyambo, Khozya D; Zyongwe, Nancy M; Hamainza, Busiku; Thuma, Philip E
Background Today's uncertain HIV funding landscape threatens to slow progress towards treatment goals. Understanding the costs of antiretroviral therapy (ART) will be essential for governments to make informed policy decisions about the pace of scale-up under the 2013 WHO HIV Treatment Guidelines, which increase the number of people eligible for treatment from 17.6 million to 28.6 million. The study presented here is one of the largest of its kind and the first to describe the facility-level cost of ART in a random sample of facilities in Ethiopia, Malawi, Rwanda, South Africa and Zambia. Methods & Findings In 2010–2011, comprehensive data on one year of facility-level ART costs and patient outcomes were collected from 161 facilities, selected using stratified random sampling. Overall, facility-level ART costs were significantly lower than expected in four of the five countries, with a simple average of $208 per patient-year (ppy) across Ethiopia, Malawi, Rwanda and Zambia. Costs were higher in South Africa, at $682 ppy. This included medications, laboratory services, direct and indirect personnel, patient support, equipment and administrative services. Facilities demonstrated the ability to retain patients alive and on treatment at these costs, although outcomes for established patients (2–8% annual loss to follow-up or death) were better than outcomes for new patients in their first year of ART (77–95% alive and on treatment). Conclusions This study illustrated that the facility-level costs of ART are lower than previously understood in these five countries. While limitations must be considered, and costs will vary across countries, this suggests that expanded treatment coverage may be affordable. Further research is needed to understand investment costs of treatment scale-up, non-facility costs and opportunities for more efficient resource allocation. PMID:25389777
Background It is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of antenatal (ANC) and post-natal care (PNC) and post-partum modern contraceptives. Methods Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008–09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman’s adoption of modern contraceptives after a recent live birth. Results Tests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice. Conclusions While the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice. PMID:23289547
Background To date, male circumcision prevalence has been estimated using surveys of men self-reporting their circumcision status. HIV prevention trials and observational studies involving female participants also collect data on partners' circumcision status as a risk factor for HIV/STIs. A number of studies indicate that reports of circumcision status may be inaccurate. This study assessed different methods for improving self- and partner reporting of circumcision status. Methods/Findings The study was conducted in urban and rural Zambia and urban Swaziland. Men (N?=?1264) aged 18–50 and their female partners (N?=?1264), and boys (N?=?840) aged 13–17 were enrolled. Participants were recruited from HIV counseling and testing sites, health centers, and surrounding communities. The study experimentally assessed methods for improving the reporting of circumcision status, including: a) a simple description of circumcision, b) a detailed description of circumcision, c) an illustration of a circumcised and uncircumcised penis, and d) computerized self-interviewing. Self-reports were compared to visual examination. For men, the error in reporting was largely unidirectional: uncircumcised men more often reported they were circumcised (2–7%), depending on setting. Fewer circumcised men misrepresented their status (0.05–5%). Misreporting by women was significantly higher (11–15%), with the error in both directions. A sizable number of women reported that they did not know their partner's circumcision status (3–8%). Computerized interviewing did not improve accuracy. Providing an illustration, particularly for illiterate participants, significantly improved reporting of circumcision status, decreasing misreporting among illiterate participants from 13% to 10%, although misreporting was not eliminated. Conclusions Study results suggest that the prevalence of circumcision may be overestimated in Zambia and Swaziland; the error in reporting is higher among women than among men. Improved reporting when a description or illustration is provided suggests that the source of the error is a lack of understanding of male circumcision. PMID:22629312
Hewett, Paul C.; Haberland, Nicole; Apicella, Lou; Mensch, Barbara S.
Background Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either ‘Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)’ or ‘Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)’, while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia. Methods A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ?350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined. Results Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with ‘ARVs during pregnancy and breastfeeding’ and further reduced by 15% with ‘Lifelong ART’. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners. Conclusion The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment. PMID:24604067
Background Several frameworks have been constructed to analyse the factors which influence and shape the uptake of evidence into policy processes in resource poor settings, yet empirical analyses of health policy making in these settings are relatively rare. National policy making for cotrimoxazole (trimethoprim-sulfamethoxazole) preventive therapy in developing countries offers a pertinent case for the application of a policy analysis lens. The provision of cotrimoxazole as a prophylaxis is an inexpensive and highly efficacious preventative intervention in HIV infected individuals, reducing both morbidity and mortality among adults and children with HIV/AIDS, yet evidence suggests that it has not been quickly or evenly scaled-up in resource poor settings. Methods Comparative analysis was conducted in Malawi, Uganda and Zambia, using the case study approach. We applied the ‘RAPID’ framework developed by the Overseas Development Institute (ODI), and conducted a total of 47 in-depth interviews across the three countries to examine the influence of context (including the influence of donor agencies), evidence (both local and international), and the links between researcher, policy makers and those seeking to influence the policy process. Results Each area of analysis was found to have an influence on the creation of national policy on cotrimoxazole preventive therapy (CPT) in all three countries. In relation to context, the following were found to be influential: government structures and their focus, donor interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, we found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Further, local operational research results seem to have been taken up more quickly, while randomised controlled trials (the gold standard of clinical research) was not necessarily translated into policy so swiftly. Finally the links between different research and policy actors were of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get cotrimoxazole preventive therapy onto the policy agenda. Conclusions This analysis underscores the importance of considering national level variables in the explanation of the uptake of evidence into national policy settings, and recognising how local policy makers interpret international evidence. Local priorities, the ways in which evidence was interpreted, and the nature of the links between policy makers and researchers could either drive or stall the policy process. Developing the understanding of these processes enables the explanation of the use (or non-use) of evidence in policy making, and potentially may help to shape future strategies to bridge the research-policy gaps and ultimately improve the uptake of evidence in decision making. PMID:21679387
A review of the published and unpublished literature on bacterial resistance in human and animals was performed. Sixty-eight articles/reports from the Democratic Republic of Congo (DRC), Mozambique, Tanzania and Zambia were reviewed. The majority of these articles were from Tanzania. There is an increasing trend in the incidence of antibiotic resistance; of major concern is the increase in multidrug- resistant Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Vibrio cholera, non-typhoid Salmonella and other pathogens responsible for nosocomial infections. The increase in methicillin- resistant Staphylococcus aureus and extended-spectrum beta-lactamase (ESBL) producers in the countries under review confirms the spread of these clones worldwide. Clinical microbiology services in these countries need to be strengthened in order to allow a coordinated surveillance for antimicrobial resistance and provide data for local treatment guidelines and for national policies to control antimicrobial resistance. While the present study does not provide conclusive evidence to associate the increasing trend in antibiotic resistance in humans with the use of antibiotics in animals, either as feed additives or veterinary prescription, we strongly recommend a one-health approach of systematic surveillance across the public and animal health sectors, as well as the adherence to the FAO (Food and Agriculture Organization)-OIE (World Organization of animal Health) -WHO(World Health Organization) recommendations for non-human antimicrobial usage. PMID:24119299
Trypanosomiasis has been endemic in wildlife in Zambia for more than a century. The disease has been associated with neurological disorders in humans. Current conservation strategies by the Zambian government of turning all game reserves into state-protected National Parks (NPs) and game management areas (GMAs) have led to the expansion of the wildlife and tsetse population in the Luangwa and Zambezi valley ecosystem. This ecological niche lies in the common tsetse fly belt that harbors the highest tsetse population density in Southern Africa. Ecological factors such as climate, vegetation and rainfall found in this niche allow for a favorable interplay between wild reservoir hosts and vector tsetse flies. These ecological factors that influence the survival of a wide range of wildlife species provide adequate habitat for tsetse flies thereby supporting the coexistence of disease reservoir hosts and vector tsetse flies leading to prolonged persistence of trypanosomiasis in the area. On the other hand, increase in anthropogenic activities poses a significant threat of reducing the tsetse and wildlife habitat in the area. Herein, we demonstrate that while conservation of wildlife and biodiversity is an important preservation strategy of natural resources, it could serve as a long-term reservoir of wildlife trypanosomiasis. PMID:22693499
Munang'andu, Hetron Mweemba; Siamudaala, Victor; Munyeme, Musso; Nalubamba, King Shimumbo
Objectives To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of Prevention of Mother-to-Child Transmission of HIV. Design We conducted a factorial randomized controlled trial of two video-based interventions. Methods “Methods-focused” and “Motivational” messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia. Results Among couples not using contraception prior to randomization (N=782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the “Methods” video which focused on the IUD and contraceptive implant was associated with a significantly lower pregnancy incidence (HR=0.38; 95%CI:0.19–0.75) relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR=0.22; 95%CI:0.08–0.58) and couples with HIV+ women (HR=0.23; 95%CI:0.09–0.55). Conclusions The “Methods video” intervention was previously shown to increase uptake of longer-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the IUD and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods. PMID:23202814
In low-income settings, human immunodeficiency virus (HIV)-positive mothers must choose between breastfeeding their infants and risking transmission of HIV or replacement feeding their infants and risking diarrheal disease from contaminated water. We conducted a cross-sectional study of children < 2 years of age of 254 HIV-positive mothers in peri-urban Zambia to assess their exposure to waterborne fecal contamination. Fecal indicators were found in 70% of household drinking water samples. In a multivariable analysis, factors associated with diarrhea prevalence in children < 2 years were mother having diarrhea (adjusted odds ratio [aOR] = 5.18, 95% confidence interval [CI] = 1.65–16.28), child given water in the past 2 days (aOR = 4.08, 95% CI = 1.07–15.52), child never being breastfed (aOR = 2.67, 95% CI = 1.06–6.72), and rainy (versus dry) season (aOR = 4.60, 95% CI = 1.29–16.42). Children born to HIV-positive mothers were exposed to contaminated water through direct intake of drinking water, indicating the need for interventions to ensure microbiological water quality. PMID:21813854
The HIV Prevention Trials Network (HPTN) is conducting the HPTN 071(PopART) study in 21 communities in Zambia and South Africa with support from a consortium of funders. HPTN 071(PopART) is a community-randomized trial of a combination prevention strategy to reduce HIV incidence in the context of the generalized epidemic of southern Africa. The full PopART intervention strategy is anchored in home-based HIV testing and facilitated linkage of HIV-infected persons to care through community health workers, and universal antiretroviral therapy for seropositive persons regardless of CD4+ cell count or HIV viral load. In order to further reduce risk of HIV acquisition among uninfected individuals, the study aims to expand voluntary medical male circumcision, diagnosis and treatment of sexually transmitted infections, behavioral counseling, and condom distribution. The full PopART intervention strategy also incorporates promotion of other interventions designed to reduce HIV and tuberculosis transmission, including optimization of the prevention of mother to child HIV transmission and enhanced individual and public health tuberculosis services. Success for the PopART strategy depends upon the ability to increase coverage for the study interventions whose uptake is a necessary antecedent to a prevention effect. Processes will be measured to assess the degree of penetration of the interventions into the communities. A randomly sampled population cohort from each community will be used to measure the impact of the PopART strategy on HIV incidence over three years. We describe the strategy being tested and progress to date in the HPTN 071(PopART) study. PMID:23764639
Vermund, Sten H.; Fidler, Sarah J.; Ayles, Helen; Beyers, Nulda; Hayes, Richard J.
The HIV Prevention Trials Network (HPTN) is conducting the HPTN 071 (PopART) study in 21 communities in Zambia and South Africa with support from a consortium of funders. HPTN 071 (PopART) is a community-randomized trial of a combination prevention strategy to reduce HIV incidence in the context of the generalized epidemic of southern Africa. The full PopART intervention strategy is anchored in home-based HIV testing and facilitated linkage of HIV-infected persons to care through community health workers and universal antiretroviral therapy for seropositive persons regardless of CD4+ cell count or HIV viral load. To further reduce the risk of HIV acquisition among uninfected individuals, the study aims to expand voluntary medical male circumcision, diagnosis and treatment of sexually transmitted infections, behavioral counseling, and condom distribution. The full PopART intervention strategy also incorporates promotion of other interventions designed to reduce HIV and tuberculosis transmission, including optimization of the prevention of mother-to-child HIV transmission and enhanced individual and public health tuberculosis services. Success for the PopART strategy depends on the ability to increase coverage for the study interventions whose uptake is a necessary antecedent to a prevention effect. Processes will be measured to assess the degree of penetration of the interventions into the communities. A randomly sampled population cohort from each community will be used to measure the impact of the PopART strategy on HIV incidence over 3 years. We describe the strategy being tested and progress to date in the HPTN 071 (PopART) study. PMID:23764639
Vermund, Sten H; Fidler, Sarah J; Ayles, Helen; Beyers, Nulda; Hayes, Richard J
Abstract We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4(+) T cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia. We compared baseline characteristics of patients by sex and age at ART initiation [categorized as 16-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years and older]. We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4(+) T cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable. Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ?50 years. Compared with 16-29 year olds, 40-49 year olds (-46 cells/mm(3)), 50-59 year olds (-53 cells/mm(3)), and 60+ year olds (-60 cells/mm(3)) had reduced CD4(+) T cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ?40 years (AHR 1.25 for 40-49 year olds, 1.56 for 50-59 year olds, and 2.97 for 60+ year olds). Adherence and retention in care were poorest among 16-29 year olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4(+) T cell count recovery and increased risk of death. Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with a higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations. PMID:24998881
Vinikoor, Michael J; Joseph, Jessica; Mwale, Jonas; Marx, Melissa A; Goma, Fastone M; Mulenga, Lloyd B; Stringer, Jeffrey S A; Eron, Joseph J; Chi, Benjamin H
Bovine tuberculosis (bTB) and fasciolosis are important but neglected diseases that result in chronic infections in cattle. However, in Zambia, these diseases are mainly diagnosed at abattoirs during routine meat inspection. Albeit the coinfection status, these diseases have been reported as nothing more than normal separate findings without an explanatory phenomena. Forthwith, we formulated this study to assess the possible association of the two diseases in a known high prevalence area on the Kafue basin ecosystem. Of the 1,680 animals screened, 600 (35.7%; 95% CI 33.4%–38%) and 124 (7.4%; 95% CI 6.1%–8.6%) had fasciolosis and tuberculous lesions; respectively, whilst 72 had both fasciola and tuberculous lesions representing 12% (95% CI 9.4%–14.6%) and 58.1% (95% CI; 49.3%–66.7%) of the total positives for fasciola and tuberculosis, respectively. Jaundice was seen in 304 animals, 18.1% (95% CI; 16.3%–19.9%) and was significantly correlated to fasciolosis (r = 0.59, P < 0.0001). A significant association (?2 = 76.2, df = 1, and P < 0.0001) was found between fasciolosis and tuberculous lesions. Simple logistic regression intimated fasciolosis as a strong predictor for tuberculous lesions with animals that had fasciola being five times more likely to have tuberculous lesions (odds ratio = 4.8, 95% CI: 3.3–7.0). This study indicates that transmission and spatial risk factors of communicable and noncommunicable diseases such as bTB and fasciolosis can be correlated in an ecosystem such as the Kafue flats. PMID:23213629
Munyeme, Musso; Munang'andu, Hetron Mweemba; Nambota, Andrew; Muma, John Bwalya; Phiri, Andrew Malata; Nalubamba, King Shimumbo
HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n = 1500) and a follow-up survey (n = 1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (? = -0.22, p = 0.423). Being tested for HIV was associated with a reduction in stigma (? = -0.57, p = 0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (? = -0.78, p = 0.080 vs. ? = -0.37, p = 0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma. PMID:23422056
Abstract Objective To follow the trends in all-cause mortality in Lusaka, Zambia, during the scale-up of a national programme of antiretroviral therapy (ART). Methods Between November 2004 and September 2011, we conducted 12 survey rounds as part of a cross-sectional study in Lusaka, with independent sampling in each round. In each survey, we asked the heads of 3600 households to state the number of deaths in their households in the previous 12 months and the number of orphans aged less than 16 years in their households and investigated the heads’ knowledge, attitudes and practices related to human immunodeficiency virus (HIV). Findings The number of deaths we recorded – per 100 person–years – in each survey ranged from 0.92 (95% confidence interval, CI: 0.78–1.09) in September 2011, to 1.94 (95% CI: 1.60–2.35) in March 2007. We found that mortality decreased only modestly each year (mortality rate ratio: 0.98; 95% CI: 0.95–1.00; P?=?0.093). The proportion of households with orphans under the age of 16 years decreased from 17% in 2004 to 7% in 2011. The proportions of respondents who had ever been tested for HIV, had a comprehensive knowledge of HIV, knew where to obtain free ART and reported that a non-pregnant household member was receiving ART gradually increased. Conclusion The expansion of ART services in Lusaka was not associated with a reduction in all-cause mortality. Coverage, patient adherence and retention may all have to be increased if ART is to have a robust and lasting impact at population level in Lusaka. PMID:25378727
Chi, Benjamin H; Kusanthan, Thankian; Chilopa, Batista; Levy, Jens; Sikazwe, Izukanji; Mwaba, Peter; Stringer, Jeffrey SA
As universal testing moves onto the HIV agenda, there is a need for more understanding of the relatively low uptake of HIV testing and the dynamics of disclosure in Sub-Saharan Africa. Despite the expanding provision of anti-retroviral therapy in Zambia since 2004, disclosure of HIV status - beyond a closed network - remains limited. Drawing on 20 years of living and working in a high HIV prevalence country, research on HIV-related stigma and existing literature on disclosure, this paper explores the reasons that lie behind limited disclosure. Unravelling why HIV disclosure remains "a navigation in a moral field", the pattern of silence around HIV and the routine and often subtle presence of HIV in daily life reveals two key dynamics. The first dynamic is shifting public/private boundaries and retaining a wider identity. People living with HIV juggle the pragmatic advantages of disclosing to a limited circle with the importance of maintaining not only their moral integrity, status and (for some) professional and group identity but also of maintaining their privacy. A more public disclosure ("speaking it" more widely) shifts private-public boundaries and can be threatening, dangerous and can fix identity. Furthermore, disclosure carries obligations which, given high levels of poverty, can be hard to meet. The second dynamic is a pattern of implicit understanding. It can be easier in a context of high HIV prevalence to opt for silence, in its various forms, with the presence of HIV implicitly understood but not often explicitly spoken about. Although this gives more room for manoeuvre and for respect, silence too can be dangerous and certain situations dictate that it is better to breach the silence. More aggressive promotion of HIV testing needs to both respect and consider how to work within these existing dynamics to facilitate safe disclosure. PMID:20680855
Background This paper presents results from an evaluation of the effect of a community health worker (CHW) –based, interpersonal communication campaign (IPC) for increasing insecticide-treated mosquito net (ITN) use among children in Luangwa District, Zambia, an area with near universal coverage of ITNs and moderate to low malaria parasite prevalence. Methods A quasi-experimental community randomized control trial was conducted from 2008 to 2010. CHWs were the unit of randomization. Cross-sectional data were collected from houses in both 2008 and 2010 using simple random sampling of a complete household enumeration of the district. A difference-in -differences approach was used to analyse the data. Results ITN use among children <5?years old in households with ?1 ITN increased overall from 54% in 2008 to 81% in 2010 (?2 = 96.3, p <0.01); however, there was no difference in increase between the treatment and control arms in 2010 (p >0.05). ITN use also increased among children five to 14?years old from 37% in 2008 to 68% in 2010. There was no indication that the CHW-based intervention activities had a significant effect on increasing ITN use in this context, over and above what is already being done to disseminate information on the importance of using an ITN to prevent malaria infection. Discussion ITN use increased dramatically in the district between 2008 and 2010. It is likely that IPC activities in general may have contributed to the observed increase in ITN use, as the increased observed in this study was far higher than the increase observed between 2008 and 2010 malaria indicator survey (MIS) estimates. Contamination across control communities, coupled with linear settlement patterns and subsequent behavioural norms related to communication in the area, likely contributed to the observed increase in net use and null effect in this study. PMID:22958441
We evaluated the association of the number of late antiretroviral therapy (ART) refills with patient outcomes in a large public-sector human immunodeficiency virus treatment program in Lusaka, Zambia. Using pharmacy data routinely collected during 2004-2010, we calculated the number of late refills during the initial year of ART. We used multivariable Cox proportional hazard regression to examine the association between the number of late refills and death or program failure (i.e., death, loss to follow-up, or program withdrawal) >12 months after ART initiation, with and without stratification by the medication possession ratio (MPR) during the initial year of ART. Of 53,015 adults who received ART for ?12 months (median follow-up duration, 86.1 months; interquartile range, 53.2-128.2 months), 26,847 (50.6%) had 0 late refills, 16,762 (31.6%) had 1, 6,505 (12.3%) had 2, and 2,901 (5.5%) had ?3. Kaplan-Meier analysis revealed that ?3 late refills was associated with a greater mortality risk than 1 and 2 late refills (p<0.001, by the log-rank test). The mortality risk was greater for patients with 2 late refills [adjusted hazard ratio (HR), 1.17; 95% confidence interval (CI), 0.99-1.38] or ?3 late refills (adjusted HR, 1.51; 95% CI, 1.23-1.87), compared with that for patients with 0-1 late refills. Program failure was associated with ?2 late refills. An MPR of <80% was associated with similar increases in mortality risk across late-refill strata. Monitoring late refills during the initial period of ART may help resource- and time-constrained clinics identify patients at risk for program failure. PMID:23924188
Vinikoor, Michael J; Schuttner, Linnaea; Moyo, Crispin; Li, Michelle; Musonda, Patrick; Hachaambwa, Lottie M; Stringer, Jeffrey S A; Chi, Benjamin H
Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (?95%), suboptimal (80–94%) and poor (<80%). Results Overall, 27 115 treatment-naďve adults initiated and continued ART for ?12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9–1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4–2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/µl vs 217 cells/µl; P < 0.001), 24 months (213 cells/µl vs 246 cells/µl; P < 0.001), 30 months (226 cells/µl vs 261 cells/µl; P < 0.001) and 36 months (245 cells/µl vs 275 cells/µl; P < 0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings. PMID:19223334
Chi, Benjamin H; Cantrell, Ronald A; Zulu, Isaac; Mulenga, Lloyd B; Levy, Jens W; Tambatamba, Bushimbwa C; Reid, Stewart; Mwango, Albert; Mwinga, Alwyn; Bulterys, Marc; Saag, Michael S; Stringer, Jeffrey SA
Background Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run. Methods A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times. Results Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p<0.01). Using simulation modeling, we found that a large portion of this increase could be explained by changes in operational conditions before and after integration such as reduced staff availability (p<0.01) and longer breaks between consecutive patients (p<0.05). Controlling for these differences, integration of services, per se, would have resulted in a significant decrease in waiting times for OPD and a moderate decrease for HIV services. Conclusions Integrating health services has the potential of reducing waiting times due to more efficient use of resources. However, one needs to ensure that other operational factors such as staff availability are not adversely affected due to integration. PMID:22545108
Background The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. Methods Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities’ infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. Results Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers’ PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers’ ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. Conclusions These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early. PMID:24011137
Introduction The utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis. Objectives To determine risk factors associated with positive QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) results and the level of agreement between the tests; to explore the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST. Methods Adult household contacts of tuberculosis patients were invited to participate in a cross-sectional study across 24 communities in Zambia and South Africa. HIV, QFT-GIT and TST tests were done. A questionnaire was used to assess risk factors. Results A total of 2,220 contacts were seen. 1,803 individuals had interpretable results for both tests, 1,147 (63.6%) were QFT-GIT positive while 725 (40.2%) were TST positive. Agreement between the tests was low (kappa?=?0.24). QFT-GIT and TST results were associated with increasing age (adjusted OR [aOR] for each 10 year increase for QFT-GIT 1.15; 95% CI: 1.06–1.25, and for TST aOR: 1.10; 95% CI 1.01–1.20). HIV positivity was less common among those with positive results on QFT-GIT (aOR: 0.51; 95% CI: 0.39–0.67) and TST (aOR: 0.61; 95% CI: 0.46–0.82). Smear positivity of the index case was associated with QFT-GIT (aOR: 1.25; 95% CI: 0.90–1.74) and TST (aOR: 1.39; 95% CI: 0.98–1.98) results. We found little evidence in our data to support our hypotheses. Conclusion QFT-GIT may not be more sensitive than the TST to detect risk factors associated with tuberculous infection. We found little evidence to support the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST. PMID:21483746
Background Priority-setting decisions are based on an important, but not sufficient set of values and thus lead to disagreement on priorities. Accountability for Reasonableness (AFR) is an ethics-based approach to a legitimate and fair priority-setting process that builds upon four conditions: relevance, publicity, appeals, and enforcement, which facilitate agreement on priority-setting decisions and gain support for their implementation. This paper focuses on the assessment of AFR within the project REsponse to ACcountable priority setting for Trust in health systems (REACT). Methods This intervention study applied an action research methodology to assess implementation of AFR in one district in Kenya, Tanzania, and Zambia, respectively. The assessments focused on selected disease, program, and managerial areas. An implementing action research team of core health team members and supporting researchers was formed to implement, and continually assess and improve the application of the four conditions. Researchers evaluated the intervention using qualitative and quantitative data collection and analysis methods. Results The values underlying the AFR approach were in all three districts well-aligned with general values expressed by both service providers and community representatives. There was some variation in the interpretations and actual use of the AFR in the decision-making processes in the three districts, and its effect ranged from an increase in awareness of the importance of fairness to a broadened engagement of health team members and other stakeholders in priority setting and other decision-making processes. Conclusions District stakeholders were able to take greater charge of closing the gap between nationally set planning and the local realities and demands of the served communities within the limited resources at hand. This study thus indicates that the operationalization of the four broadly defined and linked conditions is both possible and seems to be responding to an actual demand. This provides arguments for the continued application and further assessment of the potential of AFR in supporting priority-setting and other decision-making processes in health systems to achieve better agreed and more sustainable health improvements linked to a mutual democratic learning with potential wider implications. PMID:25142148
Introduction In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. Methods The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. Results The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p?=?0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p?=?0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p?=?0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. Conclusion This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful evaluation of such complex health intervention. Trial number ClinicalTrials.gov NCT01942278 PMID:24751780
Background Unsafe drinking water presents a particular threat to people living with HIV/AIDS (PLHIV) due to the increased risk of opportunistic infections, diarrhea-associated malabsorption of essential nutrients, and increased exposure to untreated water for children of HIV-positive mothers who use replacement feeding to reduce the risk of HIV transmission. This population may particularly benefit from an intervention to improve water quality in the home. Methods and Findings We conducted a 12-month randomized, controlled field trial in Zambia among 120 households with children <2 years (100 with HIV-positive mothers and 20 with HIV-negative mothers to reduce stigma of participation) to assess a high-performance water filter and jerry cans for safe storage. Households were followed up monthly to assess use, drinking water quality (thermotolerant coliforms (TTC), an indicator of fecal contamination) and reported diarrhea (7-day recall) among children <2 years and all members of the household. Because previous attempts to blind the filter have been unsuccessful, we also assessed weight-for-age Z-scores (WAZ) as an objective measure of diarrhea impact. Filter use was high, with 96% (596/620) of household visits meeting the criteria for users. The quality of water stored in intervention households was significantly better than in control households (3 vs. 181 TTC/100 mL, respectively, p<0.001). The intervention was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among children <2 years (LPR?=?0.47, 95% CI: 0.30–0.73, p?=?0.001) and 54% among all household members (LPR?=?0.46, 95% CI: 0.30–0.70, p<0.001). While reduced WAZ was associated with reported diarrhea (?0.26; 95% CI: ?0.37 to ?0.14, p<0.001), there was no difference in WAZ between intervention and control groups. Conclusion In this population living with HIV/AIDS, a water filter combined with safe storage was used correctly and consistently, was highly effective in improving drinking water quality, and was protective against diarrhea. Trial Registration Clinicaltrials.gov NCT01116908 PMID:23082124
The Cervical Cancer Prevention Program in Zambia (CCPPZ) has increasingly used community-level structures to increase the uptake and ensure the sustainability of the program. Traditional marriage counselors, the alangizi, who have existed in the Zambian society for many years, are one of the structures used by the program to impart cervical cancer knowledge and increase access to screening and care using an existing community structure. Several steps were followed in developing this intervention: (a) ensuring the alangizi understood the process of screening by encouraging them to go through the screening process; (b) workshops were arranged for the alangizi to meet and share experiences during which lessons were given on cervical cancer by health workers as well; and (c) eight alangizi were chosen to help document the lessons as part of ensuring that cervical cancer information is accurate and passed in a consistent manner. Over 70 alangizi, who had undergone cervical cancer screening, were trained by CCPPZ. A 'Cervical Cancer Training Manual for Marriage Counsellors' was developed to help the alangizi integrate cervical cancer lessons in their routine teachings. An evaluation was conducted during the training of the alangizi that forms the basis for this paper. The results show that although the alangizi face key challenges in their work (e.g. changing social contexts), they are still considered relevant by most communities in Zambia and are potentially an important avenue for cervical cancer and other health information. This paper shows that it is possible to integrate sexual and reproductive health messages into existing structures in the community. However, it is important to design culturally specific and sensitive healthcare strategies that embrace locally accepted good practices. PMID:24722743
A health facility-based (HF) approach to delivering anthelminthic drugs to children aged 12-59 months in Zambia was compared with an approach where community-directed treatment (ComDT) was added to the HF approach (HF+ComDT). This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12-59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12-36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ?3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment. PMID:22677105
Halwindi, H; Magnussen, P; Siziya, S; Meyrowitsch, D W; Olsen, A
Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350?cells/?L) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate “real world” programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes. PMID:23606977
Gomez, G. B.; Venter, W. D. F.; Lange, J. M. A.; Rees, H.; Hankins, C.
Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350?cells/ ? L) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate "real world" programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes. PMID:23606977
Gomez, G B; Venter, W D F; Lange, J M A; Rees, H; Hankins, C
This study estimates the location, quality, and quantity of undiscovered copper in stratabound deposits within the Neoproterozoic Roan Group of the Katanga Basin in the Democratic Republic of the Congo and Zambia. The study area encompasses the Central African Copperbelt, the greatest sediment-hosted copper-cobalt province in the world, containing 152 million metric tons of copper in greater than 80 deposits. This study (1) delineates permissive areas (tracts) where undiscovered sediment-hosted stratabound copper deposits may occur within 2 kilometers of the surface, (2) provides a database of known sediment-hosted stratabound copper deposits and prospects, (3) estimates numbers of undiscovered deposits within these permissive tracts at several levels of confidence, and (4) provides probabilistic estimates of amounts of copper and mineralized rock that could be contained in undiscovered deposits within each tract. The assessment, conducted in January 2010 using a three-part form of mineral resource assessment, indicates that a substantial amount of undiscovered copper resources might occur in sediment-hosted stratabound copper deposits within the Roan Group in the Katanga Basin. Monte Carlo simulation results that combine grade and tonnage models with estimates of undiscovered deposits indicate that the mean estimate of undiscovered copper in the study area is 168 million metric tons, which is slightly greater than the known resources at 152 million metric tons. Furthermore, significant value can be expected from associated metals, particularly cobalt. Tracts in the Democratic Republic of the Congo (DRC) have potential to contain near-surface, undiscovered deposits. Monte Carlo simulation results indicate a mean value of 37 million metric tons of undiscovered copper may be present in significant prospects.
Zientek, Michael L.; Bliss, James D.; Broughton, David W.; Christie, Michael; Denning, Paul D.; Hayes, Timothy S.; Hitzman, Murray W.; Horton, John D.; Frost-Killian, Susan; Jack, Douglas J.; Master, Sharad; Parks, Heather L.; Taylor, Cliff D.; Wilson, Anna B.; Wintzer, Niki E.; Woodhead, Jon
Over the past decade, efforts to increase the use of insecticide-treated bed nets (ITNs) have relied primarily on the routine distribution of bed nets to pregnant women attending antenatal services or on the mass distribution of bed nets to households. While these distributions have increased the proportion of households owning ITNs and the proportion of people sleeping under an ITN the night prior to the survey, the role that behaviour-change communication (BCC) plays in the use of ITNs remains unquantified.This paper uses two analytic approaches, propensity score matching and treatment effect modelling, to examine the relationship between exposure to the BCC messages and the use of a bed net the previous night, using the 2010 Zambia Malaria Indicator Survey (MIS).When matched on similar propensity scores, a statistically significant 29.5 percentage point difference in ITN use is observed between exposed and unexposed respondents. Fifty-nine per cent of unexposed respondents reported sleeping under an ITN the previous night, compared to 88% of the exposed respondents. A smaller but similarly significant difference between exposed and unexposed groups, 12.7 percentage points, is observed in the treatment effect model, which also controls for the number of bed nets owned by the household and exposure to malaria information from health workers.Using either approach, a statistically significant effect of exposure to BCC messages on a woman's use of an ITN was found. Propensity score matching has the advantage of using statistically-matched pairs and relying on the assumption that given the measured covariates, outcome is independent of treatment assignment (conditional independence assumption), thereby allowing us to mimic a randomized control trial. Results from propensity score matching indicate that BCC messages account for a 29-percentage point increase in the use of ITNs among Zambian households that already own at least one ITN.These analyses serve to illustrate that BCC programmes can contribute to national programmes seeking to increase the use of ITNs inside the home. They also offer a viable approach for evaluating the effectiveness of other BCC programmes promoting behaviour that will reduce malaria transmission or mitigate the consequences of infection. PMID:25174278
OBJECTIVES In high-tuberculosis (TB)-endemic countries, comorbidity of pulmonary TB in hospitalised patients with non-communicable diseases is well documented. In this study, we evaluated the use of the Xpert® MTB/RIF assay for the detection of concomitant pulmonary TB in patients admitted to the University Teaching Hospital, Lusaka, Zambia, with a primary obstetric or gynaecological condition. METHODS The Study population were inpatients admitted with a primary obstetric or gynaecological problem who had a concomitant cough and were able to expectorate a sputum sample. Sputum samples from 94 patients were analysed for the presence of Mycobacterium tuberculosis (M.tb) by standard smear microscopy, MGIT culture, MGIT drug-susceptibility testing (DST) and the Xpert® MTB/RIF assay. The sensitivity and specificity of the Xpert® MTB/RIF assay were evaluated against the culture gold standard. RESULTS Twenty-six of 94 (27.7%) patients had culture-confirmed pulmonary TB. The Xpert® MTB/RIF assay had a sensitivity of 80.8% [95% CI: 60.0–92.7%]) compared against MGIT culture. The Xpert® MTB/RIF assay was more sensitive than sputum smear microscopy (21/26 (80.8%) vs. 13/26 (50.0%), P = 0.02) and detected an additional eight culture-confirmed cases. Culture DST analysis identified two monoresistant M.tb strains: one resistant to rifampicin (rifampicin sensitive by the Xpert® MTB/RIF assay) and one to ethambutol. HIV infection was linked with a 3-fold increase in risk of TB, accounting for 87.5% (21/24) of TB cases. 50% of cases presented as comorbidities with other communicable diseases (CDs) and non-communicable diseases (NCDs). CONCLUSIONS As an alternative to sputum microscopy, the Xpert® MTB/RIF assay provides a sensitive, specific and rapid method for the diagnosis of pulmonary TB in obstetric or gynaecological inpatients. Pulmonary TB is an important cause of concomitant comorbidity to the obstetric or gynaecological condition necessitating admission. TB and HIV comorbidities with other communicable and non-communicable diseases were also common. More proactive screening for TB comorbidity is required in obstetric and gynaecological wards. PMID:23834035
Introduction Building on earlier works demonstrating the effectiveness and acceptability of provider-initiated counselling and testing (PITC) services in integrated outpatient departments of urban primary healthcare clinics (PHCs), this study seeks to understand the relative utility of PITC services for identifying clients with early-stage HIV-related disease compared to traditional voluntary testing and counselling (VCT) services. We additionally seek to determine whether there are any significant differences in the clinical and demographic profile of PITC and VCT clients. Methods Routinely collected, de-identified data were collated from two cohorts of HIV-positive patients referred for HIV treatment, either from PITC or VCT in seven urban-integrated PHCs. Univariate and multivariate analyses were conducted to compare the two cohorts across demographic and clinical characteristics at enrolment. Results Forty-five per cent of clients diagnosed via PITC had CD4<200, and more than 70% (i.e. two thirds) had CD4<350 at enrolment, with significantly lower CD4 counts than that of VCT clients (p<0.001). PITC clients were more likely to be male (p=0.0005) and less likely to have secondary or tertiary education (p<0.0001). Among those who were initiated on antiretroviral therapy (ART), PITC clients had lower odds of initiating treatment within four weeks of enrolment into HIV care (adjusted odds ratio, or AOR: 0.86; 95% confidence interval, or CI: 0.75–0.99; p=0.035) and significantly lower odds of retention in care at six months (AOR: 0.84; CI: 0.77–0.99; p=0.004). Conclusions In Lusaka, Zambia, large numbers of individuals with late-stage HIV are being incidentally diagnosed in outpatient settings. Our findings suggest that PITC in this setting does not facilitate more timely diagnosis and referral to care but rather act as a “safety net” for individuals who are unwilling or unable to seek testing independently. Further work is needed to document the way provision of clinic-based services can be strengthened and linked to community-based interventions and to address socio-cultural norms and socio-economic status that underpin healthcare-seeking behaviour. PMID:23010377
Topp, Stephanie M; Li, Michelle S; Chipukuma, Julien M; Chiko, Matimba M; Matongo, Evelyn; Bolton-Moore, Carolyn; Reid, Stewart E
Background Malaria is a serious illness among children aged 5 years and below in Zambia, which carries with it many adverse effects including anemia and high parasites exposure that lead to infant and childhood mortality. Due to poor accessibility to modern health facilities, malaria is normally managed at home using indigenous and cosmopolitan medicines. In view of problems and implications associated with management of severe malaria at home, rectal artesunate is being proposed as a first aid drug to slow down multiplication of parasites in children before accessing appropriate treatment. Methods A qualitative study using standardised in-depth and Focuss Group Discussions (FGDs) guides to collect information from four (4) villages in Nakonde district, was conducted between February and March 2004. The guides were administered on 29 key informants living in the community and those whose children were admitted in the health facility. Participants in the 12 FGDs came from the 4 participating villages. Participants and key informants were fathers, younger and older mothers including grandmothers and other influential people at household level. Others were traditional healers, headmen, village secretaries, tradtional birth attendants, church leaders and black smiths. FGDs and interview transcriptions were coded to identify common themes that were related to recognition, classification and naming of malaria illness, care-seeking behaviour and community treatment practices for severe malaria. Results Parental prior knowledge of the disease was important as the majority of informants (23 out of 29) and participants (69 out of 97) mentioned four combined symptoms that were used to recognise severe malaria. The symptoms were excessive body hotness, convulsions, vomiting yellow things and bulging of the fontanelle. On the other hand, all informants mentioned two or more of symptoms associated with severe malaria. In all 12 FGDs, participants reported that treatment of severe malaria commenced with the family and moved into the community as the illness progressed. Although treatment of severe diarrheal effects, were common among the winamwanga, no rectal medicines to treat severe malaria were identified. Apart from the anti-malarial fansidar, which was mentioned by 23 in IDIs and 40 in FGDs, participants and informants also frequently mentioned indigenous medicines provided by healers and other respectable herbalists for repelling evil spirits, once a child had severe malaria. Mothers were the important arms for administration of ant-malarial drugs in the villages. Referrals began with healers to CHWs, where no CHWs existed healers directly referred sick children to the health facility. Conclusion Our findings showed that there is a precedent for rectal application of traditional medicine for childhood illness. Therefore rectal artesunate may be a well-received intervention in Nakonde District, provided effective sensitisation, to mothers and CHWs is given which will strengthen the health care delivery system at community level. PMID:15792501
In developing countries, people are dying from treatable diseases because they cannot reach medical care when they need it most. Typical methods of transport, such as wheelbarrows or motorcycles, are too slow, dangerous, ...
Proposes a model of sexual activity among secondary school-going Zambian girls. Identifies the role of dating as an intervening variable in explaining the variation in sexual activity among teenagers. Schools are an important setting for the young to meet and initiate sexual relationships. Theoretical and policy implications are discussed.…
Storytelling performances collected in 1988-89 from five Bemba-speaking ethnic groups: Bemba, Bisa, Bwile, Lunda and Tabwa. Soundtrack is in original language with English subtitles. Video material is the basis of a book-length study titled...
This paper contrasts two perspectives for evaluating educational programs: (1) a growth curve model of personal development in the sociocultural context; and (2) a narrowing staircase model of educational success. According to the first perspective, development occurs along personal, social, and cognitive dimensions, and arises from the…
Mycoplasma contamination of the licensed anthrax vaccine administered to military personnel has been suggested as a possible cause of Persian Gulf illness. Vaccine samples tested by nonmilitary laboratories were negative for viable mycoplasma and mycoplasma DNA and did not support its survival. Mycoplasma contamination of anthrax vaccine should not be considered a possible cause of illness. PMID:11749759
Mwansa, James; Mutela, Kabanga; Zulu, Isaac; Amadi, Beatrice; Kelly, Paul
Flow in the Zambezi River Basin, the fourth largest river basin in Africa, is highly regulated by several large hydropower structures. However, only 30% of the river's hydropower potential is currently being utilized and multiple new hydropower schemes are planned. While the hydrology of this system has been explored in some detail, there has been limited investigation of how the
M. Kunz; D. B. Senn; S. Thuering; F. S. Anselmetti; B. Wehrli; A. Wueest
Disasters, by definition are events that appear suddenly and with little warning. They are usually short lived, with extreme events bringing death, injury and destruction of buildings and communications. Their aftermath can be as damaging as their physical effects through destruction of sanitation and water supplies, destruction of housing and breakdown of transport for food, temporary shelter and emergency services. Since floods are one of the natural disasters which endanger both life and property, it becomes vital to know its extents and where the hazards exists. Flood disasters manifest natural processes on a larger scale and information provided by Remote Sensing is a most appropriate input to analysis of actual events and investigations of potential risks. An analytical and qualitative image processing and interpretation of Remotely Sensed data as well as other data such as rainfall, population, settlements not to mention but a few should be used to derive good mitigation strategies. Since mitigation is the cornerstone of emergency management, it therefore becomes a sustained action that will reduce or eliminate long term risks to people and property from natural hazards such as floods and their effects. This will definitely involve keeping of homes and other sensitive structures away from flood plains. Promotion of sound land use planning based on this known hazard, "FLOODS" is one such form of mitigation that can be applied in flood affected areas within flood plain. Therefore future mitigation technologies and procedures should increasingly be based on the use of flood extent information provided by Remote Sensing Satellites like the NOAA AVHRR as well as information on the designated flood hazard and risk areas.
This is the final report of a three-and-a-half-year project that pilot tested the usefulness of various information and communication technology (ICT) applications in the provision of literacy programmes. The report is based on data collected by in-country evaluators during the term of the project as well as from a follow-up study a year later.…
Background The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely studied and poorly understood. Methods A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners and 21 prison officers in four Zambian prisons to assess the health and human rights concerns of female detainees. Key informant interviews with 46 officials from government and non-governmental organizations and a legal and policy review were also conducted. Results Despite special protection under international and regional law, incarcerated women's health needs–including prenatal care, prevention of mother-to-child transmission of HIV, and nutritional support during pregnancy and breastfeeding–are not being adequately met in Zambian prisons. Women are underserved by general healthcare programs including those offering tuberculosis and HIV testing, and reported physical and sexual abuse conducted by police and prison officers that could amount to torture under international law. Conclusions There is an urgent need for women's healthcare services to be expanded, and for general prison health campaigns, including HIV and tuberculosis testing and treatment, to ensure the inclusion of female inmates. Abuses against women in Zambian police and prison custody, which violate their rights and compromise their health, must be halted immediately. PMID:21696625
with respect to the measurement of poverty and the concept of participation. Keywords: sustainable development by mainstream thinking on poverty and livelihoods. It champions a neoliberal program constructed on the sanctity the latest in- stallment in the ever-changing fashionable semantics of the "development community
The Third World Science Project (TWSP) is designed to add a multicultural element to existing science syllabi (for students aged 11-16) in the United Kingdom. The project seeks to develop an appreciation of the: boundless facination of the natural world; knowledge, skills, and expertise possessed by men/women everywhere; application of knowledge…
University Coll. of North Wales, Bangor (United Kingdom). School of Education.
BACKGROUND: Population level data on mental health from Africa are limited, but available data indicate mental problems to represent a substantial public health problem. The negative impact of HIV on mental health suggests that this could particularly be the case in high prevalence populations. We examined the prevalence of mental distress, distribution patterns and the ways HIV might influence mental
SummaryGender-based violence was commonly directed against female pupils by teachers and male pupils using non-consensual sex, corporal punishment and abusive language. The victims didn't report the matter for fear of reprisals.ResultsThe pupils were aged between 10 and 21 years (with majority between 16 and 20 years old) and equal gender representation. 29 (58%) pupils reported being sexually abused by teachers,
Numerous observational studies and three clinical trials have shown male circumcision (MC) to be partially protective against HIV acquisition in heterosexual men. This has led to consideration of introducing circumcision as an HIV prevention strategy in parts of sub-Saharan Africa. This study assesses the acceptability of male circumcision as an intervention to improve male genital hygiene and reduce sexually transmitted
over 20,000 Mozambicans for nearly a decade. After the repatriation of Mozambican refugees, Ukwimi evolved into a government-run agricultural resettlement scheme until it's re-opening as a refugee camp for Angolan refugees in 2001. Through theoretically...
At the Second World Water Forum in 2000, the problems relating to water around the world were described as a consequence of the lack of good governance in water. The Global Water Partnership defines water governance as the range of political, social, economic and administrative systems that are in place to develop and manage water resources, and delivery of water
This paper focuses on the application of the participatory research approach in non-Western contexts. The aim is to provide critical insights into the participatory research discourse through an examination of its theory and practice based on our own experiences of using this approach in our doctoral research in five Central Asian countries and…
There is a growing concern in central and southern Africa about the negative effects of deforestation caused by shifting cultivation and charcoal production. In the absence of long-term studies that document and assess impacts of tropical deforestation, it is difficult to evaluate the relevance of current policy interventions that address the negative effects of deforestation. To contribute to the knowledge
Fires are dominant factors in shaping the structure and composition of vegetation in African savanna ecosystems. Emissions such as CO2, NOx, CH4, and other compounds originating from these fires are suspected to contribute substantially to changes in global biogeochemical processes. Limited quantitative data exist detailing characteristics of biomass, burning conditions, and the postfire environment in African savannas. Fourteen test sites,
Ronald W. Shea; Barbara W. Shea; J. Boone Kauffman; Darold E. Ward; Craig I. Haskins; Mary C. Scholes
Governments, UN agencies and international and local NGOs have mounted a concerted effort to remobilise sport as a vehicle for broad, sustainable social development. This resonates with the call for sport to be a key component in national and international development objectives. Missing in these efforts is an explicit focus on physical education within state schools, which still enroll most children in the global South. This article focuses on research into one of the few instances where physical education within the national curriculum is being revitalised as part of the growing interest in leveraging the appeal of sport and play as means to address social development challenges such as HIV/AIDS. It examines the response to the Zambian government's 2006 Declaration of Mandatory Physical Education (with a preventive education focus on HIV/AIDS) by personnel charged with its implementation and illustrates weaknesses within the education sector. The use of policy instruments such as decrees/mandates helps ensure the mainstreaming of physical education in development. However, the urgency required to respond to new mandates, particularly those sanctioned by the highest levels of government, can result in critical pieces of the puzzle being ignored, thereby undermining the potential of physical education (and sport) within development. PMID:21949950
BACKGROUND: The premise for using antenatal care (ANC) clinic data for estimating HIV prevalence in the general population is the finding from community studies in sub-Saharan Africa that total HIV prevalence in pregnant women attending ANC clinics closely approximate levels in the total general population of both women and men aged 15–49 years. In this study, the validity of national
...water sector (i.e., water supply, sanitation, and drainage systems) and architecture...Sector [cir] Water supply [cir] Sanitation [cir] Drainage systems [cir] Engineering...bottom of the pyramid water supply and sanitation service delivery 2. Under Best...
Background Complex biomedical research can lead to disquiet in communities with limited exposure to scientific discussions, leading to rumours or to high drop-out rates. We set out to test an intervention designed to address apprehensions commonly encountered in a community where literacy is uncommon, and where complex biomedical research has been conducted for over a decade. We aimed to determine if it could improve the validity of consent. Methods Data were collected using focus group discussions, key informant interviews and observations. We designed an intervention that exposed participants to a detailed demonstration of laboratory processes. Each group was interviewed twice in a day, before and after exposure to the intervention in order to assess changes in their views. Results Factors that motivated people to participate in invasive biomedical research included a desire to stay healthy because of the screening during the recruitment process, regular advice from doctors, free medical services, and trust in the researchers. Inhibiting factors were limited knowledge about samples taken from their bodies during endoscopic procedures, the impact of endoscopy on the function of internal organs, and concerns about the use of biomedical samples. The belief that blood can be used for Satanic practices also created insecurities about drawing of blood samples. Further inhibiting factors included a fear of being labelled as HIV positive if known to consult heath workers repeatedly, and gender inequality. Concerns about the use and storage of blood and tissue samples were overcome by a laboratory exposure intervention. Conclusion Selecting a group of members from target community and engaging them in a laboratory exposure intervention could be a useful tool for enhancing specific aspects of consent for biomedical research. Further work is needed to determine the extent to which improved understanding permeates beyond the immediate group participating in the intervention. PMID:25254378
These studies represent the first adaptation of the Motivational Interviewing (MI) behavior change approach in the developing world, using health workers directly from the community. The objective was to compare the effectiveness of the standard practice of health education (comparison group) to MI (experimental group) in initiating and sustaining safe water treatment and storage behavior. Methods: focus groups and community
Preservation and conservation of library materials is an important aspect of library and information management. Their importance and necessity are more paramount in countries where resources are limited and libraries need to balance them with the needs of an ever increasing number of students hoping to use them. This article reports on the…
BACKGROUND: Evidence suggests that HIV prevalence amongst young Zambians has declined recently, especially in higher-education groups. We studied trends in key sexual behaviour indicators among 15–24 year-olds from 1995 to 2003, including the associations between sexual behaviour change and education. METHODS: The data stem from a series of three population-based surveys conducted in 1995 (n = 1720), 1999 (n =
Ingvild F Sandřy; Charles Michelo; Seter Siziya; Knut Fylkesnes
The vulnerabilities that underlie barriers faced by the rural poor whilst trying to access and adhere to “free” antiretroviral treatment (ART) demand more attention. This paper highlights barriers that poor rural Zambians co-infected with tuberculosis (TB) and HIV and their households faced in accessing ART between September 2006 and July 2007, and accounts for patient outcomes by the end of
by the lender and how these have been adapted to suit seasonal agricultural production credit requirements. Econometric models are developed to examine the influence of key economic factors such as nominal and real interest rates, loan fees, and loan term...
In areas of Africa hard hit by HIV\\/AIDS, there are growing concerns that many women lose access to land after the death of their husbands. However, there remains a dearth of quantitative evidence on the proportion of widows who lose access to their deceased husband’s land, whether they lose all or part of that land, and whether there are factors
While there is much attention on perceived risk of HIV and subsequent cautionary behavior, evidence of the reciprocity of the relationship between recent risky sexual behavior and perceived risks of HIV infection remains scarce. This paper tests the hypothesis that having multiple sex partners within the last 12 months influences individual's perceived risk of HIV among Zambian men and women.
We have surveyed the impact of chemical hazard label elements on four target sectors, i.e. the agricultural, industrial, transport and the consumer (the general public) sectors, in order to assess the type of reactions the respondents perceive to a given chemical label element such as symbol, hazard phrase, color, and hazard signal word. The survey revealed that the level of education, gender and/or age did not influence the respondents' perception of the extent of hazard but rather familiarity or frequency of use of the chemicals and acquaintance with chemical label elements was significant in the assessment of the extent of perceived hazard posed by a given chemical. Symbols such as the St Andrews Cross--though common--is virtually not understood by more than 80% of the respondents in all the sectors. We noted that respondents appreciate symbols they can relate to, which are flame-like, ghost-like and exert immediate impacts to respondents. Color codes have found use in the agriculture sector because of their ease to be recalled especially by the majority of illiterate farm workers. The survey revealed that red in agricultural circles is well associated with high toxicity while other colors such as yellow and blue can not clearly be associated with hazard. The word "toxic" is not used in the industry and transport sectors where the most hazard signal word is "danger". The Globally Harmonized System (GHS) classification adopted "danger" and "warning" for use as signal words. The survey revealed that effective chemical hazard symbols must not be too abstract to the client but should contain features that are known or easily comprehended. PMID:16426665
Discusses training needs of agricultural students and the process, activities, and resources utilized by a simulation game designed to encourage development of appropriate conflict resolution and communications skills and to create awareness of agricultural extension needs. Summarizes results of field test evaluation of VILLAGE and deficiencies in…
Epilepsy is a neurologic disorder that results in recurrent, unprovoked seizures. The biomedical burden of epilepsy can be substantial, but for many the social consequences may be just as extreme, with epilepsy victims suffering from social abandonment as well as economic and physical vulnerabilities. Since its founding in 2000, the Chikankata…
P a g e | 1 ZAMBIA HUMAN RESOURCES FOR TREATING NEW CANCER CASES IN ZAMBIA Executive Summary The purpose of this report is to describe the human resources needed in Zambia to treat new cancer patients. The population of Zambia is approximately
2011 Summer/Fall Issue Page The Critical Path Working with the Children of Zambia -- As told children in Lusaka, Zambia. Up until that time, I had no idea where Zambia was and was surprised with her with the Children of Zambia Page 1 Message From The Director of Page 2 Personality Tintypes Page 3 The GSFC
Abstracts Background With regards to equity, the objective for health care systems is “equal access for equal needs”. We examined associations of predisposing, enabling and need factors with health facility utilization in areas with high HIV prevalence and few people being aware of their HIV status. Methods The data is from a population-based survey among adults aged 15years or older conducted in 2003. The current study is based on a subset of this data of adults 15–49 years with a valid HIV test result. A modified Health behaviour model guided our analytical approach. We report unadjusted and adjusted odds ratios and their 95% confidence intervals from logistic regression analyses. Results Totals of 1042 males and 1547 females in urban areas, and 822 males and 1055 females in rural areas were included in the study. Overall, 53.1% of urban and 56.8% of rural respondents utilized health facilities past 12 months. In urban areas, significantly more females than males utilized health facilities (OR=1.4 (95% CI [1.1, 1.6]). Higher educational attainment (10+ years of schooling) was associated with utilization of health facilities in both urban (OR=1.7, 95% CI [1.3, 2.1]) and rural (OR=1.4, 95% CI [1.0, 2.0]) areas compared to respondents who attained up to 7 years of schooling. Respondents who self-rated their health status as very poor/ poor/fair were twice more likely to utilize health facilities compared to those who rated their health as good/excellent. Respondents who reported illnesses were about three times more likely to utilize health facilities compared to those who did not report the illnesses. In urban areas, respondents who had mental distress were 1.7 times more likely to utilize health facilities compare to those who had no mental distress. Compared to respondents who were HIV negative, respondents who were HIV positive were 1.3 times more likely to utilize health facilities. Conclusion The health care needs were the factors most strongly associated with health care seeking. After accounting for need differentials, health care seeking differed modestly by urban and rural residence, was somewhat skewed towards women, and increased substantially with socioeconomic position. PMID:23145945
Background Well-documented shortages of health care workers in sub-Saharan Africa are exacerbated by the increased human resource demands of rapidly expanding HIV care and treatment programmes. The successful continuation of existing programmes is threatened by health care worker burnout and HIV-related illness. Methods From March to June 2007, we studied occupational burnout and utilization of HIV services among health providers in the Lusaka public health sector. Providers from 13 public clinics were given a 36-item, self-administered questionnaire and invited for focus group discussions and key-informant interviews. Results Some 483 active clinical staff completed the questionnaire (84% response rate), 50 staff participated in six focus groups, and four individuals gave interviews. Focus group participants described burnout as feeling overworked, stressed and tired. In the survey, 51% reported occupational burnout. Risk factors were having another job (RR 1.4 95% CI 1.2–1.6) and knowing a co-worker who left in the last year (RR 1.6 95% CI 1.3–2.2). Reasons for co-worker attrition included: better pay (40%), feeling overworked or stressed (21%), moving away (16%), death (8%) and illness (5%). When asked about HIV testing, 370 of 456 (81%) reported having tested; 240 (50%) tested in the last year. In contrast, discussion groups perceived low testing rates. Both discussion groups and survey respondents identified confidentiality as the prime reason for not undergoing HIV testing. Conclusion In Lusaka primary care clinics, overwork, illness and death were common reasons for attrition. Programmes to improve access, acceptability and confidentiality of health care services for clinical providers and to reduce workplace stress could substantially affect workforce stability. PMID:19594917
Kruse, Gina R; Chapula, Bushimbwa Tambatamba; Ikeda, Scott; Nkhoma, Mavis; Quiterio, Nicole; Pankratz, Debra; Mataka, Kaluba; Chi, Benjamin H; Bond, Virginia; Reid, Stewart E
In addressing issues related to problems of democratisation in Africa, this paper attempts to relate the issue to the need for citizenship education and the role that can play in social development. Citizenship should be central to the formation of viable civil societies that claim a tangible stake in national public spaces in post-Cold War…
Scarcity of simple and reliable methods of estimating soil organic carbon (SOC) turnover and lack of data from long-term experiments make it difficult to estimate attainable soil C sequestration in tropical improved fallows. Testing and validating existing and widely used SOC models would help to determine attainable C storage in fallows. The Rothamsted C (RothC) model, therefore, was tested using
In response to the declining soil fertility in southern Africa and the negative effects that this leads to, such as food insecurity besides other developmental challenges, fertilizer tree systems (FTS) were developed as technological innovation to help smallholder farmers to build soil organic matter and fertility in a sustainable manner. In this paper, we trace the historical background and highlight
sectors has resulted in water pollution, destruction of fisheries, loss of biodiversity and deforestation. Chinese investors and firms from other countries, whose investments predate those of China, caused these environmental issues. They can also...
??Preintervention Knowledge, Attitudes and Practices with respect to breastfeeding among Healthworkers from Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital (UTH) and mothers… (more)
BackgroundMany HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART) can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation.MethodsA prospective cohort study
Catherine G. Sutcliffe; Janneke H. van Dijk; Bornface Munsanje; Francis Hamangaba; Pamela Siniwymaanzi; Philip E. Thuma; William J. Moss
A case study of a Zambian community-based wildlife project within the Administrative Management Design for Game Management Areas (ADMADE) programme illustrates the role and significance of contextual factors in the action strategies of its two local designated beneficiaries—the local chief and his lineage and members of other lineages. The study describes how each of these wildlife user groups, neither of
Peri-urban communities, which face health risks of both urban and rural environments, have grown extensively with recent global urbanization. These communities' combination of multiple HIV risk factors with the lack of a formalized sexual education system sets the stage for high-risk behavior in peri-urban youth. We conducted a cross-sectional survey of children (ages 5–17, N=331) and accompanying caretakers in peri-urban
Julia Carnevale; Adrienne B. Gropper; Jessica Agnew-Blais; Matthew J. Mimiaga; Anna Mhango; Richard Bail; Mary Ngoma
Youth peer education (YPE) programs are a popular strategy for HIV prevention in sub-Saharan Africa. However, research on the effectiveness of YPE programs is scarce and the wide variation in programs makes it difficult to generalize research findings. Measuring quality and comparing program effectiveness require the use of standardized…
Although there is a growing literature on the clinical performance of visual inspection with acetic acid in HIV-infected women, to the best of our knowledge, none have studied visual inspection with acetic acid enhanced by digital cervicography. We estimated clinical performance of cervicography and cytology to detect cervical intraepithelial neoplasia grade 2 or worse. Sensitivity and specificity of cervicography were 84% [95% confidence interval (CI): 72 to 91) and 58% (95% CI: 52 to 64). At the high-grade squamous intraepithelial lesion or worse cutoff for cytology, sensitivity and specificity were 61% (95% CI: 48 to 72) and 58% (95% CI: 52 to 64). In our study, cervicography seems to be as good as cytology in HIV-infected women. PMID:24977474
Bateman, Allen C; Parham, Groesbeck P; Sahasrabuddhe, Vikrant V; Mwanahamuntu, Mulindi H; Kapambwe, Sharon; Katundu, Katundu; Nkole, Theresa; Mulundika, Jacqueline; Pfaendler, Krista S; Hicks, Michael L; Shibemba, Aaron; Vermund, Sten H; Stringer, Jeffrey S A; Chibwesha, Carla J
Globalization and urbanization with their inherent developmental activities and ecological transformations impact on malaria epidemiology. Entomological factors involved in malaria transmission in periurban Lusaka were assessed prior to vector control reintroduction. Data was collected through standard entomological and epidemiological protocols and a pretested structured questionnaire. Larval habitats were characterized as transient (43%), semipermanent (36%), and permanent (21%). Anopheles arabiensis and An. gambiae ss. were the only vectors identified. A shift in vector population was noted, with the later outnumbering the former. Plasmodium falciparum monoinfection rates were 25.6% (95% CI: 20.9–30.7) (n = 297). Parasitaemia was 31.8% (95% CI: 23.2–42.2), 25.7% (95% CI: 13.5–41.3), and 23.3% (95% CI: 17.4–29.6) in under 5, 5 to 14, and above 15 age groups, respectively. Low knowledge levels on vector control tools with an average of 7 residents per household were also observed. This study confirmed a local malaria transmission paradigm. The epidemiology necessitated deployment of an integrated vector management strategy with intensified information education and communication. PMID:23056060
Chanda, Emmanuel; Baboo, Kumar S.; Shinondo, Cecilia J.
The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. PMID:24786142
BACKGROUND: Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs)
Mosquito net ownership is rising in sub-Saharan Africa but will substantially reduce malaria only if nets are used and the most vulnerable household members sleep under them. We used data from 9 large-scale household surveys conducted in 6 African countries from 2000 to 2004 that enumerated all household members and nets owned, analyzing only net-owning households. Across countries, women of reproductive age and children under 5 (without gender bias) were most likely to use the net; least likely were children of age 5-14 and adult males. Nets commonly covered 2-3 people. If a baby net was used, fewer people used the family net. Pregnant women were more likely to use a net in 2004 than in 2000. In several countries, a sizable minority of nets owned were not used. Understanding intra-household net-use patterns helps malaria control programs more effectively direct their efforts to increase their public health impact. PMID:17984361
In a cluster randomized trial, Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective.
Kojo Yeboah-Antwi; Portipher Pilingana; William B. Macleod; Katherine Semrau; Kazungu Siazeele; Penelope Kalesha; Busiku Hamainza; Phil Seidenberg; Arthur Mazimba; Lora Sabin; Karen Kamholz; Donald M. Thea; Davidson H. Hamer
The purpose of the study conducted from December 2001 through February 2002 was to collect data needed to facilitate the design of a partnership program involving Mpongwe Development Company (MDC) that would enable the adoption of sustainable...
Background Active, population-wide mass screening and treatment (MSAT) for chronic Plasmodium falciparum carriage to eliminate infectious reservoirs of malaria transmission have proven difficult to apply on large national scales through trained clinicians from central health authorities. Methodology Fourteen population clusters of approximately 1,000 residents centred around health facilities (HF) in two rural Zambian districts were each provided with three modestly remunerated community health workers (CHWs) conducting active monthly household visits to screen and treat all consenting residents for malaria infection with rapid diagnostic tests (RDT). Both CHWs and HFs also conducted passive case detection among residents who self-reported for screening and treatment. Results Diagnostic positivity was higher among symptomatic patients self-reporting to CHWs (42.5%) and HFs (24%) than actively screened residents (20.3%), but spatial and temporal variations of diagnostic positivity were highly consistent across all three systems. However, most malaria infections (55.6%) were identified through active home visits by CHWs rather than self-reporting to CHWs or HFs. Most (62%) malaria infections detected actively by CHWs reported one or more symptoms of illness. Most reports of fever and vomiting, plus more than a quarter of history of fever, headache and diarrhoea, were attributable to malaria infection. The minority of residents who participated >12 times had lower rates of malaria infection and associated symptoms in later contacts but most residents were tested <4 times and high malaria diagnostic positivity (32%) in active surveys, as well as incidence (1.7 detected infections per person per year) persisted in the population. Per capita cost for active service delivery by CHWs was US$5.14 but this would rise to US$10.68 with full community compliance with monthly testing at current levels of transmission, and US$6.25 if pre-elimination transmission levels and negligible treatment costs were achieved. Conclusion Monthly active home visits by CHWs equipped with RDTs were insufficient to eliminate the human infection reservoir in this typical African setting, despite reasonably high LLIN/IRS coverage. However, dramatic impact upon infection and morbidity burden might be attainable and cost-effective if community participation in regular testing could be improved and the substantial, but not necessarily prohibitive, costs are affordable to national programmes. PMID:24678631
Liberal and other critics of the ANC in government in South Africa frequently refer to the malign influence of ‘exile’ on the culture of the party, citing alleged secrecy, paranoia and lack of internal democracy, as the inevitable consequences of the years spent abroad – but they do this without much knowledge of the real experience of exile. This article
We measured the level of heavy metal accumulation in lake sediments, herbivorous (Oreochromis niloticus) and carnivorous (Serranochromis thumbergi) fish, and crayfish (Cherax quadricarinatus) from Lake Itezhi-tezhi (ITT) and Lake Kariba. We used atomic absorption spectrophotometry to quantify the levels of seven\\u000a heavy metals (Cr, Co, Cu, Zn, Cd, Pb, and Ni). The sediment and the herbivorous fish O. niloticus accumulated
Shouta M. M. NakayamaYoshinori; Yoshinori Ikenaka; Kaampwe Muzandu; Kennedy Choongo; Balazs Oroszlany; Hiroki Teraoka; Naoharu Mizuno; Mayumi Ishizuka
Summary50 women were enlisted with ages ranging between 18 and 49 years Verbal threats physical beatings, verbal abuse and non-consensual sexual intercourse were the forms Domestic violence took.MethodA semistructured schedule based on Convenience sampling Method was used. The 50 women were drawn from a drop-in centre for abused women in Lusaka.Results29 out of 50 or 58% were married, 7 or
IntroductionThe utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis.ObjectivesTo determine risk factors associated with positive QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) results and the level of agreement between the tests; to explore the hypotheses that positivity in QFT-GIT is more related
Kwame Shanaube; James Hargreaves; Katherine Fielding; Ab Schaap; Katherine-Anne Lawrence; Bernadette Hensen; Charalambos Sismanidis; Angela Menezes; Nulda Beyers; Helen Ayles; Peter Godfrey-Faussett; Madhukar Pai
Background There is an emerging corpus of work on the impact of the HIV\\/AIDS epidemic on education in sub-Saharan Africa. This mainly employs demographic models to make projections of student enrolments and teacher requirements. However, there is a paucity of research in basic schools to examine the experiences of AIDS-affected teachers and students.Purpose This study explored staff and student perceptions
??Moringa oleifera is an important multipurpose tropical tree under-recognized for its nutritional and medicinal properties. Leaves of M. oleifera collected from the sub-Saharan African countries… (more)
Staple food prices in cities in eastern and southern Africa rose sharply between late 2007 and early 2009, leading to estimates of massive increases in food insecurity and hunger. However, in assessing the impacts of soaring food prices on urban consumers’ access to food it is important to consider food price changes relative to changes in per capita incomes. In
Nicole M. Mason; T. S. Jayne; Antony Chapoto; Cynthia Donovan
Generally accepted as universal, the construct of adaptive behavior differs in its manifestations across different cultures and settings. The Vineland-II (Sparrow et al. in "Vineland Adaptive Behavior Scales, Second edn." AGS Publishing, Circle Pines, MN, 2005) was translated into Chitonga and adapted to the setting of rural Southern…
Tan, Mei; Reich, Jodi; Hart, Lesley; Thuma, Philip E.; Grigorenko, Elena L.
BACKGROUND: Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual's perspective on the illness. Although individual variations are important in determining
, Paraguay, Bolivia, Zambia, Angola, and elsewhere. Intensive forestry practiced within subtropical forests storage, and water supplies (1). However, spatially and temporally detailed information on global
[ more news Â»] Most Read ETHIOPIA: Traffickers exploit World Cup fever OPT: Why violence against women\\ETHIOPIA: Traffickers exploit World Cup fever88451\\Analysis: Yemen's aid conundrum88452\\SOUTH AFRICA: More
://www.irinnews.org/Report.aspx?ReportId=88437 Photo: Madeleine Price Ball/Wikimedia Are careers in our DNA code? Africa Asia Middle East reports: Home Africa Asia Middle East Latin America & Caribbean Weekly reports Global Issues In Item Page 2 of 2http://www.irinnews.org/Report.aspx?ReportId=88437 AFRICA: Talking about climate change
The deuterium\\/hydrogen isotope ratios (?D) of xylem waters from pigeon pea (Cajanus cajan) and sesbania (Sesbania sesban) plants grown in semi-arid Zambia were investigated to know the seasonal variation in water sources for those crops. The study was conducted at a field site in the Zambia National Irrigation Research Station from November 2000 until April 2001. We measured the ?D
Zambia like all other countries in the world is faced with environmental problems brought about by a variety of human activities. In Zambia the major environmental issues as identified by Nation Environmental Action Plan (NEAP) of 1994 are water pollution, poor sanitation, land degradation, air pollution, poor waste management, misuse of chemicals, wildlife depletion and deforestation. Zambian has been using
article title: Southern Africa View larger JPEG image ... visibility of smoke plumes and haze. The southern tip of South Africa is at the bottom of the image, and Zambia is at the top. ... MISR Team. Aug 25, 2000 - South Africa to Zambia including the Okavango Delta. project: ...
The purpose of this chapter is to explore the extent to which violence can be said to underlie any form of Stae formation in precolonial Africa. This is done by examining the role of violence in State formation in west central Zambia from the 17th century onwards. The chapter shows that State formation in west central Zambia entailed the imposition
The Nyasaland Emergency in 1959 proved a decisive turning point in the history of the Federation of Rhodesia and Nyasaland, which from 1953 to 1963 brought together the territories of Northern Rhodesia (Zambia), Southern Rhodesia (Zambia) and Nyasaland (Malawi) under a settler-dominated federal government. The British and Nyasaland governments defended the emergency by claiming to have gathered intelligence which showed
Liberia Nigeria South Africa Zambia Cameroon Ghana Libyan Arab Jama. Northern Mariana Island Sri Lanka Haiti Maldives Peru Tanzania-UR Azerbaijan Congo Honduras Mali Philippines Thailand Bahrain Congo DR
Companies (ESCOS): Lessons from Zambia Visit to Hoppecke GmbH Brilon Solar Battery Manufacturing and Recycling Coffee Break Coffee Break Presentations Research Groups University of Oldenburg Burak Turker
...Principe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Swaziland Tanzania Togo Tunisia Uganda Zambia Zimbabwe...China (mainland-born), India, Pakistan, South Korea, Philippines, and Vietnam. Hong Kong...
...Principe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Swaziland Tanzania Togo Tunisia Uganda Zambia Zimbabwe...China [mainland-born], India, Pakistan, South Korea, Philippines, and Vietnam. Hong Kong...
...Principe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Swaziland Tanzania Togo Tunisia Uganda Zambia Zimbabwe...China (mainland-born), India, Pakistan, South Korea, Philippines, and Vietnam. Hong Kong...
Leone, Singapore, Slovakia, Sri Lanka, Sudan, Sweden, Switzerland, Tajikistan, Trinidad and Tobago, Jordan, Kenya, Kyrgyzstan, New Zealand, Nigeria, Panama, Peru, Poland, Republic of South Africa, Romania, Rwanda, Saudi Arabia, Slovakia, Sudan, Turkey, Uganda, Ukraine, United Kingdom, Yemen, Zambia, Zimbabwe
...Mozambique, Nepal, Niger, Rwanda, Samoa, Sao Tome and Principe, Senegal, Sierra Leone, Solomon Islands, Somalia, South Sudan, Tanzania, Timor-Leste, Togo, Tuvalu, Uganda, Vanuatu, Yemen, or Zambia); or (4) A Caribbean...
...Mozambique, Nepal, Niger, Rwanda, Samoa, Sao Tome and Principe, Senegal, Sierra Leone, Solomon Islands, Somalia, South Sudan, Tanzania, Timor-Leste, Togo, Tuvalu, Uganda, Vanuatu, Yemen, or Zambia); or (iv) A Caribbean...
...Mozambique, Nepal, Niger, Rwanda, Samoa, Sao Tome and Principe, Senegal, Sierra Leone, Solomon Islands, Somalia, South Sudan,Tanzania, Timor-Leste, Togo, Tuvalu, Uganda, Vanuatu, Yemen, or Zambia); or (4) A Caribbean...
, Ivory Coast, Kenya, Liberia, Malawi, Mali, Morocco, Mozambique, Namibia, Nigeria, Rwanda, Senegal, South Africa, Sudan, Tanzania, Uganda, Zambia, and Zimbabwe. MSU's work in Africa spans a wide range of human
& Nevis Antilles Cyprus Indonesia New Zealand Sudan Argentina Czech Republic Iran Nicaragua Sierra Leone South Vietnam Canada Guinea Malawi Singapore Uzbekistan Cayman Islands Guyana Malaysia Slovakia Yugoslavia Chile Haiti Mexico Somalia Zambia China Honduras Mongolia South
social marketing in Louisiana, 1993 to 1996. American journal of public healthsocial marketing and reproductive health communication campaigns in Zambia. BMC Public Healthsocial marketing in Louisiana, 1993 to 1996. American journal of public health
??To determine the incidence, common indications,appropriateness and outcome of blood transfusions and blood products among adult in-patients admitted to the University teaching Hospital, Lusaka, Zambia.… (more)
countries as Bolivia, Chad, the Democratic Republic of the Congo, Niger, and Zambia, have more than 95% of their territory within the hydrologic boundaries of one or more international basins. Perhaps even more
associated nephrotic syndrome, pathologic changes, immunoglobulin levels and serum complement pre- and post-treatment with niridazole and ampicillin Kidney Boonpucknavig, S.; et al., 1976, J. Nat. Re- search Council Thailand, v. 8 (1), 51-66 Plasmodium... Irish farm Kidney Fine, J., 1975, Med. J. Zambia, v. 9 (4), 98- 101 survey of post-mortem reports for possible relationships between human schistosomiasis and hydronephrosis: Zambia Kidney Fritel, D.; Bariety, J.; and Gentilini, ?., 1970...
The complement fixation test (CFT), the c-ELISA and an indirect LppQ ELISA were compared to post-mortem (PM) inspection for\\u000a the diagnosis of contagious bovine pleuropneumonia (CBPP). Sera from 797 cattle in the CBPP affected area of Kazungula, Zambia\\u000a and 202 sera from Lusaka, Zambia, a CBPP-free area were used. The clinical history of CBPP was recorded and all the cattle
Geofrey Muuka; Bernard Mudenda Hang’ombe; King Shimumbo Nalubamba; Swithine Kabilika; Lucas Mwambazi; John Bwalya Muma
Zambia like all other countries in the world is faced with environmental problems brought about by a variety of human activities. In Zambia the major environmental issues as identified by Nation Environmental Action Plan (NEAP) of 1994 are water pollution, poor sanitation, land degradation, air pollution, poor waste management, misuse of chemicals, wildlife depletion and deforestation. Zambian has been using a lot of radioactive materials in its various industries. The country has taken several projects with help of external partners. These partners however left these projects in the hands of the Zambians without developing their capacities to manage these radioactive sources. The Government recognized the need to manage these sources and passed legislation governing the management of radioactive materials. The first act of Parliament on Radiation Protection work was passed in 1975 to legislate the use of ionizing radiation. However, because of financial constraints the Country is facing, these regulations have remained unimplemented. Fortunately the international Community has been working in partnership with the Zambian Government in the Management of Radioactive Material. Therefore this paper will present the following aspects of radioactive waste management in Zambia: review Existing Legislation in Zambia regarding management of spent/radioactive sources; capacity building in the field of management of radioactive waste; management of spent and disused radiation sources; existing disposal systems in Zambia regarding spent/orphaned sources; existing stocks of radioactive sources in the Zambian industries.
Sequential band-6 imagery of the Zambesi Basin of southern Africa recorded substantial changes in burn patterns resulting from late dry season grass fires. One example from northern Botswana, indicates that a fire consumed approximately 70 square miles of grassland over a 24-hour period. Another example from western Zambia indicates increased fire activity over a 19-day period. Other examples clearly define the area of widespread grass fires in Angola, Botswana, Rhodesia and Zambia. From the fire patterns visible on the sequential portions of the imagery, and the time intervals involved, the rates of spread of the fires are estimated and compared with estimates derived from experimental burning plots in Zambia and Canada. It is concluded that sequential ERTS-1 imagery, of the quality studied, clearly provides the information needed to detect and map grass fires and to monitor their rates of spread in this region during the late dry season.
Most vital surface water bodies in developing countries are under serious threat of degradation resulting from constant discharge of polluted effluents stemming from industrial, agricultural, mining and domestic/sewage activities. The most affected river systems are those traversing cities and towns in urban areas. The Kafue River in Zambia is one such river system that is threatened with serious degradation and probable loss of biodiversity. Kafue River cuts across the country in a North-South direction, stretches for about 1576 km before draining into the Zambezi River. It covers an area of 152,000 km 2 and generates a mean annual runoff of 350 m 3/s which represents about 12% of the Zambezi’s mean annual runoff at the confluence [Water Resources Development and Vector-borne Diseases in Zambia: Report of a National Seminar held at Kafue Gorge, Zambia, WHO, Geneva, 1995]. The area coverage of the Kafue River Basin (KRB) is approximately 20% of Zambia’s land area (743,000 km 2) and approximately 17% of the Zambezi Basin [Water Resources Use in the Zambezi Basin: Proceedings of a Workshop held at Kasane, Botswana, IUCN, 1993]. More than half of Zambia’s population live in the KRB, of which about 65% are in urban while 35% are in rural areas. Over the years, however, the Kafue River has been receiving all sorts of pollutant and effluents from all sectors of economical development in Zambia that include mining, industrial and agricultural. The continuous discharge of pollutants into the Kafue river has led to the deterioration of the river water quality. The consequences have been heightened eutrophic conditions, increased heavy metal concentration in the river sediments and aquatic life, increased suspended solids, etc. leading to proliferation of Salvinia molesta in some sections of the river, decreased fish catch and fish size and objectionable taste of the Kafue River water. Fishermen along the Chanyanya-Kafue Gorge stretch of the Kafue River have complained about the alleged loss of taste and the decrease in both the fish catch and size in these areas of the Kafue River. The communities along the same stretch have also complained about the objectionable taste of the river water [Report of the Proceedings of the First Multi-sectoral Workshop on the Effects of Environmental Pollution and Degradation on the Kafue River Basin (KRB) on the Community in the Kafue Town Area, AREZ, 2001]. This paper reviews the water quality of the Kafue River resulting from anthropogenic activities and proposes the framework for the sustainable management of river water quality.
in Zambia, as well as in other aid-dependent countries in Sub-Saharan Africa. Keywords: aid effectiveness in countries such as Botswana, Indonesia, South Korea, Tanzania and Mozambique (Radelet, 2006). However, in many other countries, e.g. Chad, the Democratic Republic of Congo6 , Niger, Mali, Central African
Micro-finance institutions are critical to Africa's quest for solutions to the continent's development challenge. The area of their greatest potential impact, rural Africa, is not only home to the bulk of the continent's population, but also the vast majority of Africa's poor. This paper not only defines MFIs with examples from Zambia, South Africa, Mali and Zimbabwe, it also establishes
The Bruchidius centromaculatus group is defined. Six African species of the group with the female pygidium with eye-like foveae are revised. B. meridionalis from Angola, Burundi, Central African Republic, Rwanda, South Africa, Zaire, and Zambia, Bruchidius raddianae from Algeria, Burkina Faso, Egypt, India, Iran, Israel, Jordan, Lybia, Mali, Morocco, Mauritania, Niger, Oman, Saudi Arabia, Senegal, Sri Lanka, Sudan, Tunisia, and
, cell phone batteries are available every- where, so if you're going to design a medical device in a resource- limited place like Zambia, you want it to run on cell phone batteries." It's also a lesson edu- cation must prepare people for success, where success was an ambition to impact society
The privatisation of Zambia's copper mines has paved the way for increased levels of foreign direct investment in the economy. The incentives provided to the mining companies have been very attractive to investors. However, the weakness of the Zambian state is clearly demonstrated in the development agreements it signed with the mining companies at the expense of the welfare of
Objective To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.Design Prospective, cluster randomised and controlled effectiveness study.Setting Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at
Christopher J Gill; Grace Phiri-Mazala; Nicholas G Guerina; Joshua Kasimba; Charity Mulenga; William B MacLeod; Nelson Waitolo; Anna B Knapp; Mark Mirochnick; Arthur Mazimba; Matthew P Fox; Lora Sabin; Philip Seidenberg; Jonathon L Simon; Davidson H Hamer
We estimate semiparametric regression models of chronic undernutrition (stunting) using the 1992 Demographic and Health Surveys (DHS) from Tanzania and Zambia. We focus particularly on the influence of the child's age, the mother's body mass index, and spatial influences on chronic undernutrition. Conventional parametric regression models are not flexible enough to cope with possibly nonlinear effects of the continuous covariates
Ngianga B. Kandala; Stefan Lang; Stephan Klasen; Ludwig Fahrmeir
Examples are presented of applications of a fast Fourier transform algorithm to analyze time series of images of Normalized Difference Vegetation Index values. The results obtained for a case study on Zambia indicated that differences in vegetation development among map units of an existing agroclimatic map were not significant, while reliable differences were observed among the map units obtained using the Fourier analysis.
Menenti, M.; Azzali, S.; Verhoef, W.; Van Swol, R.
...species of equidae if captured in the wild or imported from a zoo or other facility where it would be unlikely that the animal...Vietnam, Zaire, Zambia, Zimbabwe, or any other region of the world where screwworm is considered to exist may be imported into...
URBAN EXTENTS Botswana Congo, Democra Congo Namibia Zambia GRUMPv1 A t l a n t i c O c e a n ďż˝ 0 250 500 Km Lambert Azimuthal Equal Area Projection Urban Extent Administrative Units National Boundaries Note: National boundaries are derived from the population grids and thus may appear coarse. Urban
, South Africa, Sudan, and Zambia (0% of the region's population). For these countries FAO biomass will market opportunities that could be used to re- invest in restorative land management practices and charcoal pro- duction Definitions Group 1: Business as usual scenarios B u s i n e s s - a s - usual (BAU
, but does not necessarily reflect nationality or ethnicity. South America 9 North America 1,492 (USA: 1 Ghana 2 South Korea 2 Kenya 4 Sri Lanka 1 Bolivia 2 Liberia 1 Taiwan 1 Brazil 1 Malawi 2 Tibet Peru 1 Sudan 1 Yemen 3 Total 9 Tanzania 2 Total 49 Uganda 2 Grand Total 1,604 Zambia 1 Zimbabwe 4
exchanges and collaboration between scientists from the countries of the South and of the industrial Ocean: South Africa, Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde-et-Principe, Senegal, Seychelles, Sierra Leone, Somalia, Sudan, Swaziland, Tanzania, Chad, Togo, Tunisia, Zambia
RWANDA NIGER THE GAMBIA CAPE VERDE D'IVOIRE NIGERIA AFRICAN REPUBLIC SUDAN SOUTH SUDAN CHAD LIBYA ALGERIA ZAMBIA SOUTH ANGOLA NAMIBIA GABON CENTRAL EQUATORIAL GUINEA BENIN Cďż˝TE GHANA SWAZILAND LESOTHO BURUNDI GUATEMALA PANAMACOSTA EL SALVADOR RICA NICARAGUA JAMAICA THE BAHAMAS HAITI DOMINICAN REPUBLIC SOUTH THAILAND
, Sudan, South Sudan, Swaziland, Tanzania, Togo, Uganda, Zaire, Zambia, Zimbabwe The MasterCard Foundation Fellowships Programs AFRICAN STUDIES CENTER Africa Malawi; South Africa; Burundi; Mozambique; Kenya; Rwanda, Niger, Nigeria, Rwanda, Sao Tome and Principe, Sinegal, Seychelles, Sierra Leone, Somalia, South Africa
1 Morocco 1 Mozambique 1 Namibia 1 Niger 1 Nigeria 13 Senegal 1 South Africa 14 Sudan 2 Tanzania 2 Uganda 1 Zambia 1 Asia 2,459 East Asia 1,389 China 790 Hong Kong 20 Japan 58 North Korea 3 South Korea 353 Taiwan 165 South and Central Asia 942 Bangladesh 22 India 864 Kazakhstan 12 Nepal 16 Pakistan 15
have white venters, and those from east Africa and Sudan are gray to gray-brown. Most individuals have). DISTRIBUTION. Chaerephon chapini is widespread in Af- rica from Ghana in the northwest to Sudan, Uganda, and Kenya and south to Zambia, Zimbabwe, Botswana, and Namibia (Fig. 2). No fossils are known. FORM
For 30 years, the Academy for Educational Development (AED) has worked to support African development. In Uganda, Tanzania, and Botswana AED promoted some of Africa's first AIDS prevention programs. AED is funding research in Ethiopia, Tanzania, and perhaps Zambia that will target stigma and its role in AIDS prevention. Working with governments…
Academy for Educational Development, Washington, DC.
In four crowded townships of Lusaka, Zambia, the prevalence of cryptosporidiosis in 222 children with diarrhea was 18%, with marked temporal and geographic variation over the course of one rainy season. Using data on the finding of oocysts ofCryptosporidium parvumin urban water supplies, the areas under study were categorized as high or low risk. Prevalence of cryptosporidiosis in children with
MBIKO NCHITO; PAUL KELLY; SANDIE SIANONGO; NKANDU P. LUO; ROGER FELDMAN; MICHAEL FARTHING; K. SRI BABOO
A survey of basic education in 13 Eastern African countries (Madagascar, Burundi, Comores, Ethiopia, Mauritius, Botswana, Kenya, Lesotho, Swaziland, Tanzania, Zambia, Malawi, and Somalia) covers basic education programs and UNICEF's supporting role. Basic education is seen as a concept evolved in the region, involving formal school systems and…
United Nations Educational, Scientific, and Cultural Organization, Nairobi (Kenya). Regional Office of Science and Technology for Africa.
Description of education services to refugees in Africa focuses on three case studies: Institute of In-Service Teacher Training (IITT) in Somalia; Sudan Extension Unit (SEU); and Namibian Extension Unit (NEU) in Angola and Zambia. Highlights include refugee problems, the relevance of distance and open learning approaches, and international…
A half century ago, when there were fewer fossils (and not so many paleoanthropologists), characterizing the genus Homo was relatively straightforward. In addition to modern humans, Neanderthals could be included, along with other archaics such\\u000a as Broken Hill (now Kabwe) from Zambia and the Ngandong assemblage from Java. Also, it was becoming clear that Atlanthropus from northern Africa, and Pithecanthropus
An intercountry workshop on distance learning (DL) was conducted at the University of Khartoum, Sudan, in November 1991. Individuals involved in the World Health Organization's (WHO's) Health Learning Materials network in nine African countries (Sudan, Ethiopia, Guyana, Kenya, Mauritius, Tanzania, Uganda, Zambia, and Zimbabwe) met to share their…
The geo-demographic, economic, and infrastructural makeup of 12 African countries (Botswana. Gambia, Kenya, Lesotho, Malawi, Nigeria, Sierra Leone, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) were compared to determine the potential benefits to them of a Commonwealth of Learning (COL) distance education initiative. Data were collected on…
INTELECON Research & Consultancy Ltd., Vancouver (British Columbia).
for businesses, especially to women AIDS support, de-worming treatment, and vaccines Clean water and well: Bolivia and Haiti Africa: Burkina Faso, Chad, Congo, Kenya, Niger, Rwanda, Somalia, Sudan, Uganda, Zambia: Provide clean water and dug wells- waterborne infection common even before the earthquake Provide
, dedicated to the peace and conflict resolution on the continent. Kaunda is now devoting his life to fighting to the establishment of peace and conflict resolution on the continent. Kaunda is now devoting his life to fighting HIV of the Republic of Zambia from 1964 to 1991. In 1992, Kaunda founded the Kenneth Kaunda Peace Foundation
This article looks at the influence of Bemba music on politics in Zambia. It covers close to four decades of Bemba music in Zambian politics from pre- and post-independence in 1964 up to 2008. Starting with the Bemba dirge, the article shows how Zambian music in popular (or pop) culture has crisscrossed with music in politics. In order to sharpen
During the last decade, the seed sector has been included in economic reform programmes in a number of countries in sub-Saharan Africa but it is not clear whether these initiatives have helped or hindered the process of improving small farmers' access to improved seed. This study explores this issue using the contrasting experiences of the seed sector in Malawi, Zambia
This paper aims to explain why divergentpopulation policies and programs arise in otherwisesimilar countries and to clarify how such policiesrelate to fertility decline. An analysis wasundertaken of demographic and policy change over a 30year period in four pairs of developing countries: Algeria and Tunisia; Bangladesh and Pakistan; thePhilippines and Thailand; and Zambia and Zimbabwe. Insome countries, popular demand for family
" the conservation sta- tus of their elephants to allow sale of stock- piled ivory. But just 2 years after CITES placed a 9-year moratorium on future ivory sales (1), elephant poaching is on the rise. The petitioning enforcement is effective, and sales will not be detrimental to elephants. Yet, Zambia Elephants, Ivory
the earliest stone technologies known, with well-dated Oldowan sites occurring in eastern Africa between w 2. The results suggest Mode 1 technology in the Luangwa Valley may post-date the Oldowan in eastern and southern's personal copy The dating and interpretation of a Mode 1 site in the Luangwa Valley, Zambia Lawrence Barham
ObjectiveIn Zambia, where emergency medical services are very limited, the police are frequently called to the scene for unaccompanied people experiencing seizures or exhibiting disturbed behaviors during a seizure. Police officers receive no formal medical training to manage such encounters. We developed and administered a police-specific survey to assess knowledge, attitudes, and practices (KAP) regarding epilepsy among police officers in
Edward Mbewe; Alan Haworth; Masharip Atadzhanov; Elwyn Chomba; Gretchen L. Birbeck
Cooperative breeding has been described for several cichlids from the genus Julidochromis (Perciformes: Cichlidae) under laboratory conditions, but field evidence is scarce. Here we describe the breeding system of the cichlid Julidochromis ornatus (Boulenger) in Lake Tanganyika (Zambia). Groups defended a breeding shelter under a large flat stone. Smaller group members stayed and fed under or close to the stone,
The Public Health Leadership Program (PHLP) hosted a first-ever "Gathering" on April 11, 2014 School of Global Public Health Alumni Association, the event focused on connectivity, providing at the Gillings School of Global Public Health, led the group from his hotel room in Zambia. (The original plan
The status of student political activism in the 1970s and 1980s in such nations as the United States, Britain, India, Japan, Italy, Canada, West Germany, Greece, Zambia and Latin America is examined. The volume consists of 13 chapters written by scholars who all agree that student activism is not now at peak levels of the 1960s, yet student…
organizations (e.g. universities, industries, and NGOs) in Malawi, Tanzania, Zambia, India, Vietnam, Nepal of food systems Areas of work include: population growth, climate change and pressure on the land, rapid urbanization and their impact on food production. GCFSI also focuses on ICT solutions to address the pressures
Ogilby, 1838:5. Type locality ``Damara- land, South West Africa.'' Georychus lugardi De Winton, 1898,'' Zambia. Cryptomys ovamboensis Roberts, 1946:315. Type locality ``On- dongwa, Ovamboland, South West vagina and prominent mammae. C. damarensis has 6 paired mam- mae (4 pectoral, 2 inguinal). Body
Because social support persons are excluded from modern obstetric care in Zambia, the aim of this study was to explore the views of 84 mothers and 40 health staff about allowing women to be attended by a supportive companion during labor in Zambian urban and rural maternities. Most of the mothers wanted a companion present to provide emotional and practical
Margaret C Maimbolwa; Nsama Sikazwe; Bawa Yamba; Vinod Diwan; Anna-Berit Ransjö-Arvidson
Although urban planners in Third World countries enjoy relatively high levels of power and autonomy, little is known about their values, attitudes, and professional role orientations. The findings are reported of a questionnaire survey designed to elicit information on the professional culture of planners from Barbados, India, Jamaica, Zambia, and Zimbabwe. Particular attention is given to respondents' perceived attributes of
This paper explores dependent development, industrialisation and transitions to the semiperiphery, examining tensions between geopolitics, racial and class conflict that evolved into a ‘reciprocal blockade’ in the Central African Federation (CAF), comprising Southern Rhodesia (now Zimbabwe), Northern Rhodesia (Zambia) and Nyasaland (Malawi). The 1923 transfer of power from the chartered British South Africa Company to a semi-autonomous, settler-dominated government in
By the late nineteenth century, Victoria Falls was a popular travel destination for Europeans, South Africans, and Americans who hoped to find adventure amidst what they deemed a wild physical and cultural landscape. Although a tourism industry was first established on the northern side of the Zambezi (Zambia), the southern side of the Falls (Zimbabwe) quickly joined in commercial development.
The failure of conventional wildlife management in Eastern and Southern Africa has led several countries to implement community-based wildlife programs. We examine the assumptions these initiatives make about rural hunters, and describe how the programs attempt to induce individuals away from illegal hunting. Using game theory and a case study from Zambia, we find that these programs misunderstand some of
Democratic Republic of the Congo 3 Republic of Zambia 2 Republic of Zimbabwe 1 The Republic of the Sudan 2 of Luxembourg 1 Romania 2 Russia 11 NIS NIS 34 Arab Republic of Egypt 12 Federal Democratic Republic,50,46,6 2011 5 Republic of Azerbaijan 3 Republic of Italy 1 Ukraine 5 Republic of Uzbekistan 2 United
Namibia is a vast and arid African country neighbouring South Africa, Botswana, Zimbabwe, Zambia, Angola and the Atlantic Ocean, with a population of only two million. Namibia achieved its independence in 1990 after a protracted and brutal struggle, latterly against South African occupation, but rooted in the resistance to German colonisation that…
This study explores the language policy and practice of the Southern African Development Community (SADC), an African regional economic organisation made up of 14 member states (Angola, Botswana, Democratic Republic of Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, South Africa, Swaziland, United Republic of Tanzania, Zambia…
This book reviews trends in household well-being in Africa during the 1990s. Using the better data sets now available, the main factors behind observed poverty changes are examined in eight countries: Ethiopia, Ghana, Madagascar, Mauritania, Nigeria, Uganda, Zambia, and Zimbabwe. A broad view of poverty is taken, which includes income poverty and…
, Zambia, and Zanzibar--sustained control could avert about 151 million malaria cases over the next five years, similar in impact to childhood vaccination campaigns Â· Sustained control could avert costs absenteeism Â· Sustained control is a"best buy"in glob