Access, Quality, and Opportunity: A Case Study of Zambia Open Community Schools (ZOCS)

ERIC Educational Resources Information Center

Mwalimu, Michelle

2011-01-01

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…

Urbanization in Zambia. An International Urbanization Survey Report to the Ford Foundation.

ERIC Educational Resources Information Center

Simmance, Alan J. F.

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…

An analytical perspective of Global health initiatives in Tanzania and Zambia.

PubMed

Mwisongo, Aziza; Soumare, Alice Ntamwishimiro; Nabyonga-Orem, Juliet

2016-07-18

A number of Global health initiatives (GHIs) have been created to support low and middle income countries. Their support has been of different forms. The African Region has benefitted immensely from GHIs and continues to register an increase in health partnerships and initiatives. However, information on the functioning and operationalisation of GHIs in the countries is limited. This study involved two country case studies, one in Tanzania and the other one in Zambia. Data were collected using a semi-structured questionnaire. The aims were to understand and profile the GHIs supporting health development and to assess their governance and alignment with country priorities, harmonisation and alignment of their interventions and efforts, and contribution towards health systems strengthening. The respondents included senior officers from health stakeholder agencies at the national and sub-national levels. The qualitative data were analysed using thematic content analysis in MAXQDA software. Health systems in both Tanzania and Zambia are decentralised. They have benefitted from GHI support in fighting the common health problems of HIV/AIDS, tuberculosis, malaria and vaccine-preventable diseases. In both countries, no GHI adequately made use of the existing Sector-wide Approach (SWAp) mechanisms but they largely operate through their unique structures and committees. GHI efforts to improve general health governance have not been matched with similar efforts from the countries. Their support to health system strengthening has not been comprehensive but has involved the selection of a few areas some of which were disease-focused. On the positive side, however, in both Tanzania and Zambia improved alignment with the countries' priorities is noted in that most of the proposals submitted to the GHIs refer to the priorities, objectives and strategies in the national health development plans and, GHIs depend on the national health information systems. GHIs are important funders

200 junior doctors sacked in Zambia.

PubMed

Ahmad, K

2000-07-29

Since December 1999 junior doctors in Zambia have been on strike, demanding from the government better working conditions, better pay, and improvements in hospital services. However, on June 20, 2000, around 200 junior doctors were dismissed by the Zambian government, who asserts that the action was taken in the public¿s interest. Nevertheless, the doctors argue that the move came at a time when the country is struggling with a critical shortage of doctors and with an HIV/AIDS crisis. In addition, health policy experts say that the dismissal could further undermine the alarming conditions of Zambia's health care system. It is noted that there are only 800 doctors registered with the Zambian Medical Council, but WHO estimates that the country needs 1500 clinicians. To meet such a shortage, the government has hired Cuban and Chinese doctors. They are paid more and given more benefits than the Zambian doctors, generating complaints from the president of the junior doctors' representative body.

The Audio-Visual Services in Fifteen African Countries. Comparative Study on the Administration of Audio-Visual Services in Advanced and Developing Countries. Part Four. First Edition.

ERIC Educational Resources Information Center

Jongbloed, Harry J. L.

As the fourth part of a comparative study on the administration of audiovisual services in advanced and developing countries, this UNESCO-funded study reports on the African countries of Cameroun, Republic of Central Africa, Dahomey, Gabon, Ghana, Kenya, Libya, Mali, Nigeria, Rwanda, Senegal, Swaziland, Tunisia, Upper Volta and Zambia. Information…

An Examination of Professionalism in the Zambia Army

DTIC Science & Technology

2014-12-12

corporateness . According to Huntington’s definition, professional officers should never intervene in politics, because officers would lose their...colonial Masters. Therefore, they depicted the African worker as powerless and devoid of self -awareness. This study seeks to put an officer in an African...the Zambia National Broadcasting Corporation radio station that he had taken over the reign of the country in a military coup. The coup was thwarted

Predictors of Attitudes toward Intimate Partner Violence: A Comparative Study of Men in Zambia and Kenya

ERIC Educational Resources Information Center

Lawoko, Stephen

2008-01-01

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…

Facilitators and barriers for HIV-testing in Zambia: A systematic review of multi-level factors.

PubMed

Qiao, Shan; Zhang, Yao; Li, Xiaoming; Menon, J Anitha

2018-01-01

It was estimated that 1.2 million people live with HIV/AIDS in Zambia by 2015. Zambia has developed and implemented diverse programs to reduce the prevalence in the country. HIV-testing is a critical step in HIV treatment and prevention, especially among all the key populations. However, there is no systematic review so far to demonstrate the trend of HIV-testing studies in Zambia since 1990s or synthesis the key factors that associated with HIV-testing practices in the country. Therefore, this study conducted a systematic review to search all English literature published prior to November 2016 in six electronic databases and retrieved 32 articles that meet our inclusion criteria. The results indicated that higher education was a common facilitator of HIV testing, while misconception of HIV testing and the fear of negative consequences were the major barriers for using the testing services. Other factors, such as demographic characteristics, marital dynamics, partner relationship, and relationship with the health care services, also greatly affects the participants' decision making. The findings indicated that 1) individualized strategies and comprehensive services are needed for diverse key population; 2) capacity building for healthcare providers is critical for effectively implementing the task-shifting strategy; 3) HIV testing services need to adapt to the social context of Zambia where HIV-related stigma and discrimination is still persistent and overwhelming; and 4) family-based education and intervention should involving improving gender equity.

Linking national and global population agendas: case studies from eight developing countries.

PubMed

Lee, K; Walt, G

1995-06-01

This comparative study of the determinants of family planning policy initiation and implementation focuses on four pairs of countries: Zambia/Zimbabwe, Algeria/Tunisia, Pakistan/Bangladesh, and Philippines/Thailand. The conclusion is drawn that global efforts had an influence on national policy makers and on putting family planning issues on the policy agenda. Global impacts were affected by national economic and social conditions and the broader political and economic relations with Western countries. The absolute level of economic development was found to be unrelated to the timing of initiation of family planning on national policy agendas. Stronger national family planning programs occurred in countries where policy makers linked economic development at whatever level with the need to limit population growth. Pakistan and Thailand in the 1960s illustrated this commitment to family planning programs, and Zambia and Algeria illustrated the lack of connection between development and population growth at the policy level and the lack of family planning on the policy agenda. Affiliation with the West during the 1960s meant early initiation of family planning in Pakistan/Bangladesh and Philippines/Thailand. Stronger commitment to program implementation occurred only in Thailand during the 1970s and Zimbabwe during the 1980s. Commitment lessened in the Philippines and Pakistan. Program implementation and national support of family planning were viewed as also dependent upon domestic factors, such as sufficient resources. Algeria/Tunisia and Zambia/Zimbabwe were countries that promoted family planning only after national political ideology shifted and anti-imperialist sentiments subsided. The impact of the international Cairo conference on these countries was minimal in terms of policy change. Most of the countries however desired greater support from donors. Even objections from the Vatican and internal domestic pressures were insufficient to prevent countries such as

Multi-country analysis of treatment costs for HIV/AIDS (MATCH): facility-level ART unit cost analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia.

PubMed

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

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. 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). 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.

Multi-Country Analysis of Treatment Costs for HIV/AIDS (MATCH): Facility-Level ART Unit Cost Analysis in Ethiopia, Malawi, Rwanda, South Africa and Zambia

PubMed Central

Tagar, Elya; Sundaram, Maaya; Condliffe, Kate; Matatiyo, Blackson; Chimbwandira, Frank; Chilima, Ben; Mwanamanga, Robert; Moyo, Crispin; Chitah, Bona Mukosha; Nyemazi, Jean Pierre; Assefa, Yibeltal; Pillay, Yogan; Mayer, Sam; Shear, Lauren; Dain, Mary; Hurley, Raphael; Kumar, Ritu; McCarthy, Thomas; Batra, Parul; Gwinnell, Dan; Diamond, Samantha; Over, Mead

2014-01-01

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

Epilepsy Care in Zambia: A Study of Traditional Healers

PubMed Central

Baskind, Roy; Birbeck, Gretchen

2005-01-01

Summary Purpose Most people with epilepsy (PWE) reside in developing countries with limited access to medical care. In sub-Saharan Africa (SSA), traditional healers (THs) play a prominent role in caring for PWE, yet little is known about epilepsy care by THs. We conducted a multimethod, qualitative study to better understand the epilepsy care delivered by THs in Zambia. Methods We conducted focus-group discussions with THs, in-depth semistructured interviews with a well-recognized TH at his place of work, and multiple informal interviews with health-care providers in rural Zambia. Results THs recognize the same symptoms that a neurologist elicits to characterize seizure onset (e.g., olfactory hallucinations, jacksonian march, automatisms). Although THs acknowledge a familial propensity for some seizures and endorse causes of symptomatic epilepsy, they believe witchcraft plays a central, provocative role in most seizures. Treatment is initiated after the first seizure and usually incorporates certain plant and animal products. Patients who do not experience further seizures are considered cured. Those who do not respond to therapy may be referred to other healers. Signs of concomitant systemic illness are the most common reason for referral to a hospital. As a consequence of this work, our local Epilepsy Care Team has developed a more collaborative relationship with THs in the region. Conclusions THs obtain detailed event histories, are treatment focused, and may refer patients who have refractory seizures to therapy to other healers. Under some circumstances, they recognize a role for modern health care and refer patients to the hospital. Given their predominance as care providers for PWE, further understanding of their approach to care is important. Collaborative relationships between physicians and THs are needed if we hope to bridge the treatment gap in SSA. PMID:16026565

Cost of abortions in Zambia: A comparison of safe abortion and post abortion care.

PubMed

Parmar, Divya; Leone, Tiziana; Coast, Ernestina; Murray, Susan Fairley; Hukin, Eleanor; Vwalika, Bellington

2017-02-01

Unsafe abortion is a significant but preventable cause of maternal mortality. Although induced abortion has been legal in Zambia since 1972, many women still face logistical, financial, social, and legal obstacles to access safe abortion services, and undergo unsafe abortion instead. This study provides the first estimates of costs of post abortion care (PAC) after an unsafe abortion and the cost of safe abortion in Zambia. In the absence of routinely collected data on abortions, we used multiple data sources: key informant interviews, medical records and hospital logbooks. We estimated the costs of providing safe abortion and PAC services at the University Teaching Hospital, Lusaka and then projected these costs to generate indicative cost estimates for Zambia. Due to unavailability of data on the actual number of safe abortions and PAC cases in Zambia, we used estimates from previous studies and from other similar countries, and checked the robustness of our estimates with sensitivity analyses. We found that PAC following an unsafe abortion can cost 2.5 times more than safe abortion care. The Zambian health system could save as much as US$0.4 million annually if those women currently treated for an unsafe abortion instead had a safe abortion.

An Integrated Hydro-Economic Model for Economy-Wide Climate Change Impact Assessment for Zambia

NASA Astrophysics Data System (ADS)

Zhu, T.; Thurlow, J.; Diao, X.

2008-12-01

Zambia is a landlocked country in Southern Africa, with a total population of about 11 million and a total area of about 752 thousand square kilometers. Agriculture in the country depends heavily on rainfall as the majority of cultivated land is rain-fed. Significant rainfall variability has been a huge challenge for the country to keep a sustainable agricultural growth, which is an important condition for the country to meet the United Nations Millennium Development Goals. The situation is expected to become even more complex as climate change would impose additional impacts on rainwater availability and crop water requirements, among other changes. To understand the impacts of climate variability and change on agricultural production and national economy, a soil hydrology model and a crop water production model are developed to simulate actual crop water uses and yield losses under water stress which provide annual shocks for a recursive dynamic computational general equilibrium (CGE) model developed for Zambia. Observed meteorological data of the past three decades are used in the integrated hydro-economic model for climate variability impact analysis, and as baseline climatology for climate change impact assessment together with several GCM-based climate change scenarios that cover a broad range of climate projections. We found that climate variability can explain a significant portion of the annual variations of agricultural production and GDP of Zambia in the past. Hidden beneath climate variability, climate change is found to have modest impacts on agriculture and national economy of Zambia around 2025 but the impacts would be pronounced in the far future if appropriate adaptations are not implemented. Policy recommendations are provided based on scenario analysis.

Improving Allocation And Management Of The Health Workforce In Zambia.

PubMed

Walsh, Fiona J; Musonda, Mutinta; Mwila, Jere; Prust, Margaret Lippitt; Vosburg, Kathryn Bradford; Fink, Günther; Berman, Peter; Rockers, Peter C

2017-05-01

Building a health workforce in low-income countries requires a focused investment of time and resources, and ministries of health need tools to create staffing plans and prioritize spending on staff for overburdened health facilities. In Zambia a demand-based workload model was developed to calculate the number of health workers required to meet demands for essential health services and inform a rational and optimized strategy for deploying new public-sector staff members to the country's health facilities. Between 2009 and 2011 Zambia applied this optimized deployment policy, allocating new health workers to areas with the greatest demand for services. The country increased its health worker staffing in districts with fewer than one health worker per 1,000 people by 25.2 percent, adding 949 health workers to facilities that faced severe staffing shortages. At facilities that had had low staffing levels, adding a skilled provider was associated with an additional 103 outpatient consultations per quarter. Policy makers in resource-limited countries should consider using strategic approaches to identifying and deploying a rational distribution of health workers to provide the greatest coverage of health services to their populations. Project HOPE—The People-to-People Health Foundation, Inc.

Antimicrobial Resistant Enteropathogenic Escherichia coli and Salmonella spp. in Houseflies Infesting Fish in Food Markets in Zambia.

PubMed

Songe, Mwansa M; Hang'ombe, Bernard M; Knight-Jones, Theodore J D; Grace, Delia

2016-12-28

Diarrhea is one of the most common diseases and is a leading cause of death in developing countries. This is often caused by contaminated food. Poor food hygiene standards are exacerbated by the presence of flies which can transmit a variety of infectious microorganisms, particularly through animal source foods. This fact becomes especially important in developing countries like Zambia, where fish is a highly valued source of protein. Our interest in this study was to identify if the flies that beset food markets in Zambia carry important pathogenic bacteria on their bodies, and subsequently if these bacteria carry resistance genes to commonly used antibiotics, which would indicate problems in eradicating these pathogens. The present study took into account fish vendors' and consumers' perception of flies and interest in interventions to reduce their numbers. We conducted semi-structured interviews with (1) traders (comprised of randomly selected males and females) and (2) consumers (including randomly selected males and females). Thereafter, we collected flies found on fish in markets in Mongu and Lusaka districts of Zambia. For the entire study, a total of 418 fly samples were analyzed in the laboratory and Salmonella spp. and enteropathogenic Escherichia coli were isolated from the flies. Further laboratory screening revealed that overall, 17.2% (72/418) (95% CI; 43.2%-65.5%) of total samples analyzed contained Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli . These significant findings call for a strengthening of the antibiotic administering policy in Zambia and the development of sustainable interventions to reduce fly numbers in food markets and improve food safety and hygiene.

Ethnoveterinary treatments for common cattle diseases in four districts of the Southern Province, Zambia.

PubMed

Syakalima, Michelo; Simuunza, Martin; Zulu, Victor Chisha

2018-02-01

Ethno veterinary knowledge has rarely been recorded, and no or limited effort has been made to exploit this knowledge despite its widespread use in Zambia. This study documented the types of plants used to treat important animal diseases in rural Zambia as a way of initiating their sustained documentation and scientific validation. The study was done in selected districts of the Southern Zambia, Africa. The research was a participatory epidemiological study conducted in two phases. The first phase was a pre-study exploratory rapid rural appraisal conducted to familiarize the researchers with the study areas, and the second phase was a participatory rural appraisal to help gather the data. The frequency index was used to rank the commonly mentioned treatments. A number of diseases and traditional treatments were listed with the help of local veterinarians. Diseases included: Corridor disease (Theileriosis), foot and mouth disease, blackleg, bloody diarrhea, lumpy skin disease, fainting, mange, blindness, coughing, bloat, worms, cobra snakebite, hemorrhagic septicemia, and transmissible venereal tumors. The plant preparations were in most diseases given to the livestock orally (as a drench). Leaves, barks, and roots were generally used depending on the plant type. Ethno veterinary medicine is still widespread among the rural farmers in the province and in Zambia in general. Some medicines are commonly used across diseases probably because they have a wide spectrum of action. These medicines should, therefore, be validated for use in conventional livestock healthcare systems in the country to reduce the cost of treatments.

Etiologic pattern of genital ulcers in Lusaka, Zambia: has chancroid been eliminated?

PubMed

Makasa, Mpundu; Buve, Anne; Sandøy, Ingvild Fossgard

2012-10-01

Genital ulcers are a public health problem in developing countries. The World Health Organization recommends the use of syndromic guidelines for sexually transmitted infection treatment in resource-constrained countries. Monitoring local etiologies provides information that may aid policy for sexually transmitted infection treatment. We investigated the etiology of genital ulcer disease among outpatients in Lusaka, Zambia. Swabs from genital ulcers of 200 patients were tested using polymerase chain reaction for Treponema pallidum, herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), Haemophilus ducreyi, and Chlamydia trachomatis. The prevalence of the detected pathogens was as follows; HSV-2, 28%; T. pallidum, 11.5%; C. trachomatis, 3%; HSV-1, 0.5%; and H. ducreyi, 0%. Coinfection with HSV-2 and T. pallidum was 1.5%, and coinfection of HSV-2 and C. trachomatis was 1%. In 55% of the patients, no etiologic diagnosis could be established. H. ducreyi was not detected, whereas HSV-2 and T. pallidum were the commonest pathogens. Nondetection of H. ducreyi requires further studies. If the present findings are validated, treatment guidelines would require to be revised in Zambia.

Catholic Schools in Zambia: 1891-1924.

ERIC Educational Resources Information Center

Carmody, Brendan

1999-01-01

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)

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

Deschooling Language Study in East Africa: The Zambia Plan.

ERIC Educational Resources Information Center

Roberts, David Harrill

The second language learning methods of Southern Baptist missionaries in Zambia are described. Instead of studying the new language in a school setting, the student receives a week of orientation and is then placed in the community and expected to practice communicating with the native speakers at every opportunity. The student follows a course…

Antimicrobial Resistant Enteropathogenic Escherichia coli and Salmonella spp. in Houseflies Infesting Fish in Food Markets in Zambia

PubMed Central

Songe, Mwansa M.; Hang’ombe, Bernard M.; Knight-Jones, Theodore J. D.; Grace, Delia

2016-01-01

Diarrhea is one of the most common diseases and is a leading cause of death in developing countries. This is often caused by contaminated food. Poor food hygiene standards are exacerbated by the presence of flies which can transmit a variety of infectious microorganisms, particularly through animal source foods. This fact becomes especially important in developing countries like Zambia, where fish is a highly valued source of protein. Our interest in this study was to identify if the flies that beset food markets in Zambia carry important pathogenic bacteria on their bodies, and subsequently if these bacteria carry resistance genes to commonly used antibiotics, which would indicate problems in eradicating these pathogens. The present study took into account fish vendors’ and consumers’ perception of flies and interest in interventions to reduce their numbers. We conducted semi-structured interviews with (1) traders (comprised of randomly selected males and females) and (2) consumers (including randomly selected males and females). Thereafter, we collected flies found on fish in markets in Mongu and Lusaka districts of Zambia. For the entire study, a total of 418 fly samples were analyzed in the laboratory and Salmonella spp. and enteropathogenic Escherichia coli were isolated from the flies. Further laboratory screening revealed that overall, 17.2% (72/418) (95% CI; 43.2%–65.5%) of total samples analyzed contained Extended-Spectrum Beta-Lactamase (ESBL)-producing E. coli. These significant findings call for a strengthening of the antibiotic administering policy in Zambia and the development of sustainable interventions to reduce fly numbers in food markets and improve food safety and hygiene. PMID:28036049

Addressing HIV in Zambia through traditional games.

PubMed

Njelesani, Janet; Njelesani, Donald

2018-05-18

There has been a proliferation of organizations in Zambia touting the mobilization of traditional games as a tool to prevent HIV. However, there is a dearth of evidence on how culturally important activities like traditional games are being incorporated into programing. The purpose of this study was to explore how traditional games are used as a strategy to prevent HIV in Zambia. This qualitative study generated data from 17 case studies of HIV programs operating in Lusaka, Zambia. Observations of the programs were conducted and 44 interviews with program staff were completed. Participants believed that traditional games can engage youth while helping them learn about HIV. However, when traditional games were implemented, they were oversimplified and taught via regimented practices that did not foster critical thinking. This kind of implementation comes at the expense of the development of skills needed to retain and act on information essential for HIV prevention. The results of the study also reveal that due to the increase in cultural pride that has welcomed the revival of traditional games, there are opportunities to encourage government and political support for their systematic integration to address HIV in Zambia.

Ethnoveterinary treatments for common cattle diseases in four districts of the Southern Province, Zambia

PubMed Central

Syakalima, Michelo; Simuunza, Martin; Zulu, Victor Chisha

2018-01-01

Aim: Ethno veterinary knowledge has rarely been recorded, and no or limited effort has been made to exploit this knowledge despite its widespread use in Zambia. This study documented the types of plants used to treat important animal diseases in rural Zambia as a way of initiating their sustained documentation and scientific validation. Materials and Methods: The study was done in selected districts of the Southern Zambia, Africa. The research was a participatory epidemiological study conducted in two phases. The first phase was a pre-study exploratory rapid rural appraisal conducted to familiarize the researchers with the study areas, and the second phase was a participatory rural appraisal to help gather the data. The frequency index was used to rank the commonly mentioned treatments. Results: A number of diseases and traditional treatments were listed with the help of local veterinarians. Diseases included: Corridor disease (Theileriosis), foot and mouth disease, blackleg, bloody diarrhea, lumpy skin disease, fainting, mange, blindness, coughing, bloat, worms, cobra snakebite, hemorrhagic septicemia, and transmissible venereal tumors. The plant preparations were in most diseases given to the livestock orally (as a drench). Leaves, barks, and roots were generally used depending on the plant type. Conclusion: Ethno veterinary medicine is still widespread among the rural farmers in the province and in Zambia in general. Some medicines are commonly used across diseases probably because they have a wide spectrum of action. These medicines should, therefore, be validated for use in conventional livestock healthcare systems in the country to reduce the cost of treatments. PMID:29657394

Moving Towards Inclusive Education Policies and Practices? Basic Education for AIDS Orphans and Other Vulnerable Children in Zambia

ERIC Educational Resources Information Center

Robson, Sue; Kanyanta, Sylvester Bonaventure

2007-01-01

The global spread of HIV and AIDS has presented a major threat to development, affecting the health of the poor and many aspects of social and economic development. The greatest impact of the epidemic has been felt in sub-Saharan Africa, and Zambia ranks among the worst hit countries. The Free Basic Education Policy in Zambia upholds the right of…

Factors influencing modes of transport and travel time for obstetric care: a mixed methods study in Zambia and Uganda.

PubMed

Sacks, Emma; Vail, Daniel; Austin-Evelyn, Katherine; Greeson, Dana; Atuyambe, Lynn M; Macwan'gi, Mubiana; Kruk, Margaret E; Grépin, Karen A

2016-04-01

Transportation is an important barrier to accessing obstetric care for many pregnant and postpartum women in low-resource settings, particularly in rural areas. However, little is known about how pregnant women travel to health facilities in these settings. We conducted 1633 exit surveys with women who had a recent facility delivery and 48 focus group discussions with women who had either a home or a facility birth in the past year in eight districts in Uganda and Zambia. Quantitative data were analysed using univariate statistics, and qualitative data were analysed using thematic content analysis techniques. On average, women spent 62-68 min travelling to a clinic for delivery. Very different patterns in modes of transport were observed in the two countries: 91% of Ugandan women employed motorized forms of transportation, while only 57% of women in Zambia did. Motorcycle taxis were the most commonly used in Uganda, while cars, trucks and taxis were the most commonly used mode of transportation in Zambia. Lower-income women were less likely to use motorized modes of transportation: in Zambia, women in the poorest quintile took 94 min to travel to a health facility, compared with 34 for the wealthiest quintile; this difference between quintiles was ∼50 min in Uganda. Focus group discussions confirmed that transport is a major challenge due to a number of factors we categorized as the 'three A's:' affordability, accessibility and adequacy of transport options. Women reported that all of these factors had influenced their decision not to deliver in a health facility. The two countries had markedly different patterns of transportation for obstetric care, and modes of transport and travel times varied dramatically by wealth quintile, which policymakers need to take into account when designing obstetric transport interventions. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Epidemiological analysis of tick-borne diseases in Zambia.

PubMed

Simuunza, Martin; Weir, William; Courcier, Emily; Tait, Andy; Shiels, Brian

2011-02-10

Tick-borne diseases are a constraint to livestock production in many developing countries as they cause high morbidity and mortality, which results in decreased production of meat, milk and other livestock by-products. The most important tick-borne diseases of livestock in sub-Saharan Africa are East Coast fever (caused by Theileria parva), babesiosis (caused by Babesia bigemina and B. bovis), anaplasmosis (caused by Anaplasma marginale) and heartwater (caused by Ehrlichia ruminantium). Despite their economic importance, information on the epidemiology of these diseases in many countries, including Zambia, is often inadequate, making rational disease control strategies difficult to implement. In this study 18S and 16S rRNA gene PCR assays were used for a comprehensive epidemiological analysis of tick-borne disease of cattle in three provinces of Zambia (Lusaka, Central and Eastern). All the disease pathogens under study (T. parva, T. mutans, T. taurotragi, B. bovis, B. bigemina, Anaplasma spp and E. ruminantium) were prevalent in each of the provinces surveyed. However, variation was observed in prevalence between regions and seasons. There was no association between live vaccination against East Coast fever and being PCR positive for T. parva. A number of risk factors were shown to be associated with (a) the occurrence of tick-borne pathogens in cattle and (b) cattle tick burdens in the wet season. A negative association was observed between the number of co-infecting pathogens and the erythrocyte packed cell volume (PCV) of carrier cattle. Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.

Provision and Management of Special Education in Community Schools: A Case of Donata, Malaikha and Shalom Community Schools in Zambia

ERIC Educational Resources Information Center

Mwamba, Mwenya N.

2016-01-01

Community schools appeared in Zambia in 1992 beginning with Lusaka and they quickly spread to other parts of the country. The Ministry of General Education recognizes its obligation to provide education of good quality to all children in response to national and international protocols to which Zambia is a part. The creation of Community Schools…

Insecticide-treated nets mass distribution campaign: benefits and lessons in Zambia.

PubMed

Masaninga, Freddie; Mukumbuta, Nawa; Ndhlovu, Ketty; Hamainza, Busiku; Wamulume, Pauline; Chanda, Emmanuel; Banda, John; Mwanza-Ingwe, Mercy; Miller, John M; Ameneshewa, Birkinesh; Mnzava, Abraham; Kawesha-Chizema, Elizabeth

2018-04-24

Zambia was an early adopter of insecticide-treated nets strategy in 2001, and policy for mass distribution with long-lasting insecticidal nets (LLINs) in 2005. Since then, the country has implemented mass distribution supplemented with routine delivery through antenatal care and under five clinics in health facilities. The national targets of universal (100%) coverage and 80% utilization of LLINs have not been attained. Free mass LLIN distribution campaign in Zambia offers important lessons to inform future campaigns in the African region. This study reviewed LLIN free mass distribution campaign information derived from Zambia's national and World Health Organization Global Malaria Programme annual reports and strategic plans published between 2001 and 2016. In 2014, a nationwide mass distribution campaign in Zambia delivered all the 6.0 million LLINs in 6 out of 10 provinces in 4 months between June and September before the onset of the rainy season. Compared with 235,800 LLINs and 2.9 million LLINs distributed on a rolling basis in 2008 and 2013, respectively, the 2014 mass campaign, which distributed 6 million LLINs represented the largest one-time-nationwide LLIN distribution in Zambia. The province (Luapula) with highest malaria transmission, mostly with rural settings recorded 98-100% sleeping spaces in homes covered with LLINs. The percentage of households owning at least 1 LLIN increased from 50.9% in 2006 to 77.7% in 2015. The 2014 mass campaign involved a coordinated response with substantial investments into macro (central) and micro (district) level planning, capacity building, tracking and logistics management supported by a new non-health sector partnership landscape. Coordination of LLIN distribution and logistics benefited from the mobile phone technology to transmit "real time" data on commodity tracking that facilitated timely delivery to districts. Free mass distribution of LLINs policy was adopted in 2005 in Zambia. Consistently implemented

Assessing income redistributive effect of health financing in Zambia.

PubMed

Mulenga, Arnold; Ataguba, John Ele-Ojo

2017-09-01

Ensuring an equitable health financing system is a major concern particularly in many developing countries. Internationally, there is a strong debate to move away from excessive reliance on direct out-of-pocket (OOP) spending towards a system that incorporates a greater element of risk pooling and thus affords greater protection for the poor. This is a major focus of the move towards universal health coverage (UHC). Currently, Zambia with high levels of poverty and income inequality is implementing health sector reforms for UHC through a social health insurance scheme. However, the way to identify the health financing mechanisms that are best suited to achieving this goal is to conduct empirical analysis and consider international evidence on funding universal health systems. This study assesses, for the first time, the progressivity of health financing and how it impacts on income inequality in Zambia. Three broad health financing mechanisms (general tax, a health levy and OOP spending) were considered. Data come from the 2010 nationally representative Zambian Living Conditions and Monitoring Survey with a sample size of 19,397 households. Applying standard methodologies, the findings show that total health financing in Zambia is progressive. It also leads to a statistically significant reduction in income inequality (i.e. a pro-poor redistributive effect estimated at 0.0110 (p < 0.01)). Similar significant pro-poor redistribution was reported for general taxes (0.0101 (p < 0.01)) and a health levy (0.0002 (p < 0.01)). However, the redistributive effect was not significant for OOP spending (0.0006). These results further imply that health financing redistributes income from the rich to the poor with a greater potential via general taxes. This points to areas where government policy may focus in attempting to reduce the high level of income inequality and to improve equity in health financing towards UHC in Zambia. Copyright © 2017 Elsevier Ltd. All rights

Health inequities, environmental insecurity and the attainment of the millennium development goals in sub-Saharan Africa: the case study of Zambia.

PubMed

Anyangwe, Stella C E; Mtonga, Chipayeni; Chirwa, Ben

2006-09-01

The United Nations Millennium Development Goals (MDGs) are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to age-old problems. Extreme poverty is a cause and consequence of low income, food insecurity and hunger, education and gender inequities, high disease burden, environmental degradation, insecure shelter, and lack of access to safe drinking water and basic sanitation. It is also directly linked to unsound governance and inequitable distribution of public wealth. While many regions in the world will strive to attain the MDGs by 2015, most of the countries in sub-Saharan Africa, with major human development challenges associated with socio-economic disparities, will not. Zambia's MDG progress reports of 2003 and 2005 show that despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV/AIDS epidemic, it is not likely that Zambia will achieve even half of the goals. Zambia's systems have been weakened by high disease burden and excess mortality, natural and man-made environmental threats and some negative effects of globalization such as huge external debt, low world prices for commodities and the human resource "brain drain", among others. Urgent action must follow political will, and some tried and tested strategies or "quick wins" that have been proven to produce high positive impact in the short term, need to be rapidly embarked upon by Zambia and other countries in sub-Saharan Africa if they are to achieve the Millennium Development Goals.

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis.

PubMed

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-05

Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. The study focused on all 72 health districts of Zambia. We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Technical and scale efficiency in the delivery of child health services in Zambia: results from data envelopment analysis

PubMed Central

Achoki, Tom; Hovels, Anke; Masiye, Felix; Lesego, Abaleng; Leufkens, Hubert; Kinfu, Yohannes

2017-01-01

Objective Despite tremendous efforts to scale up key maternal and child health interventions in Zambia, progress has not been uniform across the country. This raises fundamental health system performance questions that require further investigation. Our study investigates technical and scale efficiency (SE) in the delivery of maternal and child health services in the country. Setting The study focused on all 72 health districts of Zambia. Methods We compiled a district-level database comprising health outcomes (measured by the probability of survival to 5 years of age), health outputs (measured by coverage of key health interventions) and a set of health system inputs, namely, financial resources and human resources for health, for the year 2010. We used data envelopment analysis to assess the performance of subnational units across Zambia with respect to technical and SE, controlling for environmental factors that are beyond the control of health system decision makers. Results Nationally, average technical efficiency with respect to improving child survival was 61.5% (95% CI 58.2% to 64.8%), which suggests that there is a huge inefficiency in resource use in the country and the potential to expand services without injecting additional resources into the system. Districts that were more urbanised and had a higher proportion of educated women were more technically efficient. Improved cooking methods and donor funding had no significant effect on efficiency. Conclusions With the pressing need to accelerate progress in population health, decision makers must seek efficient ways to deliver services to achieve universal health coverage. Understanding the factors that drive performance and seeking ways to enhance efficiency offer a practical pathway through which low-income countries could improve population health without necessarily seeking additional resources. PMID:28057650

Underutilisation of routinely collected data in the HIV programme in Zambia: a review of quantitatively analysed peer-reviewed articles.

PubMed

Munthali, Tendai; Musonda, Patrick; Mee, Paul; Gumede, Sehlulekile; Schaap, Ab; Mwinga, Alwyn; Phiri, Caroline; Kapata, Nathan; Michelo, Charles; Todd, Jim

2017-06-13

The extent to which routinely collected HIV data from Zambia has been used in peer-reviewed published articles remains unexplored. This paper is an analysis of peer-reviewed articles that utilised routinely collected HIV data from Zambia within six programme areas from 2004 to 2014. Articles on HIV, published in English, listed in the Directory of open access journals, African Journals Online, Google scholar, and PubMed were reviewed. Only articles from peer-reviewed journals, that utilised routinely collected data and included quantitative data analysis methods were included. Multi-country studies involving Zambia and another country, where the specific results for Zambia were not reported, as well as clinical trials and intervention studies that did not take place under routine care conditions were excluded, although community trials which referred patients to the routine clinics were included. Independent extraction was conducted using a predesigned data collection form. Pooled analysis was not possible due to diversity in topics reviewed. A total of 69 articles were extracted for review. Of these, 7 were excluded. From the 62 articles reviewed, 39 focused on HIV treatment and retention in care, 15 addressed prevention of mother-to-child transmission, 4 assessed social behavioural change, and 4 reported on voluntary counselling and testing. In our search, no articles were found on condom programming or voluntary male medical circumcision. The most common outcome measures reported were CD4+ count, clinical failure or mortality. The population analysed was children in 13 articles, women in 16 articles, and both adult men and women in 33 articles. During the 10 year period of review, only 62 articles were published analysing routinely collected HIV data in Zambia. Serious consideration needs to be made to maximise the utility of routinely collected data, and to benefit from the funds and efforts to collect these data. This could be achieved with government support

Schistosomiasis in Zambia: a systematic review of past and present experiences.

PubMed

Kalinda, Chester; Chimbari, Moses J; Mukaratirwa, Samson

2018-04-30

The speedy rate of change in the environmental and socio-economics factors may increase the incidence, prevalence and risk of schistosomiasis infections in Zambia. However, available information does not provide a comprehensive understanding of the biogeography and distribution of the disease, ecology and population dynamics of intermediate host snails. The current study used an information-theoretical approach to understand the biogeography and prevalence schistosomiasis and identified knowledge gaps that would be useful to improve policy towards surveillance and eradication of intermediate hosts snails in Zambia. To summarise the existing knowledge and build on past and present experiences of schistosomiasis epidemiology for effective disease control in Zambia, a systematic search of literature for the period 2000-2017 was done on PubMed, Google Scholar and EBSCOhost. Using the key words: 'Schistosomiasis', 'Biomphalaria', 'Bulinus', 'Schistosoma mansoni', 'Schistosoma haematobium', and 'Zambia', in combination with Booleans terms 'AND' and 'OR', published reports/papers were obtained and reviewed independently for inclusion. Thirteen papers published in English that fulfilled the inclusion criteria were selected for the final review. The papers suggest that the risk of infection has increased over the years and this has been attributed to environmental, socio-economic and demographic factors. Furthermore, schistosomiasis is endemic in many parts of the country with infection due to Schistosoma haematobium being more prevalent than that due to S. mansoni. This review also found that S. haematobium was linked to genital lesions, thus increasing risks of contracting other diseases such as HIV and cervical cancer. For both S. haematobium and S. mansoni, environmental, socio-economic, and demographic factors were influential in the transmission and prevalence of the disease and highlight the need for detailed knowledge on ecological modelling and mapping the

Developing a Nutrition and Health Education Program for Primary Schools in Zambia

ERIC Educational Resources Information Center

Sherman, Jane; Muehlhoff, Ellen

2007-01-01

School-based health and nutrition interventions in developing countries aim at improving children's nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in…

Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) - the Zambian experience.

PubMed

Mukonka, Victor M; Malumo, Sarai; Kalesha, Penelope; Nambao, Mary; Mwale, Rodgers; Mwinga, Kasonde; Katepa-Bwalya, Mary; Babaniyi, Olusegan; Mason, Elizabeth; Phiri, Caroline; Wamulume, Pauline K

2014-01-21

Initiatives such as the Country Countdown to 2015 Conference on Millennium Development Goals (MDGs) have provided countries with high maternal and child deaths like Zambia a platform to assess progress, discuss challenges and share lessons learnt as a conduit for national commitment to reaching and attaining the MDGs four and five. This paper discusses and highlights the process of holding a successful country countdown conference and shares Zambia's experience with other countries planning to organise country countdown to 2015 Conferences on MDGs.

Increased Economic Relations Between China and Zambia in the Last Decade: Implications on Zambia’s Existing Bilateral Relations with the United States

DTIC Science & Technology

2013-12-13

Pacific region, but also the world at large. China and the U.S. have agreed to a new model of relations, based on practical cooperation and...as a significant model to determine whether the increase in China and Zambia relations lead to a change in the nature of bilateral relations between...a model in countries with similar features and given the circumstances. The last decade has seen China step up its economic activities on the

The development and evaluation of content validity of the Zambia Spina Bifida Functional Measure: Preliminary studies

PubMed Central

Amosun, Seyi L.; Shilalukey-Ngoma, Mary P.; Kafaar, Zuhayr

2017-01-01

Background Very little is known on outcome measures for children with spina bifida (SB) in Zambia. If rehabilitation professionals managing children with SB in Zambia and other parts of sub-Saharan Africa are to instigate measuring outcomes routinely, a tool has to be made available. The main objective of this study was to develop an appropriate and culturally sensitive instrument for evaluating the impact of the interventions on children with SB in Zambia. Methods A mixed design method was used for the study. Domains were identified retrospectively and confirmation was done through a systematic review study. Items were generated through semi-structured interviews and focus group discussions. Qualitative data were downloaded, translated into English, transcribed verbatim and presented. These were then placed into categories of the main domains of care deductively through the process of manifest content analysis. Descriptive statistics, alpha coefficient and index of content validity were calculated using SPSS. Results Self-care, mobility and social function were identified as main domains, while participation and communication were sub-domains. A total of 100 statements were generated and 78 items were selected deductively. An alpha coefficient of 0.98 was computed and experts judged the items. Conclusions The new functional measure with an acceptable level of content validity titled Zambia Spina Bifida Functional Measure (ZSBFM) was developed. It was designed to evaluate effectiveness of interventions given to children with SB from the age of 6 months to 5 years. Psychometric properties of reliability and construct validity were tested and are reported in another study. PMID:28951850

Changes in sexual behaviour and practice and HIV prevalence indicators among young people aged 15–24 years in Zambia: An in-depth analysis of the 2001–2002 and 2007 Zambia Demographic and Health Surveys

PubMed Central

Kembo, Joshua

2014-01-01

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

Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana.

PubMed

Emerson, C; Lipke, V; Kapata, N; Mwananyambe, N; Mwinga, A; Garekwe, M; Lanje, S; Moshe, Y; Pals, S L; Nakashima, A K; Miller, B

2016-07-01

Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.

Health system productivity change in Zambia: A focus on the child health services.

PubMed

Achoki, Tom; Kinfu, Yohannes; Masiye, Felix; Frederix, Geert W J; Hovels, Anke; Leufkens, Hubert G

2017-02-01

Efficiency and productivity improvement have become central in global health debates. In this study, we explored productivity change, particularly the contribution of technological progress and efficiency gains associated with improvements in child survival in Zambia (population 15 million). Productivity was measured by applying the Malmquist productivity index on district-level panel data. The effect of socioeconomic factors was further analyzed by applying an ordinary least squares regression technique. During 2004-2009, overall productivity in Zambia increased by 5.0 per cent, a change largely attributed to technological progress rather than efficiency gains. Within-country productivity comparisons revealed wide heterogeneity in favor of more urbanized and densely populated districts. Improved cooking methods, improved sanitation, and better educated populations tended to improve productive gains, whereas larger household size had an adverse effect. Addressing such district-level factors and ensuring efficient delivery and optimal application of existing health technologies offer a practical pathway for further improving population health.

Expanding contraceptive choice in the developing world: lessons from the Lao People's Democratic Republic and the Republic of Zambia.

PubMed

d'Arcangues, Catherine M; Ba-Thike, Katherine; Say, Lale

2013-12-01

Women need different forms of contraception over their lifetime. In the developed world, they have access to some 20 different methods. In developing countries, only a few options are available. This paper focuses on four under-used methods: intrauterine devices, implants, emergency contraception and female condoms. It examines reasons for their low uptake, strategies used for their adoption, and challenges in sustaining these efforts, in two countries: Laos and Zambia. In-country documentation and reports from international partners were reviewed; questionnaires were sent and interviews carried out with ministry officials, senior providers, and local representatives of international organisations and international non-governmental organisations. In Laos, the family planning programme is relatively young; its challenges include ensuring the sustainability of services and supplies, improving the quality of IEC to dispel misconceptions surrounding contraception, and developing novel distribution systems to reach rural populations. Zambia has a much older programme, which lost ground in the face of competing health priorities. Its challenges include strengthening the supply chain management, coordinating the multiple groups of providers and ensuring the sustainability of services in rural areas. The contrast offered by Laos and Zambia illustrates the importance of regular evaluation to identify priority areas for improving contraceptive delivery.

Cigarette Price and Other Factors Associated with Brand Choice and Brand Loyalty in Zambia: Findings from the ITC Zambia Survey

PubMed Central

Salloum, Ramzi G.; Goma, Fastone; Chelwa, Grieve; Cheng, Xi; Zulu, Richard; Kaai, Susan C.; Quah, Anne C.K.; Thrasher, James F.; Fong, Geoffrey T.

2015-01-01

Objectives Little is known about cigarette pricing and brand loyalty in sub-Saharan Africa. This study examines these issues in Zambia, analyzing data from the International Tobacco Control (ITC) Zambia Survey. Methods Data from Wave 1 of the ITC Zambia Survey (2012) were analyzed for current smokers of factory-made (FM) cigarettes compared to those who smoked both FM and roll-your-own (RYO) cigarettes, using multivariate logistic regression models to identify the predictors of brand loyalty and reasons for brand choice. Results 75% of FM-only smokers and 64% of FM+RYO smokers reported having a regular brand. Compared with FM-only smokers, FM+RYO smokers were, on average, older (28% vs. 20% ≥ 40 years), low income (64% vs. 43%), and had lower education (76% vs. 44% < secondary). Mean price across FM brands was ZMW0.50 (USD0.08) per stick. Smokers were significantly less likely to be brand-loyal (>1 year) if they were aged 15-17 years (vs. 40-54 years) and if they had moderate (vs. low) income. Brand choice was predicted mostly by friends, taste, and brand popularity. Price was more likely to be a reason for brand loyalty among FM+RYO smokers, among ≥55 year old smokers, and among those who reported being more addicted to cigarettes. Conclusions These results in Zambia document the high levels of brand loyalty in a market where price variation is fairly small across cigarette brands. Future research is needed on longitudinal trends to evaluate the effect of tobacco control policies in Zambia. PMID:25631482

Priorities for Antiretroviral Therapy Research in Sub-Saharan Africa: A 2002 Consensus Conference in Zambia

PubMed Central

Zulu, Isaac; Schuman, Paula; Musonda, Rosemary; Chomba, Elwyn; Mwinga, Kasonde; Sinkala, Moses; Chisembele, Maureen; Mwaba, Peter; Kasonde, Dorothy; Vermund, Sten H.

2009-01-01

Background A consensus conference was held to discuss priorities for antiretroviral therapy (ART) research in Zambia, one of the world’s most heavily HIV-afflicted nations. Zambia, like other resource-limited settings, has increasing access to highly active antiretroviral therapy (HAART) because of declining drug costs, use of government-purchased generic medications, and increased global donations. For sustained delivery of care with HAART in a resource-constrained medical and public health context, operational research is required and clinical trials are desirable. The priority areas for research are most relevant today given the increasing availability of HAART. Methods A conference was held in Lusaka, Zambia, in January 2002 to discuss priority areas for ART research in Zambia, with participants drawn from a broad cross section of Zambian society. State-of-the-art reviews and 6 intensive small group discussions helped to formulate a suggested research agenda. Results Conference participants believed that the most urgent research priorities were to assess how therapeutic resources could be applied for the greatest overall benefit and to minimize the impact of nonadherence and viral resistance. Identified research priorities were as follows: To determine when to initiate HAART in relation to CD4+ cell count To assess whether HIV/AIDS can be managed well without the use of costly frequent viral load measurements and CD4+ cell count monitoring To assess whether HIV/AIDS can be managed in the same fashion in patients coinfected with opportunistic infections such as tuberculosis and HIV-related chronic diarrhea, taking into consideration complications that may occur in tuberculosis such as immune reconstitution syndrome and medication malabsorption in the presence of diarrhea To carefully assess and characterize toxicities, adverse effects, and viral resistance patterns in Zambia, including studies of mothers exposed to prepartum single-dose nevirapine To conduct

Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe

PubMed Central

Mwenge, Lawrence; Sande, Linda; Mangenah, Collin; Ahmed, Nurilign; Kanema, Sarah; d’Elbée, Marc; Sibanda, Euphemia; Kalua, Thokozani; Ncube, Gertrude; Johnson, Cheryl C.; Hatzold, Karin; Cowan, Frances M.; Corbett, Elizabeth L.; Ayles, Helen; Maheswaran, Hendramoorthy

2017-01-01

Background Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. Methods Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. Results Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. Conclusions Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services. PMID:29036171

Education and Zambia's Democratic Development: Reconstituting "Something" from the Predatory Project of Neoliberal Globalization

ERIC Educational Resources Information Center

Abdi, Ali A.; Ellis, Lee

2007-01-01

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…

Taenia solium Infections in a Rural Area of Eastern Zambia-A Community Based Study

PubMed Central

Mwape, Kabemba E.; Phiri, Isaac K.; Praet, Nicolas; Muma, John B.; Zulu, Gideon; de Deken, Reginald; Speybroeck, Niko; Dorny, Pierre; Gabriël, Sarah

2012-01-01

Background Taenia solium taeniosis/cysticercosis is a parasitic infection occurring in many developing countries. Data on the status of human infections in Zambia is largely lacking. We conducted a community-based study in Eastern Zambia to determine the prevalence of human taeniosis and cysticercosis in a rural community. Methods and Findings Stool and serum samples were collected from willing participants. Geographical references of the participants' households were determined and household questionnaires administered. Taeniosis was diagnosed in stool samples by coprology and by the polyclonal antibody-based copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA), while cysticercosis was diagnosed in serum by the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA). Identification of the collected tapeworm after niclosamide treatment and purgation was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). A total of 255 households from 20 villages participated in the study, 718 stool and 708 serum samples were collected and examined. Forty-five faecal samples (6.3%) were found positive for taeniosis on copro-Ag ELISA while circulating cysticercus antigen was detected in 5.8% (41/708) individuals. The tapeworm recovered from one of the cases was confirmed to be T. solium on PCR-RFLP. Seropositivity (cysticercosis) was significantly positively related to age (p = 0.00) and to copro-Ag positivity (taeniosis) (p = 0.03) but not to gender. Change point analysis revealed that the frequency of cysticercus antigens increased significantly in individuals above the age of 30. Copro-Ag positivity was not related to age or gender. The following risk factors were noted to be present in the study community: free-range pig husbandry system and poor sanitation with 47.8% of the households visited lacking latrines. Conclusions This study has recorded high taeniosis and cysticercosis prevalences and identified the

Taenia solium Infections in a rural area of Eastern Zambia-a community based study.

PubMed

Mwape, Kabemba E; Phiri, Isaac K; Praet, Nicolas; Muma, John B; Zulu, Gideon; Van den Bossche, Peter; de Deken, Reginald; Speybroeck, Niko; Dorny, Pierre; Gabriël, Sarah

2012-01-01

Taenia solium taeniosis/cysticercosis is a parasitic infection occurring in many developing countries. Data on the status of human infections in Zambia is largely lacking. We conducted a community-based study in Eastern Zambia to determine the prevalence of human taeniosis and cysticercosis in a rural community. Stool and serum samples were collected from willing participants. Geographical references of the participants' households were determined and household questionnaires administered. Taeniosis was diagnosed in stool samples by coprology and by the polyclonal antibody-based copro-antigen enzyme-linked immunosorbent assay (copro-Ag ELISA), while cysticercosis was diagnosed in serum by the B158/B60 monoclonal antibody-based antigen ELISA (sero-Ag ELISA). Identification of the collected tapeworm after niclosamide treatment and purgation was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). A total of 255 households from 20 villages participated in the study, 718 stool and 708 serum samples were collected and examined. Forty-five faecal samples (6.3%) were found positive for taeniosis on copro-Ag ELISA while circulating cysticercus antigen was detected in 5.8% (41/708) individuals. The tapeworm recovered from one of the cases was confirmed to be T. solium on PCR-RFLP. Seropositivity (cysticercosis) was significantly positively related to age (p = 0.00) and to copro-Ag positivity (taeniosis) (p = 0.03) but not to gender. Change point analysis revealed that the frequency of cysticercus antigens increased significantly in individuals above the age of 30. Copro-Ag positivity was not related to age or gender. The following risk factors were noted to be present in the study community: free-range pig husbandry system and poor sanitation with 47.8% of the households visited lacking latrines. This study has recorded high taeniosis and cysticercosis prevalences and identified the need for further studies on transmission

A Qualitative Study of Migrant-related Stressors, Psychosocial Outcomes and HIV Risk Behavior among Truck Drivers in Zambia

PubMed Central

Ncube, Nomagugu; Simona, Simona J.; Kansankala, Brian; Sinkala, Emmanuel; Raidoo, Jasmin

2017-01-01

Truck drivers are part of mobile populations which have been noted as a key population at risk of HIV in Zambia. This study was aimed at 1) determining Potentially Traumatic Events (PTEs), labor migrant-related stressors, psychosocial problems and HIV risk behaviors among truck drivers in Zambia and 2) examining the relationship between PTEs, migrant-related stressors, psychosocial outcomes and HIV sexual risk behavior among truck drivers in Zambia. We conducted fifteen semi-structured interviews with purposively sampled male truck drivers at trucking companies in Lusaka, Zambia. Findings indicate that truck drivers experience multiple stressors and potentially traumatic incidences, including delays and long waiting hours at borders, exposure to crime and violence, poverty, stress related to resisting temptation of sexual interactions with sex workers or migrant women, and job-related safety concerns. Multiple psychosocial problems such as intimate partner violence, loneliness, anxiety and depression-like symptoms were noted. Transactional sex, coupled with inconsistent condom use were identified as HIV sexual risk behaviors. Findings suggest the critical need to develop HIV prevention interventions which account for mobility, potentially traumatic events, psychosocial problems, and the extreme fear of HIV testing among this key population. PMID:27681145

Diagnosis and genotyping of African swine fever viruses from 2015 outbreaks in Zambia.

PubMed

Thoromo, Jonas; Simulundu, Edgar; Chambaro, Herman M; Mataa, Liywalii; Lubaba, Caesar H; Pandey, Girja S; Takada, Ayato; Misinzo, Gerald; Mweene, Aaron S

2016-04-29

In early 2015, a highly fatal haemorrhagic disease of domestic pigs resembling African swine fever (ASF) occurred in North Western, Copperbelt, and Lusaka provinces of Zambia. Molecular diagnosis by polymerase chain reaction targeting specific amplification of p72 (B646L) gene of ASF virus (ASFV) was conducted. Fourteen out of 16 domestic pigs from the affected provinces were found to be positive for ASFV. Phylogenetic analyses based on part of the p72 and the complete p54 (E183L) genes revealed that all the ASFVs detected belonged to genotypes I and Id, respectively. Additionally, epidemiological data suggest that the same ASFV spread from Lusaka to other provinces possibly through uncontrolled and/or illegal pig movements. Although the origin of the ASFV that caused outbreaks in domestic pigs in Zambia could not be ascertained, it appears likely that the virus may have emerged from within the country or region, probably from a sylvatic cycle. It is recommended that surveillance of ASF, strict biosecurity, and quarantine measures be imposed in order to prevent further spread and emergence of new ASF outbreaks in Zambia.

Measuring teamwork and taskwork of community-based “teams” delivering life-saving health interventions in rural Zambia: a qualitative study

PubMed Central

2013-01-01

Background The use of teams is a well-known approach in a variety of settings, including health care, in both developed and developing countries. Team performance is comprised of teamwork and task work, and ascertaining whether a team is performing as expected to achieve the desired outcome has rarely been done in health care settings in resource-limited countries. Measuring teamwork requires identifying dimensions of teamwork or processes that comprise the teamwork construct, while taskwork requires identifying specific team functions. Since 2008 a community-based project in rural Zambia has teamed community health workers (CHWs) and traditional birth attendants (TBAs), supported by Neighborhood Health Committees (NHCs), to provide essential newborn and continuous curative care for children 0–59 months. This paper describes the process of developing a measure of teamwork and taskwork for community-based health teams in rural Zambia. Methods Six group discussions and pile-sorting sessions were conducted with three NHCs and three groups of CHW-TBA teams. Each session comprised six individuals. Results We selected 17 factors identified by participants as relevant for measuring teamwork in this rural setting. Participants endorsed seven functions as important to measure taskwork. To explain team performance, we assigned 20 factors into three sub-groups: personal, community-related and service-related. Conclusion Community and culturally relevant processes, functions and factors were used to develop a tool for measuring teamwork and taskwork in this rural community and the tool was quite unique from tools used in developed countries. PMID:23802766

Consultancy Report: Assessment of the Zambia College of Distance Education (ZACODE)

ERIC Educational Resources Information Center

Ellis, Justin

2009-01-01

This study was carried out at the request of the Ministry of Education, Zambia. The Commonwealth of Learning contracted Turning Points Consultancy CC, a Namibian company, who provided the services of the author, to "carry out an evaluation of the Zambia College of Distance Education (ZACODE) and submit recommendations to the Ministry of…

The equity impacts of community financing activities in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2000-01-01

Although the Bamako Initiative from its very beginning was caught up in wider debates about the potential equity impact of any form of user financing, to date there has been little empirical investigation of this impact. This three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, was initiated to add to the body of relevant evidence. It sought to understand not only what had been the equity impacts of community financing activities in these countries but also how they had been brought about. As a result, it investigated equity primarily through consideration of the design of these financing activities and through the perceptions of different actors, within a limited number of purposively selected geographical areas in each country, about their strengths and weaknesses. Additional data on utilization were either collected during the course of the study (Kenya) or drawn from other available studies (Benin and Zambia). Key issues considered in the studies' assessment of equity were the extent to which both relative and absolute affordability gains were achieved, as well as as an influence over both the distributional and procedural justice of the financing activities, the pattern of decision-making. Across countries there was evidence of relative affordability gains in Benin and Kenya, but Kenyan gains were not sustained over time and no such gains were identified in Zambia. In addition, no country had given attention either to the issue of absolute affordability, through the implementation of effective exemption mechanisms to protect the poorest from the burden of payment, or to the establishment of community decision-making bodies that effectively represented the interests of all groups including the poorest. Overall, therefore, although the Benin Bamako Initiative programme might be judged as successful in terms of what appear to be its own equity objectives, the other two countries' schemes had clear equity problems even in these terms. The

The SAZA study: implementing health financing reform in South Africa and Zambia.

PubMed

Gilson, Lucy; Doherty, Jane; Lake, Sally; McIntyre, Di; Mwikisa, Chris; Thomas, Stephen

2003-03-01

This paper explores the policy-making process in the 1990s in two countries, South Africa and Zambia, in relation to health care financing reforms. While much of the analysis of health reform programmes has looked at design issues, assuming that a technically sound design is the primary requirement of effective policy change, this paper explores the political and bureaucratic realities shaping the pattern of policy change and its impacts. Through a case study approach, it provides a picture of the policy environment and processes in the two countries, specifically considering the extent to which technical analysts and technical knowledge were able to shape policy change. The two countries' experiences indicate the strong influence of political factors and actors over which health care financing policies were implemented, and which not, as well as over the details of policy design. Moments of political transition in both countries provided political leaders, specifically Ministers of Health, with windows of opportunity in which to introduce new policies. However, these transitions, and the changes in administrative structures introduced with them, also created environments that constrained the processes of reform design and implementation and limited the equity and sustainability gains achieved by the policies. Technical analysts, working either inside or outside government, had varying and often limited influence. In part, this reflected the limits of their own capacity as well as weaknesses in the way they were used in policy development. In addition, the analysts were constrained by the fact that their preferred policies often received only weak political support. Focusing almost exclusively on designing policy reforms, these analysts gave little attention to generating adequate support for the policy options they proposed. Finally, the country experiences showed that front-line health workers, middle level managers and the public had important influences over

The reach and impact of social marketing and reproductive health communication campaigns in Zambia

PubMed Central

Van Rossem, Ronan; Meekers, Dominique

2007-01-01

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 on condom use. Methods This paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on condom use, using data from the 2001–2002 Zambia Demographic and Health Survey. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioural outcomes. Results Those who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have ever used a condom (OR = 1.16 for men and 1.06 for women). Men highly exposed to Maximum condoms social marketing communication were more likely than those with low exposure to the program to have ever used a condom (OR = 1.48), and to have used a condom at their last sexual intercourse (OR = 1.23). Conclusion Findings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on condom use. The results suggest that future reproductive health communication campaigns that invest in radio programming may be more effective than those investing in television programming, and that future campaigns should seek to increase their impact among women, perhaps by focusing on the specific constrains that prevent females from using condoms. PMID:18088437

The reach and impact of social marketing and reproductive health communication campaigns in Zambia.

PubMed

Van Rossem, Ronan; Meekers, Dominique

2007-12-18

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 on condom use. This paper assesses the reach of selected radio and television programs about family planning and HIV/AIDS and of communications about the socially marketed Maximum condoms in Zambia, as well as their impact on condom use, using data from the 2001-2002 Zambia Demographic and Health Survey. To control for self-selection and endogeneity, we use a two-stage regression model to estimate the effect of program exposure on the behavioural outcomes. Those who were exposed to radio and television programs about family planning and HIV/AIDS were more likely to have ever used a condom (OR = 1.16 for men and 1.06 for women). Men highly exposed to Maximum condoms social marketing communication were more likely than those with low exposure to the program to have ever used a condom (OR = 1.48), and to have used a condom at their last sexual intercourse (OR = 1.23). Findings suggest that the reproductive health and social marketing campaigns in Zambia reached a large portion of the population and had a significant impact on condom use. The results suggest that future reproductive health communication campaigns that invest in radio programming may be more effective than those investing in television programming, and that future campaigns should seek to increase their impact among women, perhaps by focusing on the specific constrains that prevent females from using condoms.

Situation Reports--Austria, Belgium, Bolivia, Botswana, Finland, German Federal Republic, Italy, Luxembourg, Mauritania, Netherlands, Norway, Portugal, Puerto Rico, Sweden, Tanzania, Yugoslavia, and Zambia.

ERIC Educational Resources Information Center

International Planned Parenthood Federation, London (England).

Data pertaining to population and family planning in seventeen foreign countries are presented in these situation reports. Countries included are Austria, Belgium, Bolivia, Botswana, Finland, German Federal Republic, Italy, Luxembourg, Mauritania, Netherlands, Norway, Portugal, Puerto Rico, Sweden, Tanzania, Yugoslavia, and Zambia. Information is…

Cigarette price and other factors associated with brand choice and brand loyalty in Zambia: findings from the ITC Zambia Survey.

PubMed

Salloum, Ramzi G; Goma, Fastone; Chelwa, Grieve; Cheng, Xi; Zulu, Richard; Kaai, Susan C; Quah, Anne C K; Thrasher, James F; Fong, Geoffrey T

2015-07-01

Little is known about cigarette pricing and brand loyalty in sub-Saharan Africa. This study examines these issues in Zambia, analysing data from the International Tobacco Control (ITC) Zambia Survey. Data from Wave 1 of the ITC Zambia Survey (2012) were analysed for current smokers of factory-made (FM) cigarettes compared with those who smoked both FM and roll-your-own (RYO) cigarettes, using multivariate logistic regression models to identify the predictors of brand loyalty and reasons for brand choice. 75% of FM-only smokers and 64% of FM+RYO smokers reported having a regular brand. Compared with FM-only smokers, FM+RYO smokers were, on average, older (28% vs 20% ≥40 years), low income (64% vs 43%) and had lower education (76% vs 44% < secondary). Mean price across FM brands was ZMW0.50 (US$0.08) per stick. Smokers were significantly less likely to be brand loyal (>1 year) if they were aged 15-17 years (vs 40-54 years) and if they had moderate (vs low) income. Brand choice was predicted mostly by friends, taste and brand popularity. Price was more likely to be a reason for brand loyalty among FM+RYO smokers, among ≥55-year-old smokers and among those who reported being more addicted to cigarettes. These results in Zambia document the high levels of brand loyalty in a market where price variation is fairly small across cigarette brands. Future research is needed on longitudinal trends to evaluate the effect of tobacco control policies in Zambia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

"Lazy men", time-use, and rural development in Zambia.

PubMed

Whitehead, A

1999-11-01

This paper examines how work and the labor in agriculture in rural sub-Saharan Africa is measured. Section 1 presents a historical example of colonial discourses of the "lazy" African (the Lamba in Zambia). Section 2 analyzes a study carried out in rural Zambia to illustrate the relationship between stereotypes held by many Europeans, particular aspects of the colonial project, and the social relations brought about by colonialism. Section 3 examines the ways in which present work and labor approaches in sub-Saharan Africa embody value judgements which leads to distorted documentation of the division of labor between opposite genders. Sections 4 through 7 look at a time-use study conducted in Zambia and argue that studies of such nature create value judgement on what comprises work, and about how researchers and planners classify this. Overall, this article has demonstrated that time-use surveys may provide inadequate understanding of women and men's work in the absence of an understanding of the local context in which the work is undertaken, and of labor markets.

Characterization of tabanid flies (Diptera: Tabanidae) in South Africa and Zambia and detection of protozoan parasites they are harbouring.

PubMed

Taioe, Moeti O; Motloang, Makhosazana Y; Namangala, Boniface; Chota, Amos; Molefe, Nthatisi I; Musinguzi, Simon P; Suganuma, Keisuke; Hayes, Polly; Tsilo, Toi J; Chainey, John; Inoue, Noboru; Thekisoe, Oriel M M

2017-08-01

Tabanids are haematophagous flies feeding on livestock and wildlife. In the absence of information on the relationship of tabanid flies and protozoan parasites in South Africa and Zambia, the current study was aimed at characterizing tabanid flies collected in these two countries as well as detecting protozoan parasites they are harbouring. A total of 527 tabanid flies were collected whereby 70·2% were from South Africa and 29·8% were from Zambia. Morphological analysis revealed a total of five different genera collected from the sampled areas namely: Ancala, Atylotus, Haematopota, Philoliche and Tabanus. DNA extracted from South African Tabanus par and Tabanus taeniola tested positive for the presence of Trypanosoma congolense (Savannah) and Trypanosoma theileri whilst one member from T. par was positive for Trypanosoma brucei species. DNA extracted from Zambian tabanid flies tested positive for the presence of Besnoitia species at 1·27% (2/157), Babesia bigemina 5·73% (9/157), Theileria parva 30·11% (30/157) and 9·82% (14/157) for Trypanosoma evansi. This study is the first to report on relationship of Babesia and Theileria parasites with tabanid flies. Further investigations are required to determine the role of tabanids in transmission of the detected protozoan parasites in livestock and wildlife in South Africa and Zambia.

Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia.

PubMed

Chanda-Kapata, Pascalina; Campbell, Sandy; Zarowsky, Christina

2012-06-06

For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, we discuss the ongoing development of Zambia's NHRS. We reflect on our experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. We argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.

Disease constraints for utilization of the African buffalo (Syncerus caffer) on game ranches in Zambia.

PubMed

Munang'andu, Hetron M; Munag'andu, Hetron M; Siamudaala, Victor M; Nambota, Andrew; Bwalya, John M; Munyeme, Musso; Mweene, Aaron S; Takada, Ayato; Kida, Hiroshi

2006-05-01

Eco-tourism depending on wildlife is becoming increasingly profitable and landowners are beginning to favor game farming and ecotourism. In these areas, large-scale translocation of wildlife involves a diversity of species and large populations. The African buffalo (Syncerus caffer) is one of the major tourist attractions in Zambia. It accounts for 8.7% and 12.4% of the total animal species hunted in the Game Management Areas and the total hunting revenue earned in Zambia, respectively. It is ecologically an important animal species essential for the purpose of habitat control and facilitating the provision of suitable grazing pastures. However, the rearing of the African buffalo on game ranches has been hampered by its carrier state of the Southern Africa Terroritory (SAT) serotypes of foot and mouth disease virus (FMD). The African buffalo is also known to be a carrier of Theileria parva lawrencei, the causative agent of corridor disease (CD) that continues to have devastating effects on the livestock industry in Zambia. In addition, the importation of buffaloes from countries with populations endemic to bovine tuberculosis is highly restricted. Veterinary regulations in Zambia, strongly advocate against the translocation of buffaloes from protected areas to private ranches for disease control purposes thereby mounting a considerable constraint on the economic and ecological viability of the industry. It is hoped that this review will motivate the relevant government authorities in exploiting ways in which this animal species play a central role in eco-tourism.

The Epidemiology of African Swine Fever in "Nonendemic" Regions of Zambia (1989-2015): Implications for Disease Prevention and Control.

PubMed

Simulundu, Edgar; Lubaba, Caesar H; van Heerden, Juanita; Kajihara, Masahiro; Mataa, Liywalii; Chambaro, Herman Moses; Sinkala, Yona; Munjita, Samuel Munalula; Munang'andu, Hetron Mweemba; Nalubamba, King Shimumbo; Samui, Kenny; Pandey, Girja Shanker; Takada, Ayato; Mweene, Aaron S

2017-08-23

African swine fever (ASF) is a highly contagious and deadly viral hemorrhagic disease of swine. In Zambia, ASF was first reported in 1912 in Eastern Province and is currently believed to be endemic in that province only. Strict quarantine measures implemented at the Luangwa River Bridge, the only surface outlet from Eastern Province, appeared to be successful in restricting the disease. However, in 1989, an outbreak occurred for the first time outside the endemic province. Sporadic outbreaks have since occurred almost throughout the country. These events have brought into acute focus our limited understanding of the epidemiology of ASF in Zambia. Here, we review the epidemiology of the disease in areas considered nonendemic from 1989 to 2015. Comprehensive sequence analysis conducted on genetic data of ASF viruses (ASFVs) detected in domestic pigs revealed that p72 genotypes I, II, VIII and XIV have been involved in causing ASF outbreaks in swine during the study period. With the exception of the 1989 outbreak, we found no concrete evidence of dissemination of ASFVs from Eastern Province to other parts of the country. Our analyses revealed a complex epidemiology of the disease with a possibility of sylvatic cycle involvement. Trade and/or movement of pigs and their products, both within and across international borders, appear to have been the major factor in ASFV dissemination. Since ASFVs with the potential to cause countrywide and possibly regional outbreaks, could emerge from "nonendemic regions", the current ASF control policy in Zambia requires a dramatic shift to ensure a more sustainable pig industry.

Un/doing Gender? a Case Study of School Policy and Practice in Zambia

NASA Astrophysics Data System (ADS)

Bajaj, Monisha

2009-11-01

This article explores an attempt to disrupt gender inequality in a unique, low-cost private school in Ndola, Zambia. It examines deliberate school policies aimed at "undoing gender" or fostering greater gender equity. These include efforts to maintain gender parity at all levels of the school and the requirement that both young men and women carry out cleaning tasks generally viewed as "women's work". Observations, interviews, student diaries and surveys from this school and from government schools provide the basis for a comparison, indicating how the former strives to interrupt the transmission of gender inequalities as well as how students respond to these practices. The findings suggest that the pedagogical practices deployed by this school have generally succeeded in destabilising norms of gender subordination and gender-based violence, though the replicability of these practices is interrogated given broader questions about the country's public resources and political will.

Can family planning outreach bridge the urban-rural divide in Zambia?

PubMed

White, Justin S; Speizer, Ilene S

2007-09-05

Zambia experienced declining aggregate fertility and increasing aggregate contraceptive use from 1990 to 2000. Yet, in rural Zambia, progress in family planning has lagged far behind the advances made in Zambia's urban areas. The contraceptive prevalence rate in Lusaka and other urban areas outstripped the rate in rural Zambia by nearly 25 percentage points (41.2 percent versus 16.6 percent) in 2001. The total fertility rate varied between urban and rural areas by 2.5 children (4.3 versus 6.9 children). This paper considers the urban-rural differentials in Zambia and assesses family planning outreach as a tool to narrow this divide. This study uses the Zambia Demographic and Health Survey (DHS) data, collected between 2001 and 2002. Logistic regression techniques were employed to examine factors associated with contraceptive use. The first analysis tested modern contraceptive use versus traditional method use and no use. In addition, separate models were run for samples stratified by type of residence (rural or urban) to determine if different factors were associated with use by residence. A simulation determined the effect of all women receiving at least one household visit from a health worker if all other variables were held constant. Differences in modern contraceptive use between urban and rural areas persist (OR: 1.56, 95 percent CI: 1.24-1.96) even after adjusting for a number of demographic, socioeconomic, cognitive, and attitudinal factors. Household visits by a community health worker significantly increased the likelihood of modern contraceptive use among rural women (OR: 1.83; 95 percent CI: 1.29-2.58). If all rural women received at least one outreach visit per year, the prevalence rate for modern contraceptive methods would be expected to increase for this group by 5.9 percentage points, a marked increase but less than one-quarter of the total urban-rural differential. Outreach in the form of health worker visits can improve access to family planning

Peace Corps/Zambia PST 1995 Special Lessons. Nyanja.

ERIC Educational Resources Information Center

Peace Corps (Zambia).

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…

Nontuberculous Mycobacteria, Zambia

PubMed Central

van der Sande, Marianne A.B.; de Graaff, Cas S.; Parkinson, Shelagh; Verbrugh, Henri A.; Petit, Pieter L.C.; van Soolingen, Dick

2009-01-01

Clinical relevance of nontuberculous mycobacteria (NTM) isolated from 180 chronically ill patients and 385 healthy controls in Zambia was evaluated to examine the contribution of these isolates to tuberculosis (TB)–like disease. The proportion of NTM-positive sputum samples was significantly higher in the patient group than in controls; 11% and 6%, respectively (p<0.05). NTM-associated lung disease was diagnosed for 1 patient, and a probable diagnosis was made for 3 patients. NTM-positive patients and controls were more likely to report vomiting and diarrhea and were more frequently underweight than the NTM-negative patients and controls. Chest radiographs of NTM-positive patients showed deviations consistent with TB more frequently than those of controls. The most frequently isolated NTM was Mycobacterium avium complex. Multiple, not previously identified mycobacteria (55 of 171 NTM) were isolated from both groups. NTM probably play an important role in the etiology of TB-like diseases in Zambia. PMID:19193268

Strategies for Living with the Challenges of HIV and Antiretroviral Use in Zambia

ERIC Educational Resources Information Center

Jones, Deborah; Zulu, Isaac; Mumbi, Miriam; Chitalu, Ndashi; Vamos, Szonja; Gomez, Jacqueline; Weiss, Stephen M.

2009-01-01

This study sought to identify strategies for living with the challenges of HIV and antiretroviral (ARV) use among new medication users in urban Zambia. Participants (n = 160) were recruited from urban Lusaka, Zambia. Qualitative Data was drawn from monthly ARV treatment education intervention groups addressing HIV and antiretroviral use. Themes…

Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study

PubMed Central

Timæus, Ian M; Banda, Richard; Thankian, Kusanthan; Banda, Andrew; Lemba, Musonda; Stringer, Jeffrey S A; Chi, Benjamin H

2016-01-01

Objectives To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. Setting Households in Lusaka District, Zambia, 2004–2011. Participants 43 064 household heads (88% female) who enumerated 123 807 adult household members aged between 15 and 60 years. Primary outcome Premature adult mortality. Results The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. Conclusions To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services. PMID:26940113

The Nature and Role of Religious Studies at the University of Zambia: 1985-2005

ERIC Educational Resources Information Center

Carmody, Brendan

2008-01-01

The place of religion in higher education has been and remains a complex issue internationally. This article aims to outline the nature and development of Religious Studies at the University of Zambia in Lusaka (UNZA) as an instance of how religion entered higher education in an African setting. In doing so, it will also provide perspectives on…

In-home HIV testing and nevirapine dosing by traditional birth attendants in rural Zambia: a feasibility study.

PubMed

Brennan, Alana T; Thea, Donald M; Semrau, Katherine; Goggin, Caitlin; Scott, Nancy; Pilingana, Portipher; Botha, Belinda; Mazimba, Arthur; Hamomba, Leoda; Seidenberg, Phil

2014-01-01

Access to lifesaving prevention of mother-to-child transmission (PMTCT) services is problematic in rural Zambia. The simplest intervention used in Zambia has been 2-dose nevirapine (NVP) administration in the peripartum period, a regimen of 1 NVP tablet to the mother at the onset of labor and 1 dose in the form of syrup to the newborn within 4 to 72 hours after birth. This 2-dose regimen has been shown to reduce MTCT by nearly 50%. We set out to demonstrate that in-home HIV testing and NVP dosing by traditional birth attendants (TBAs) is feasible and acceptable by women in rural Zambia. This was a pilot program using TBAs to perform rapid saliva-based HIV testing and administer single-dose NVP in tablet form to the mother at the onset of labor and syrup to the infant after birth. A total of 280 pregnant women were consented and enrolled into the program, of whom 124 (44.3%) gave birth at home with the assistance of a trained TBA. Of those, 16 (12.9%) were known to be HIV positive, and 101 of the remaining 108 (93.5%) accepted a rapid HIV test. All these women tested HIV negative. In the subset of 16 mothers who were HIV positive, 13 (81.3%) took single-dose NVP administered by a TBA between 1 and 24 hours prior to birth and 100% of exposed newborns (16 of 16) received NVP syrup within 72 hours after birth, 80% of whom were dosed in the first 24 hours of life. With the substantial shortage of human resources in public health care throughout sub-Saharan Africa, it is extremely valuable to utilize lay health care workers to help extended services beyond the level of the facility. Given the high uptake of PMTCT services we believe that TBAs with proper training and support can successfully provide country-approved PMTCT. © 2013 by the American College of Nurse-Midwives.

Neonatal death in low- to middle-income countries: a global network study.

PubMed

Belizán, José M; McClure, Elizabeth M; Goudar, Shivaprasad S; Pasha, Omrana; Esamai, Fabian; Patel, Archana; Chomba, Elwyn; Garces, Ana; Wright, Linda L; Koso-Thomas, Marion; Moore, Janet; Althabe, Fernando; Kodkany, Bhala S; Sami, Neelofar; Manasyan, Albert; Derman, Richard J; Liechty, Edward A; Hibberd, Patricia; Carlo, Waldemar A; Hambidge, K Michael; Buekens, Pierre; Jobe, Alan H; Goldenberg, Robert L

2012-09-01

To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths. A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age. Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery. In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Molecular characterisation of methicillin-resistant Staphylococcus aureus (MRSA) isolated at a large referral hospital in Zambia.

PubMed

Samutela, Mulemba Tillika; Kalonda, Annie; Mwansa, James; Lukwesa-Musyani, Chileshe; Mwaba, John; Mumbula, Enoch Mulowa; Mwenya, Darlington; Simulundu, Edgar; Kwenda, Geoffrey

2017-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) is globally recognized as an important public health problem. Whereas comprehensive molecular typing data of MRSA strains is available, particularly in Europe, North America and Australia, similar information is very limited in sub-Saharan Africa including Zambia. In this study, thirty two clinical isolates of Staphylococcus aureus , collected at a large referral hospital in Lusaka, Zambia between June 2009 and December 2012 were analysed by Staphylococcal cassette chromosome mec (SCCmec), Staphylococcus protein A gene typing (spa) and detection of the Panton-Valentine Leukocidin genes (pvl) . Three SCC mec types were identified namely SCC mec type IV (65.6%), SCCmec type III (21.9%), SCC mec type I (3.1%). Nine point four percent (9.4%) of the isolates were untypable. Five spa types, which included a novel type, were detected and the most prevalent spa type was t064 (40.6%). Other spa types included spa types t2104 (31.3%), t355 (3.1%) and t1257 (21.9%). The pvl genes were detected in 3 out of 32 isolates. These molecular typing data indicated that the MRSA strains collected in Lusaka were diverse. Although the source of these MRSA was not established, these results stress the need for assessing infection prevention and control procedures at this health-care facility in order to curtail possible nosocomial infections. Furthermore, country-wide surveillance of MRSA in both the community and health-care facilities is recommended for infection prevention and control. To our knowledge, this represents the first study to characterise MRSA using molecular tools in Zambia.

Perceptions of and Attitudes towards Ageing in Zambia

ERIC Educational Resources Information Center

Mapoma, Christopher C.; Masaiti, Gift

2012-01-01

This paper reflects part of the wider outlook on ageing in general in Zambia and was intended to investigate perceptions of and attitudes towards the aged and ageing in Zambia by members of the community who, by definition and chronologically are not classified as aged i.e. not yet 60 years and over. Focus Group Discussions (FGD) were used to…

Attitudes toward abortion in Zambia.

PubMed

Geary, Cynthia Waszak; Gebreselassie, Hailemichael; Awah, Paschal; Pearson, Erin

2012-09-01

Despite Zambia's relatively progressive abortion law, women continue to seek unsafe, illegal abortions. Four domains of abortion attitudes - support for legalization, immorality, rights, and access to services - were measured in 4 communities. A total of 668 people were interviewed. Associations among the 4 domains were inconsistent with expectations. The belief that abortion is immoral was widespread, but was not associated with lack of support for legalization. Instead, it was associated with belief that women need access to safe services. These findings suggest that increasing awareness about abortion law in Zambia may be important for encouraging more favorable attitudes. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

The Epidemiology of African Swine Fever in “Nonendemic” Regions of Zambia (1989–2015): Implications for Disease Prevention and Control

PubMed Central

Lubaba, Caesar H.; Kajihara, Masahiro; Mataa, Liywalii; Chambaro, Herman Moses; Sinkala, Yona; Munjita, Samuel Munalula; Nalubamba, King Shimumbo; Samui, Kenny; Pandey, Girja Shanker; Takada, Ayato; Mweene, Aaron S.

2017-01-01

African swine fever (ASF) is a highly contagious and deadly viral hemorrhagic disease of swine. In Zambia, ASF was first reported in 1912 in Eastern Province and is currently believed to be endemic in that province only. Strict quarantine measures implemented at the Luangwa River Bridge, the only surface outlet from Eastern Province, appeared to be successful in restricting the disease. However, in 1989, an outbreak occurred for the first time outside the endemic province. Sporadic outbreaks have since occurred almost throughout the country. These events have brought into acute focus our limited understanding of the epidemiology of ASF in Zambia. Here, we review the epidemiology of the disease in areas considered nonendemic from 1989 to 2015. Comprehensive sequence analysis conducted on genetic data of ASF viruses (ASFVs) detected in domestic pigs revealed that p72 genotypes I, II, VIII and XIV have been involved in causing ASF outbreaks in swine during the study period. With the exception of the 1989 outbreak, we found no concrete evidence of dissemination of ASFVs from Eastern Province to other parts of the country. Our analyses revealed a complex epidemiology of the disease with a possibility of sylvatic cycle involvement. Trade and/or movement of pigs and their products, both within and across international borders, appear to have been the major factor in ASFV dissemination. Since ASFVs with the potential to cause countrywide and possibly regional outbreaks, could emerge from “nonendemic regions”, the current ASF control policy in Zambia requires a dramatic shift to ensure a more sustainable pig industry. PMID:28832525

Community attitudes towards childbearing and abortion among HIV-positive women in Nigeria and Zambia.

PubMed

Kavanaugh, Megan L; Moore, Ann M; Akinyemi, Odunayo; Adewole, Isaac; Dzekedzeke, Kumbutso; Awolude, Olutosin; Arulogun, Oyedunni

2013-01-01

Although stigma towards HIV-positive women for both continuing and terminating a pregnancy has been documented, to date few studies have examined relative stigma towards one outcome versus the other. This study seeks to describe community attitudes towards each of two possible elective outcomes of an HIV-positive woman's pregnancy - induced abortion or birth - to determine which garners more stigma and document characteristics of community members associated with stigmatising attitudes towards each outcome. Data come from community-based interviews with reproductive-aged men and women, 2401 in Zambia and 2452 in Nigeria. Bivariate and multivariate analyses revealed that respondents from both countries overwhelmingly favoured continued childbearing for HIV-positive pregnant women, but support for induced abortion was slightly higher in scenarios in which anti-retroviral therapy (ART) was unavailable. Zambian respondents held more stigmatising attitudes towards abortion for HIV-positive women than did Nigerian respondents. Women held more stigmatising attitudes towards abortion for HIV-positive women than men, particularly in Zambia. From a sexual and reproductive health and rights perspective, efforts to assist HIV-positive women in preventing unintended pregnancy and to support them in their pregnancy decisions when they do become pregnant should be encouraged in order to combat the social stigma documented in this paper.

A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014.

PubMed

Brathwaite, Rachel; Addo, Juliet; Smeeth, Liam; Lock, Karen

2015-01-01

To systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries. Five databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions. 26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries. Study details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website. Studies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents. Smoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.

Will savannas survive outside the parks? A lesson from Zambia

NASA Astrophysics Data System (ADS)

Kutsch, W.; Merbold, L.; Scholes, B.; Mukelabai, M.

2012-04-01

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.

Improving paediatric asthma care in Zambia

PubMed Central

Jumbe-Marsden, Emilia; Mateyo, Kondwelani; Senkwe, Mutale Nsakashalo; Sotomayor-Ruiz, Maria; Musuku, John; Soriano, Joan B; Ancochea, Julio; Fishman, Mark C

2015-01-01

Abstract Problem In 2008, the prevalence of paediatric asthma in Zambia was unknown and the national treatment guideline was outdated. Approach We created an international partnership between Zambian clinicians, the Zambian Government and a pharmaceutical company to address shortcomings in asthma treatment. We did two studies, one to estimate prevalence in the capital of Lusaka and one to assess attitudes and practices of patients. Based on the information obtained, we educated health workers and the public. The information from the studies was also used to modernize government policy for paediatric asthma management. Local setting The health-care system in Zambia is primarily focused on acute care delivery with a focus on infectious diseases. Comprehensive services for noncommunicable diseases are lacking. Asthma management relies on treatment of acute exacerbations instead of disease control. Relevant changes Seven percent of children surveyed had asthma (255/3911). Of the 120 patients interviewed, most (82/120, 68%) used oral short-acting β2-agonists for symptom control; almost half (59/120, 49%) did not think the symptoms were preventable and 43% (52/120) thought inhalers were addictive. These misconceptions informed broad-based educational programmes. We used a train-the-trainer model to educate health-care workers and ran public awareness campaigns. Access to inhalers was increased and the Zambian standard treatment guideline for paediatric asthma was revised to include steroid inhalers as a control treatment. Lessons learnt Joint activities were required to change paediatric asthma care in Zambia. Success will depend on local sustainability, and it may be necessary to shift resources to mirror the disease burden. PMID:26600616

Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia.

PubMed

Esquivel, Micaela M; Uribe-Leitz, Tarsicio; Makasa, Emmanuel; Lishimpi, Kennedy; Mwaba, Peter; Bowman, Kendra; Weiser, Thomas G

2016-11-01

Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making. To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities. In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care. Surgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care. Data were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area

Urban waste landfill planning and karstic groundwater resources in developing countries: the example of Lusaka (Zambia)

NASA Astrophysics Data System (ADS)

De Waele, J.; Nyambe, I. A.; Di Gregorio, A.; Di Gregorio, F.; Simasiku, S.; Follesa, R.; Nkemba, S.

2004-06-01

Lusaka, the capital city of Zambia with more than two million inhabitants, derives approximately 70% of its water requirements from groundwater sourced in the underlying karstic Lusaka aquifer. This water resource is, therefore, extremely important for the future of the population. The characteristics of the aquifer and the shallow water table make the resource vulnerable and in need of protection and monitoring. A joint project between the Geology Departments of the University of Cagliari and the School of Mines of the University of Zambia, to investigate the "Anthropogenic and natural processes in the Lusaka area leading to environmental degradation and their possible mitigation" was carried out in July 2001. The main objective of the study was to evaluate the extent of the present environmental degradation, assessing the vulnerability of the carbonatic aquifer and the degree of pollution of the groundwater and to make proposals to mitigate adverse environmental effects. Analyses of water samples collected during project indicate some areas of concern, particularly with respect to the levels of ammonia, nitrates and some heavy metals. As groundwater quality and quantity are prerogatives for a healthy and sustainable society, the study offers guidelines for consideration by the local and national authorities. Uptake of these guidelines should result in a number of initiatives being taken, including: (a) closure or reclamation of existing waste dumps; (b) upgrading of existing waste dumps to controlled landfills; (c) establishing new urban waste landfills and plants in geo-environmentally suitable sites; (d) local waste management projects in all compounds (residential areas) to prevent and reduce haphazard waste dumping; (e) enlarging sewerage drainage systems to all compounds; (f) enforcing control on groundwater abstraction and pollution, and demarcation of zones of control at existing drill holes; (g) providing the city with new water supplies from outside the

Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe.

PubMed

Sgaier, Sema K; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-01-01

As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0-60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0-60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side

Attitudes and decision-making about early-infant versus early-adolescent male circumcision: Demand-side insights for sustainable HIV prevention strategies in Zambia and Zimbabwe

PubMed Central

Sgaier, Sema K.; Sharma, Sunny; Eletskaya, Maria; Prasad, Ram; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Getrude; Xaba, Sinokuthemba; Nanga, Alice; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-01-01

As countries approach their scale-up targets for the voluntary medical male circumcision program for HIV prevention, they are strategizing and planning for the sustainability phase to follow. Global guidance recommends circumcising adolescent (below 14 years) and/or early infant boys (aged 0–60 days), and countries need to consider several factors before prioritizing a cohort for their sustainability phase. We provide community and healthcare provider-side insights on attitudes and decision-making process as a key input for this strategic decision in Zambia and Zimbabwe. We studied expectant parents, parents of infant boys (aged 0–60 days), family members and neo-natal and ante-natal healthcare providers in Zambia and Zimbabwe. Our integrated methodology consisted of in-depth qualitative and quantitative one-on-one interviews, and a simulated-decision-making game, to uncover attitudes towards, and the decision-making process for, early adolescent or early infant medical circumcision (EAMC or EIMC). In both countries, parents viewed early infancy and early adolescence as equally ideal ages for circumcision (38% EIMC vs. 37% EAMC in Zambia; 24% vs. 27% in Zimbabwe). If offered for free, about half of Zambian parents and almost 2 in 5 Zimbabwean parents indicated they would likely circumcise their infant boy; however, half of parents in each country perceived that the community would not accept EIMC. Nurses believed their facilities currently could not absorb EIMC services and that they would have limited ability to influence fathers, who were seen as having the primary decision-making authority. Our analysis suggests that EAMC is more accepted by the community than EIMC and is the path of least resistance for the sustainability phase of VMMC. However, parents or community members do not reject EIMC. Should countries choose to prioritize this cohort for their sustainability phase, a number of barriers around information, decision-making by parents, and supply side

Moving from legality to reality: how medical abortion methods were introduced with implementation science in Zambia.

PubMed

Fetters, Tamara; Samandari, Ghazaleh; Djemo, Patrick; Vwallika, Bellington; Mupeta, Stephen

2017-02-16

Although abortion is technically legal in Zambia, the reality is far more complicated. This study describes the process and results of galvanizing access to medical abortion where abortion has been legal for many years, but provision severely limited. It highlights the challenges and successes of scaling up abortion care using implementation science to document 2 years of implementation. An intervention between the Ministry of Health, University Teaching Hospital and the international organization Ipas, was established to introduce medical abortion and to address the lack of understanding and implementation of the country's abortion law. An implementation science model was used to evaluate effectiveness and glean lessons for other countries about bringing safe and legal abortion services to scale. The intervention involved the provision of Comprehensive Abortion Care services in 28 public health facilities in Zambia for a 2 year period, August 2009 to September 2011. The study focused on three main areas: building health worker capacity in public facilities and introducing medical abortion, working with pharmacists to provide improved information on medical abortion, and community engagement and mobilization to increase knowledge of abortion services and rights through stronger health system and community partnerships. After 2 years, 25 of 28 sites provided abortion services, caring for more than 13,000 women during the intervention. For the first time, abortion was decentralized, 19% of all abortion care was performed in health centers. At the end of the intervention, all providing facilities had managers supportive of continuing legal abortion services. When asked about the impact of medical abortion provision, a number of providers reported that medical abortion improved their ability to provide affordable safe abortion. In neighboring pharmacies only 19% of mystery clients visiting them were offered misoprostol for purchase at baseline, this increased to 47

Studies of trypanosomiasis in the Luangwa valley, north-eastern Zambia.

PubMed

Laohasinnarong, Dusit; Goto, Yasuyuki; Goto, Yasuhuki; Asada, Masahito; Nakao, Ryo; Hayashida, Kyoko; Kajino, Kiichi; Kawazu, Shin-ichiro; Sugimoto, Chihiro; Inoue, Noboru; Namangala, Boniface

2015-09-30

The present study, conducted in Zambia's Luangwa valley where both animal African trypanosomiasis (AAT) and human African trypanosomiasis (HAT) are endemic, combined the use of microscopy and molecular techniques to determine the presence of trypanosome species in cattle, goats and tsetse flies. This study was conducted between 2008 and 2010 in Petauke, Chama and Isoka districts, north-eastern Zambia. A total of 243 cattle, 36 goats and 546 tsetse flies, were examined for presence of trypanosome species using microscopy, PCR and loop-mediated isothermal amplification (LAMP). There was poor agreement among the test methods used for detection of trypanosomes species in animal blood and tsetse flies. Trypanosomes were observed in 6.1 % (95 % CI: 3.3-8.9 %) of the animals sampled by microscopy, 7.5 % (95 % CI: 4.4-10.6 %) by PCR and 18.6 % (95 % CI: 13.6-23.6 %) by PFR-LAMP. PFR-LAMP was more sensitive for detecting Trypanozoon than KIN-PCR. The highest occurrence of AAT was recorded in cattle from Petauke (58.7 %, 95 % CI: 44.7-72.7 %) while the lowest was from Isoka (5.4 %, 95 % CI: 0.8-10.0 %). Infection of both cattle and goats with Trypanosoma congolense and T. vivax was associated with clinical AAT. When selecting molecular techniques for AAT surveillance in endemic regions, the KIN-PCR and species-specific PCR may be recommended for screening animal or tsetse fly samples for T. congolense and T. vivax, respectively. On the other hand, species-specific PCR and/or LAMP might be of greater value in the screening of animal and human body fluids as well as tsetse fly samples for Trypanozoon.

Prices and mark-ups on antimalarials: evidence from nationally representative studies in six malaria-endemic countries

PubMed Central

Palafox, Benjamin; Patouillard, Edith; Tougher, Sarah; Goodman, Catherine; Hanson, Kara; Kleinschmidt, Immo; Torres Rueda, Sergio; Kiefer, Sabine; O’Connell, Kate; Zinsou, Cyprien; Phok, Sochea; Akulayi, Louis; Arogundade, Ekundayo; Buyungo, Peter; Mpasela, Felton; Poyer, Stephen; Chavasse, Desmond

2016-01-01

The private for-profit sector is an important source of treatment for malaria. However, private patients face high prices for the recommended treatment for uncomplicated malaria, artemisinin combination therapies (ACTs), which makes them more likely to receive cheaper, less effective non-artemisinin therapies (nATs). This study seeks to better understand consumer antimalarial prices by documenting and exploring the pricing behaviour of retailers and wholesalers. Using data collected in 2009–10, we present survey estimates of antimalarial retail prices, and wholesale- and retail-level price mark-ups from six countries (Benin, Cambodia, the Democratic Republic of Congo, Nigeria, Uganda and Zambia), along with qualitative findings on factors affecting pricing decisions. Retail prices were lowest for nATs, followed by ACTs and artemisinin monotherapies (AMTs). Retailers applied the highest percentage mark-ups on nATs (range: 40% in Nigeria to 100% in Cambodia and Zambia), whereas mark-ups on ACTs (range: 22% in Nigeria to 71% in Zambia) and AMTs (range: 22% in Nigeria to 50% in Uganda) were similar in magnitude, but lower than those applied to nATs. Wholesale mark-ups were generally lower than those at retail level, and were similar across antimalarial categories in most countries. When setting prices wholesalers and retailers commonly considered supplier prices, prevailing market prices, product availability, product characteristics and the costs related to transporting goods, staff salaries and maintaining a property. Price discounts were regularly used to encourage sales and were sometimes used by wholesalers to reward long-term customers. Pricing constraints existed only in Benin where wholesaler and retailer mark-ups are regulated; however, unlicensed drug vendors based in open-air markets did not adhere to the pricing regime. These findings indicate that mark-ups on antimalarials are reasonable. Therefore, improving ACT affordability would be most readily

Personal and Environmental Predictors of the Intention to Use Maternal Healthcare Services in Kalomo, Zambia

ERIC Educational Resources Information Center

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

2014-01-01

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…

"The problem is ours, it is not CRAIDS' ". Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia.

PubMed

Walsh, Aisling; Mulambia, Chishimba; Brugha, Ruairi; Hanefeld, Johanna

2012-11-28

While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn. In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011. All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. FUNDING opportunities for CBOs in Mumbwa in 2010 were scarce.Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics.Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers' skills levels had reduced. Whilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of their Zambia strategy. Assessments of need on the ground

Tenofovir in second-line ART in Zambia and South Africa: Collaborative analysis of cohort studies

PubMed Central

Wandeler, Gilles; Keiser, Olivia; Mulenga, Lloyd; Hoffmann, Christopher J; Wood, Robin; Chaweza, Thom; Brennan, Alana; Prozesky, Hans; Garone, Daniela; Giddy, Janet; Chimbetete, Cleophas; Boulle, Andrew; Egger, Matthias

2012-01-01

Objectives Tenofovir (TDF) is increasingly used in second-line antiretroviral treatment (ART) in sub-Saharan Africa. We compared outcomes of second-line ART containing and not containing TDF in cohort studies from Zambia and the Republic of South Africa (RSA). Methods Patients aged ≥ 16 years starting protease inhibitor-based second-line ART in Zambia (1 cohort) and RSA (5 cohorts) were included. We compared mortality, immunological failure (all cohorts) and virological failure (RSA only) between patients receiving and not receiving TDF. Competing risk models and Cox models adjusted for age, sex, CD4 count, time on first-line ART and calendar year were used to analyse mortality and treatment failure, respectively. Hazard ratios (HRs) were combined in fixed-effects meta-analysis. Findings 1,687 patients from Zambia and 1,556 patients from RSA, including 1,350 (80.0%) and 206 (13.2%) patients starting TDF, were followed over 4,471 person-years. Patients on TDF were more likely to have started second-line ART in recent years, and had slightly higher baseline CD4 counts than patients not on TDF. Overall 127 patients died, 532 were lost to follow-up and 240 patients developed immunological failure. In RSA 94 patients had virologic failure. Combined HRs comparing tenofovir with other regimens were 0.60 (95% CI 0.41–0.87) for immunologic failure and 0.63 (0.38–1.05) for mortality. The HR for virologic failure in RSA was 0.28 (0.09–0.90). Conclusions In this observational study patients on TDF-containing second-line ART were less likely to develop treatment failure than patients on other regimens. TDF seems to be an effective component of second-line ART in southern Africa. PMID:22743595

Development of a screening tool to predict malnutrition among children under two years old in Zambia

PubMed Central

Hasegawa, Junko; Ito, Yoichi M; Yamauchi, Taro

2017-01-01

ABSTRACT Background: Maternal and child undernutrition is an important issue, particularly in low- and middle-income countries. Children at high risk of malnutrition should be prioritized to receive necessary interventions to minimize such risk. Several risk factors have been proposed; however, until now, there has been no appropriate evaluation method to identify these children. In sub-Saharan Africa, children commonly receive regular check-ups from community health workers. A simple and easy nutrition assessment method is therefore needed for use by semi-professional health workers. Objectives: The aim of this study was to develop and test a practical screening tool for community use in predicting growth stunting in children under two years in rural Zambia. Methods: Field research was conducted from July to August 2014 in Southern Province, Zambia. Two hundred and sixty-four mother-child pairs participated in the study. Anthropometric measurements were performed on all children and mothers, and all mothers were interviewed. Risk factors for the screening test were estimated by using least absolute shrinkage and selection operator analysis. After re-evaluating all participants using the new screening tool, a receiver operating characteristic curve was drawn to set the cut-off value. Sensitivity and specificity were also calculated. Results: The screening tool included age, weight-for-age Z-score status, birth weight, feeding status, history of sibling death, multiple birth, and maternal education level. The total score ranged from 0 to 22, and the cut-off value was eight. Sensitivity and specificity were 0.963 and 0.697 respectively. Conclusions: A screening tool was developed to predict children at high risk of malnutrition living in Zambia. Further longitudinal studies are needed to confirm the test’s validity in detecting future stunting and to investigate the effectiveness of malnutrition treatment. PMID:28730929

Health worker perspectives on user fee removal in Zambia

PubMed Central

2012-01-01

Background User fees for primary care services were removed in rural districts in Zambia in 2006. Experience from other countries has suggested that health workers play a key role in determining the success of a fee removal policy, but also find the implementation of such a policy challenging. The policy was introduced against a backdrop of a major shortage in qualified health staff. Methods As part of a larger study on the experience and effect of user fee removal in Zambia, a number of case studies at the facility level were conducted. As part of these, quantitative and qualitative data were collected to evaluate health workers’ satisfaction and experiences in charging and non-charging facilities. Results Our findings show that health-care workers have mixed feelings about the policy change and its consequences. We found some evidence that personnel motivation was higher in non-charging facilities compared to facilities still charging. Yet it is unclear whether this effect was due to differences in the user fee policy or to the fact that a lot of staff interviewed in non-charging facilities were working in mission facilities, where we found a significantly higher motivation. Health workers expressed satisfaction with an apparent increase in the number of patients visiting the facilities and the removal of a deterring factor for many needy patients, but also complained about an increased workload. Furthermore, working conditions were said to have worsened, which staff felt was linked to the absence of additional resources to deal with the increased demand or replace the loss of revenue generated by fees. Conclusion These findings highlight the need to pay attention to supply-side measures when removing demand-side barriers such as user fees and in particular to be concerned about the burden that increased demand can place on already over-stretched health workers. PMID:23110690

Is green economy achievable through championing green growth? A local government experience from Zambia

PubMed Central

2016-01-01

The need to enhance environmental sustainability, sustainable development and growth that takes into account the well-being of the people and nature because of the increased production and consumption of goods and services is the major driver to the introduction of green economy in Zambia and countries in southern Africa. This article examines the extent to which local government in Zambia has embraced green growth and green economy and critically analyses the concept of green economy and green growth. This study is based on a review of planning and policy documents, a household questionnaire survey and interviews with various institutions, planners and rural development organisations. A number of policies implemented at the local government level were analysed and reflected upon irrespective of whether they contain the components of green growth and green economy and the extent to which they contribute to attaining green economy. The article argues that the need for economic diversification is important as far as green economy is concerned. The article recommends the need to invest in research and development in order to find more carbon-free economic activities. The conclusion is that local government is key to achieving green growth and green economy, because it is involved at all levels, from policy formulation to implementation.

Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia

PubMed Central

Lohela, Terhi J.; Campbell, Oona M. R.; Gabrysch, Sabine

2012-01-01

Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality. PMID:23300599

Why resort to illegal abortion in Zambia? Findings of a community-based study in Western Province.

PubMed

Koster-Oyekan, W

1998-05-01

This article presents part of the findings of a community-based study on the causes and effects of unplanned pregnancies in four districts of Western Province, Zambia. The study broke the silence around abortion in Western Province and revealed that induced abortion poses a public health problem. Using innovative methodology of recording and analyzing histories of deaths from induced abortion, the abortion mortality ratio was calculated for the study districts. Findings reveal all extremely high induced abortion mortality ratio of 120 induced abortion-related deaths per 100,000 live births. More than half the deaths were of schoolgirls. Although abortion in Zambia is legal on medical and social grounds, most women in Western Province resort to illegal abortions because legal abortion services are inaccessible and unacceptable. The main reasons women resort to abortion is for fear of being expelled from school, their unwillingness to reveal a secret relationship, to protect the health of their previous baby and common knowledge that postpartum sexual taboos have been transgressed. An inventory was made of abortion methods, taboos and abortion-providers. The article describes how health staff were involved throughout the study, and shows how recommendations were made by involving all parties concerned.

Examining the Role of Couples' Characteristics in Contraceptive use in Nigeria and Zambia.

PubMed

Ntoimo, Lorretta Favour C; Chirwa-Banda, Pamela

2017-12-01

Relationship-related characteristics influence diverse health and demographic outcomes. This study examined the role of couples' characteristics in contraceptive use. Data were obtained from 2013 Nigeria and 2013-14 Zambia Demographic and Health Surveys. The study population consisted of couples in monogamous union (married or living together) who had at least one live birth and the wife was not pregnant at the time of the survey. Prevalence of contraceptive use among couples in Nigeria was 27% and 63% in Zambia. Couples' educational attainment, religious affiliation, the frequency of listening to the radio, reported number of children, fertility preference, region of residence and household wealth index were significant predictors of contraceptive use among couples in Nigeria and Zambia. Given the significant role of couples' characteristics in the uptake of contraceptives, there is the need to encourage interventions that target couples, particularly those of poor socioeconomic status.

FIFA 11 for Health Programme: Implementation in Five Countries in Sub-Saharan Africa

ERIC Educational Resources Information Center

Fuller, Colin W.; Junge, Astrid; Amaning, Jacob; Kaijage, Rogasian R.; Kaputa, John; Magwende, George; Pambo, Prince; Dvorak, Jiri

2015-01-01

Objective: To assess the effectiveness of the FIFA 11 for Health programme in increasing children's knowledge about communicable and non-communicable diseases in five countries of Sub-Saharan Africa. Method: A prospective five-cohort study was implemented in schools in Ghana (17), Malawi (12), Namibia (11), Tanzania (18) and Zambia (11). The…

Strengthening Faculty Recruitment for Health Professions Training in Basic Sciences in Zambia

PubMed Central

Simuyemba, Moses; Talib, Zohray; Michelo, Charles; Mutale, Wilbroad; Zulu, Joseph; Andrews, Ben; Katubulushi, Max; Njelesani, Evariste; Bowa, Kasonde; Maimbolwa, Margaret; Mudenda, John; Mulla, Yakub

2014-01-01

Zambia is facing a crisis in its human resources for health (HRH), 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

Strengthening faculty recruitment for health professions training in basic sciences in Zambia.

PubMed

Simuyemba, Moses; Talib, Zohray; Michelo, Charles; Mutale, Wilbroad; Zulu, Joseph; Andrews, Ben; Nzala, Selestine; Katubulushi, Max; Njelesani, Evariste; Bowa, Kasonde; Maimbolwa, Margaret; Mudenda, John; Mulla, Yakub

2014-08-01

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.

The prevalence and distribution of schistosomiasis in Zambia.

PubMed

Boatin, B A; Wurapa, F K; Ulrich, A M

1985-09-01

This paper attempts to approach an accurate report of prevalence of schistosomiasis in Zambia by bringing together several reports. A review of some early prevalence studies in Zambia shows the prevalence of S. hematobium infection to be (14-40%) and that for S. mansoni to range from (0-7%), in the Northern and Luapula Provinces. The areas around Lakes Kariba in the south, and Bangweulu in the north had prevalence rates of (3-35%) for S. hematobium and (2-6%) for S. mansoni. A nationwide survey found the overall prevalence of S. hematobium to be about 16%. The Gwembe Valley in the South had the highest prevalence of 57.9% for S. hematobium; S. mansoni with a prevalence of (45-77%) in the Northern Province from more recent studies is not very widespread. A comprehensive study performed between 1969-73 covered almost the entire rural population and found an overall prevalence of 16.8%, varying greatly between ecozones. The 5-14 year age group showed the highest prevalence. A 1976-82 study of rural primary school children in several provinces found high prevalence rates. Specimen gathering and analysis is described for most studies analyzed, revealing some inconsistencies threatening the reliability of data. Available data do show the spotty and local nature of the prevalence rates between areas. There have not been many studies of S. mansoni prevalence, possibly due to the difficulties involved with the collection of stool specimens, but prevalence (especially seasonal) has been shown to be high in certain areas (although low generally). The areas around the 2 major lakes show considerable prevalence of both parasites, and further study is needed on the health impact of man-made lakes in Zambia and elsewhere.

Markets for hospital services in Zambia.

PubMed

Nakamba, Pamela; Hanson, Kara; McPake, Barbara

2002-01-01

Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

Aspergillus section Flavi community structure in Zambia influences aflatoxin contamination of maize and groundnut.

PubMed

Kachapulula, Paul W; Akello, Juliet; Bandyopadhyay, Ranajit; Cotty, Peter J

2017-11-16

Aflatoxins are cancer-causing, immuno-suppressive mycotoxins that frequently contaminate important staples in Zambia including maize and groundnut. Several species within Aspergillus section Flavi have been implicated as causal agents of aflatoxin contamination in Africa. However, Aspergillus populations associated with aflatoxin contamination in Zambia have not been adequately detailed. Most of Zambia's arable land is non-cultivated and Aspergillus communities in crops may originate in non-cultivated soil. However, relationships between Aspergillus populations on crops and those resident in non-cultivated soils have not been explored. Because characterization of similar fungal populations outside of Zambia have resulted in strategies to prevent aflatoxins, the current study sought to improve understanding of fungal communities in cultivated and non-cultivated soils and in crops. Crops (n=412) and soils from cultivated (n=160) and non-cultivated land (n=60) were assayed for Aspergillus section Flavi from 2012 to 2016. The L-strain morphotype of Aspergillus flavus and A. parasiticus were dominant on maize and groundnut (60% and 42% of Aspergillus section Flavi, respectively). Incidences of A. flavus L-morphotype were negatively correlated with aflatoxin in groundnut (log y=2.4990935-0.09966x, R 2 =0.79, P=0.001) but not in maize. Incidences of A. parasiticus partially explained groundnut aflatoxin concentrations in all agroecologies and maize aflatoxin in agroecology III (log y=0.1956034+0.510379x, R 2 =0.57, P<0.001) supporting A. parasiticus as the dominant etiologic agent of aflatoxin contamination in Zambia. Communities in both non-cultivated and cultivated soils were dominated by A. parasiticus (69% and 58%, respectively). Aspergillus parasiticus from cultivated and non-cultivated land produced statistically similar concentrations of aflatoxins. Aflatoxin-producers causing contamination of crops in Zambia may be native and, originate from non-cultivated areas

Serials Acquisition Problems in Developing Countries: The Zambian Experience.

ERIC Educational Resources Information Center

Lungu, Charles B. M.

1985-01-01

Analysis of serial acquisition problems in developing nations cites specific references from University of Zambia Library. Discussion covers underdeveloped economic circumstances of Third World nations, overdependence on serials of foreign origin, geographical locations of Third World countries, ill-defined acquisition policies, staffing for…

Co-circulation of multiple genotypes of African swine fever viruses among domestic pigs in Zambia (2013-2015).

PubMed

Simulundu, E; Chambaro, H M; Sinkala, Y; Kajihara, M; Ogawa, H; Mori, A; Ndebe, J; Dautu, G; Mataa, L; Lubaba, C H; Simuntala, C; Fandamu, P; Simuunza, M; Pandey, G S; Samui, K L; Misinzo, G; Takada, A; Mweene, A S

2018-02-01

During 2013-2015, several and severe outbreaks of African swine fever (ASF) affected domestic pigs in six provinces of Zambia. Genetic characterization of ASF viruses (ASFVs) using standardized genotyping procedures revealed that genotypes I, II and XIV were associated with these outbreaks. Molecular and epidemiological data suggest that genotype II ASFV (Georgia 2007/1-like) detected in Northern Province of Zambia may have been introduced from neighbouring Tanzania. Also, a genotype II virus detected in Eastern Province of Zambia showed a p54 phylogenetic relationship that was inconsistent with that of p72, underscoring the genetic variability of ASFVs. While it appears genotype II viruses detected in Zambia arose from a domestic pig cycle, genotypes I and XIV possibly emerged from a sylvatic cycle. Overall, this study demonstrates the co-circulation of multiple genotypes of ASFVs, involvement of both the sylvatic and domestic pig cycle in ASF outbreaks in Zambia and possible trans-boundary spread of the disease in south-eastern Africa. Indeed, while there is need for regional or international concerted efforts in the control of ASF, understanding pig marketing practices, pig population dynamics, pig housing and rearing systems and community engagement will be important considerations when designing future prevention and control strategies of this disease in Zambia. © 2017 Blackwell Verlag GmbH.

“The problem is ours, it is not CRAIDS’ ”. Evaluating sustainability of Community Based Organisations for HIV/AIDS in a rural district in Zambia

PubMed Central

2012-01-01

Background While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the World Bank Multi-Country AIDS Program (MAP) in Zambia as a case study, seeks to evaluate whether or not this global programme contributed to the sustainability of CBOs working in the area of HIV/AIDS in Zambia. Lessons for optimising sustainability of CBOs in lower income countries are drawn. Methods In-depth interviews with representatives of all CBOs that received CRAIDS funding (n = 18) and district stakeholders (n= 10) in Mumbwa rural district in Zambia, in 2010; and national stakeholders (n=6) in 2011. Results Funding: All eighteen CBOs in Mumbwa that received MAP funding between 2003 and 2008 had existed prior to receiving MAP grants, some from as early as 1992. This was contrary to national level perceptions that CBOs were established to access funds rather than from the needs of communities. Funding opportunities for CBOs in Mumbwa in 2010 were scarce. Health services: While all CBOs were functioning in 2010, most reported reductions in service provision. Home visits had reduced due to a shortage of food to bring to people living with HIV/AIDS and scarcity of funding for transport, which reduced antiretroviral treatment adherence support and transport of patients to clinics. Organisational capacity and viability: Sustainability had been promoted during MAP through funding Income Generating Activities. However, there was a lack of infrastructure and training to make these sustainable. Links between health facilities and communities improved over time, however volunteers’ skills levels had reduced. Conclusions Whilst the World Bank espoused the idea of sustainability in their plans, it remained on the periphery of

Aflatoxin contamination of groundnut and maize in Zambia: observed and potential concentrations.

PubMed

Kachapulula, P W; Akello, J; Bandyopadhyay, R; Cotty, P J

2017-06-01

The aims of the study were to quantify aflatoxins, the potent carcinogens associated with stunting and immune suppression, in maize and groundnut across Zambia's three agroecologies and to determine the vulnerability to aflatoxin increases after purchase. Aflatoxin concentrations were determined for 334 maize and groundnut samples from 27 districts using lateral-flow immunochromatography. Seventeen per cent of crops from markets contained aflatoxin concentrations above allowable levels in Zambia (10 μg kg -1 ). Proportions of crops unsafe for human consumption differed significantly (P < 0·001) among agroecologies with more contamination (38%) in the warmest (Agroecology I) and the least (8%) in cool, wet Agroecology III. Aflatoxin in groundnut (39 μg kg -1 ) and maize (16 μg kg -1 ) differed (P = 0·032). Poor storage (31°C, 100% RH, 1 week) increased aflatoxin in safe crops by over 1000-fold in both maize and groundnut. The L morphotype of Aspergillus flavus was negatively correlated with postharvest increases in groundnut. Aflatoxins are common in Zambia's food staples with proportions of unsafe crops dependent on agroecology. Fungal community structure influences contamination suggesting Zambia would benefit from biocontrol with atoxigenic A. flavus. Aflatoxin contamination across the three agroecologies of Zambia is detailed and the case for aflatoxin management with atoxigenic biocontrol agents provided. The first method for evaluating the potential for aflatoxin increase after purchase is presented. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Journal of Applied Microbiology published by John Wiley & Sons Ltd on behalf of The Society for Applied Microbiology.

Inequalities in public health care delivery in Zambia

PubMed Central

2014-01-01

Background Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion The results of the paper point to areas of focus in ensuring equitable access

Human-animal anthrax outbreak in the Luangwa valley of Zambia in 2011.

PubMed

Hang'ombe, Mudenda B; Mwansa, James C L; Muwowo, Sergio; Mulenga, Phillip; Kapina, Muzala; Musenga, Eric; Squarre, David; Mataa, Liywali; Thomas, Suzuki Y; Ogawa, Hirohito; Sawa, Hirofumi; Higashi, Hideaki

2012-07-01

There has been a reduction of incidences of anthrax in the developed countries but it is still a public health problem in the developing countries where communities live in interface areas with wildlife. An outbreak of anthrax in Hippopotamus amphibious was observed in Zambia. Following the death of hippopotamuses, suspected human cases were reported. The objective of this study was to isolate and confirm Bacillus anthracis and to determine the antimicrobial susceptibility for the management of the disease. Of the specimens collected, 29.4% (95% confidence interval [CI], 11.4-56.0) were from humans, 42.1% (95% CI, 21.1-66.0) were from hippopotamuses and 20.0% (95% CI, 6.61-44.3) from the soil were found to be positive were for B. anthracis. An antimicrobial susceptibility test revealed that all the isolates were found to be sensitive to the recommended antibiotics. The disease control was achieved by case management and by explaining to the communities that they should avoid contact with animals that die from unknown causes.

A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

PubMed Central

Chanda, Pascalina; Masiye, Felix; Chitah, Bona M; Sipilanyambe, Naawa; Hawela, Moonga; Banda, Patrick; Okorosobo, Tuoyo

2007-01-01

Background Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. Methods Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis). Findings The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success) from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line treatment are considered the

Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy.

PubMed

Hanson, Kara; Atuyambe, Lynn; Kamwanga, Jolly; McPake, Barbara; Mungule, Oswald; Ssengooba, Freddie

2002-07-01

Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.

77 FR 60966 - Executive-Led Trade Mission to South Africa and Zambia

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... Africa and Zambia AGENCY: International Trade Administration, Department of Commerce. ACTION: Notice...- Led Trade Mission to South Africa and Zambia scheduled for November 26- 30, 2012, to revise the dates... and scheduling constraints permit), interested U.S. agriculture, mining, transportation, water, energy...

A Survey of Library Services to Children and Young Adults in Selected Developing Countries in Africa and Asia.

ERIC Educational Resources Information Center

Craver, Kathleen W.

1985-01-01

Review of developments in children and young adult library services since 1979 discusses three factors that complicate methods used to combat illiteracy problem: population growth, language, and undeveloped readership. Countries studied are Libya, Kenya, Tanzania, Angola, Zambia, Zimbabwe, Ghana, Nigeria, Gambia, Thailand, Singapore, Philippines,…

Opportunities for Distance Education in the Commonwealth African Countries.

ERIC Educational Resources Information Center

INTELECON Research & Consultancy Ltd., Vancouver (British Columbia).

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…

Higher Education and Employment: The IIEP Experience in Five Less Developed Countries. Fundamentals of Educational Planning 32.

ERIC Educational Resources Information Center

Psacharopoulos, George; Sanyal, Bikas C.

One of a series on educational planning, this booklet reviews the findings of several studies on the employment of university graduates in five developing countries: Egypt, Philippines, Sudan, Tanzania, and Zambia. Data for these studies were collected from samples of students and former graduates. A number of facets of the topic are investigated…

Prices and mark-ups on antimalarials: evidence from nationally representative studies in six malaria-endemic countries.

PubMed

Palafox, Benjamin; Patouillard, Edith; Tougher, Sarah; Goodman, Catherine; Hanson, Kara; Kleinschmidt, Immo; Torres Rueda, Sergio; Kiefer, Sabine; O'Connell, Kate; Zinsou, Cyprien; Phok, Sochea; Akulayi, Louis; Arogundade, Ekundayo; Buyungo, Peter; Mpasela, Felton; Poyer, Stephen; Chavasse, Desmond

2016-03-01

The private for-profit sector is an important source of treatment for malaria. However, private patients face high prices for the recommended treatment for uncomplicated malaria, artemisinin combination therapies (ACTs), which makes them more likely to receive cheaper, less effective non-artemisinin therapies (nATs). This study seeks to better understand consumer antimalarial prices by documenting and exploring the pricing behaviour of retailers and wholesalers. Using data collected in 2009-10, we present survey estimates of antimalarial retail prices, and wholesale- and retail-level price mark-ups from six countries (Benin, Cambodia, the Democratic Republic of Congo, Nigeria, Uganda and Zambia), along with qualitative findings on factors affecting pricing decisions. Retail prices were lowest for nATs, followed by ACTs and artemisinin monotherapies (AMTs). Retailers applied the highest percentage mark-ups on nATs (range: 40% in Nigeria to 100% in Cambodia and Zambia), whereas mark-ups on ACTs (range: 22% in Nigeria to 71% in Zambia) and AMTs (range: 22% in Nigeria to 50% in Uganda) were similar in magnitude, but lower than those applied to nATs. Wholesale mark-ups were generally lower than those at retail level, and were similar across antimalarial categories in most countries. When setting prices wholesalers and retailers commonly considered supplier prices, prevailing market prices, product availability, product characteristics and the costs related to transporting goods, staff salaries and maintaining a property. Price discounts were regularly used to encourage sales and were sometimes used by wholesalers to reward long-term customers. Pricing constraints existed only in Benin where wholesaler and retailer mark-ups are regulated; however, unlicensed drug vendors based in open-air markets did not adhere to the pricing regime. These findings indicate that mark-ups on antimalarials are reasonable. Therefore, improving ACT affordability would be most readily

Trends of selected cattle diseases in eastern Zambia between 1988 and 2008.

PubMed

Mubamba, Chrisborn; Sitali, Joseph; Gummow, Bruce

2011-09-01

Livestock diseases have long been a challenge to livestock production and public health in sub-Saharan Africa and Zambia in particular. The Eastern Province of Zambia is one area in Zambia that is not spared by this challenge. Among various livestock diseases affecting cattle in this region, the most prominent are East Coast Fever (ECF) and African Animal Trypanasomiasis (AAT). Since little has been published on the epidemiological trends of these diseases in eastern Zambia, a retrospective epidemiological study was carried out using reports that were submitted to the provincial veterinary office over the past 20 years. This paper assists in evaluating the impact of some of these aid programmes. Data was analysed using Excel(©), SPSS(®), Epi Info(©), and Epi Map(©) software. Apparent prevalence of AAT in cattle had decreased in the study period from estimates as high as 50% in Katete and Petauke district in 1990 and 1992 respectively to just below 3% (Petauke and Katete) in 2008, thereby, reducing the provincial apparent prevalence from 20% in 1992 to just below 3% in 2008. AAT apparent prevalence dropped from estimates as high as 17% in Chadiza district and 6% in Chipata district in 1990 to just below 1% in 2008 thereby reducing the provincial mean prevalence of East Coast Fever from 6% (1990) to 1% (2008). The inclusion of donor assistance in disease control programmes for both AAT and ECF appeared to have a significant impact on the prevalence of both diseases. Copyright © 2011 Elsevier B.V. All rights reserved.

Provision of Learning and Teaching Materials for Pupils with Visual Impairment: Results from a National Survey in Zambia

ERIC Educational Resources Information Center

Akakandelwa, Akakandelwa; Munsanje, Joseph

2012-01-01

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…

Infant-mother and infant-sibling attachment in Zambia.

PubMed

Mooya, Haatembo; Sichimba, Francis; Bakermans-Kranenburg, Marian

2016-12-01

This study, the first in Zambia using the Strange Situation Procedure (SSP) to observe attachment relationships and the "very first" observational study of infant-sibling attachment, examined patterns of infant-mother and infant-sibling attachment, and tested their association. We included siblings who were substantially involved in caregiving activities with their younger siblings. We hypothesized that infants would develop attachment relationships to both mothers and siblings; the majority of infants would be classified as securely attached to both caregivers, and infant-mother and infant-sibling attachment would be unrelated. The sample included 88 low-income families in Lusaka, Zambia (average of 3.5 children; SD = 1.5). The SSP distributions (infant-mother) were 59% secure, 24% avoidant and 17% resistant, and 46% secure, 20% avoidant, 5% resistant and 29% disorganized for three- and four-way classifications, respectively. The infant-sibling classifications were 42% secure, 23% avoidant and 35% resistant, and 35% secure, 23% avoidant, 9% resistant and 33% disorganized for three- and four-way classifications, respectively. Infant-mother and infant-sibling attachment relationships were not associated.

Health professional feedback on HPV vaccination roll-out in a developing country.

PubMed

Venturas, Collette; Umeh, Kanayo

2017-04-04

Worldwide, Zambia has the highest cervical cancer incidence rates (58.4/100,000 per year) and mortality rates (36.2/100,000 per year). The human papilloma virus (HPV) vaccine is considered a vital preventative measure against cervical cancer, particularly in sub-Saharan countries, such as Zambia. Past research suggests health professionals' experiences with HPV vaccination rollout can have practical implications for effective delivery. To explore health professionals' perspectives on the HPV vaccination programme in Zambia. Researcher travelled to Zambia and conducted semi-structured interviews with fifteen health professionals working in private, government, and missionary clinics/hospitals. Observation was conducted for triangulation purposes. Thematic analysis was used to analyse the data. Five main themes emerged; medical misconceptions about the HPV vaccination, particularly with regards to infertility; fear of the unknown, including possible side effects and inadequate empirical research; need for prior desensitisation to resolve cultural barriers prior to vaccination rollout; a rural-urban divide in health awareness, particularly in relation to cancer vaccines; and economic concerns associated with access to the HPV vaccination for most of the Zambian population. Overall, the findings indicate that an essential avenue for facilitating HPV vaccination rollout in Zambia is by implementing a pre-rollout community effort that removes or softens cultural barriers, particularly in rural areas. It is also essential to correct erroneous HPV presumptions health professionals may have around infertility. Affordability remains a seemingly intractable hindrance that hampers HPV vaccination rollout in Zambia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Un/Doing Gender? A Case Study of School Policy and Practice in Zambia

ERIC Educational Resources Information Center

Bajaj, Monisha

2009-01-01

This article explores an attempt to disrupt gender inequality in a unique, low-cost private school in Ndola, Zambia. It examines deliberate school policies aimed at "undoing gender" or fostering greater gender equity. These include efforts to maintain gender parity at all levels of the school and the requirement that both young men and…

Field and office instructions in stream gauging for the Hydrological Survey of Zambia

USGS Publications Warehouse

Bidwell, L.E.

1971-01-01

The importance of water to the basic needs of man is self- evident and needs no particular emphasis. The importance of water to a developing economy cannot be overemphasized. A few decades ago, hydrology was a division of hydraulic engineering and was a tool for project survey, plan, and design. Today hydrology still remains an important part of planning and management of water use projects, but it is imperative that surface and ground-water basic data networks be designed and operated from the standpoint of both present and future water needs. Water problems are ever increasing and ever changing and preparation for the future water demands of Zambia requires knowledge of the hydrology of the country instead of the examination of piecemeal samples for each water use project. The hydrologic survey of Zambia needs to be under the guidance of competent and imaginative hydrologists solidly trained in all elements of basic data collection and analysis and not in the hands of water project planners. Hydrology is a science which requires the highest order of teamwork and the hydrologist will need the help and advice of many employees within the organization to operate the network, provide adequate research, and examine the water needs of the country. It must be thoroughly understood that communication is essential between the hydrological survey and water project planners from both the government and private sectors. It is very important to define the aims and duties of the Hydrological Branch of the Water Affairs Department in a clear cut "Statement of Policy". Personal copies of the statement should be made available to all professional employees and technicians. The reasons for the existence of the Branch may be self-apparent to heads of the organization, but to all other employees the reasons may be vague and unknown. Every member of the technical and administrative staff would benefit by an understanding of the purpose of his work. Nebulous ideas of the function of a

Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation

PubMed Central

2012-01-01

Background The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period. Aim The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia. Methods A qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively. Findings There are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression. Conclusion Identifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby. Recommendation Strategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia. PMID:22954173

The individual level cost of pregnancy termination in Zambia: a comparison of safe and unsafe abortion.

PubMed

Leone, Tiziana; Coast, Ernestina; Parmar, Divya; Vwalika, Bellington

2016-09-01

Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women.This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider

Identifying antecedent conditions responsible for the high rate of mining injuries in Zambia.

PubMed

Miller, Hugh B; Sinkala, Thomson; Renger, Ralph F; Peacock, Erin M; Tabor, Joseph A; Burgess, Jefferey L

2006-01-01

The incident rates of mining-related accidents and injuries in developing countries exceed those of developed nations. Interventions by international organizations routinely fail to produce appreciable long-term improvement. One major reason is the inability to identify and analyze the underlying factors responsible for creating unsafe working conditions. Understanding these antecedent conditions is necessary to formulate effective intervention strategies and prioritize the use of limited resources. This study utilized a logic model approach to determine the root causes and broad categories of potential interventions for mining accidents and injuries in Zambia. Results showed that policy interventions have the greatest potential for substantive change. A process of educating officials from government and mining companies about the economic and social merits of health and safety programs and extensive changes in regulatory structure and enforcement are needed.

Making Education Count for Development: Data Collection and Availability in Six PISA for Development Countries

ERIC Educational Resources Information Center

OECD Publishing, 2016

2016-01-01

This report reviews the collection, availability and quality of system-level data and metadata on education from countries participating in the PISA for Development project: Cambodia, Ecuador, Guatemala, Paraguay, Senegal and Zambia. PISA for Development aims to increase low income countries' use of PISA assessments for monitoring progress towards…

Zambia measures the impact.

PubMed

1997-02-01

The average life expectancy in Zambia will drop from 51 years to about 45 years by the year 2002 as a result of HIV/AIDS. The domestic gross product will also fall significantly because of the loss of skilled workers and health costs. These are the estimations of the Zambian Ministry of Health, which also estimates that between 300 and 400 people are newly infected with HIV every day in the country. Adults progressing to full-fledged AIDS are expected to increase from 10,000 in 1990 to over 75,000 by the year 2000. Women are 1.4 times more likely to become infected with HIV than men. Although sexual relations with female students by male teachers are prohibited by the professional code of conduct, some teachers have such relations. This is alarming in view of the findings of a study showing that 40% of teachers in the study group were infected with HIV. About 40% of girls are sexually active by the age of 15, therefore such young people are targets of AIDS-related educational services. Many older infected students will die before they can pay back their student loans. The impact of AIDS at the workplace is also distressing, as a unionized worker with AIDS could go on sick leave for half a year at the employer's expense. The cost of replacing sick workers is also high with additional delays in finding replacements. The loss of key individuals such as innovators may even seriously set back a firm by reducing sales, increasing the costs of operation, and forcing the restructuring of credit arrangements.

HIV-Related Discrimination among Grade Six Students in Nine Southern African Countries

PubMed Central

Maughan-Brown, Brendan; Spaull, Nicholas

2014-01-01

Background HIV-related stigmatisation and discrimination by young children towards their peers have important consequences at the individual level and for our response to the epidemic, yet research on this area is limited. Methods We used nationally representative data to examine discrimination of HIV-positive children by grade six students (n = 39,664) across nine countries in Southern Africa: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Descriptive statistics are used to compare discrimination by country, gender, geographic location and socioeconomic status. Multivariate logistic regression is employed to assess potential determinants of discrimination. Results The levels and determinants of discrimination varied significantly between the nine countries. While one in ten students in Botswana, Malawi, South Africa and Swaziland would “avoid or shun” an HIV positive friend, the proportions in Lesotho, Mozambique, Zambia and Zimbabwe were twice as high (approximately 20%). A large proportion of students believed that HIV positive children should not be allowed to continue to attend school, particularly in Zambia (33%), Lesotho (37%) and Zimbabwe (42%). The corresponding figures for Malawi and Swaziland were significantly lower at 13% and 12% respectively. Small differences were found by gender. Children from rural areas and poorer schools were much more likely to discriminate than those from urban areas and wealthier schools. Importantly, we identified factors consistently associated with discrimination across the region: students with greater exposure to HIV information, better general HIV knowledge and fewer misconceptions about transmission of HIV via casual contact were less likely to report discrimination. Conclusions Our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools situated in rural areas and poorer

HIV-related discrimination among grade six students in nine Southern African countries.

PubMed

Maughan-Brown, Brendan; Spaull, Nicholas

2014-01-01

HIV-related stigmatisation and discrimination by young children towards their peers have important consequences at the individual level and for our response to the epidemic, yet research on this area is limited. We used nationally representative data to examine discrimination of HIV-positive children by grade six students (n = 39,664) across nine countries in Southern Africa: Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Descriptive statistics are used to compare discrimination by country, gender, geographic location and socioeconomic status. Multivariate logistic regression is employed to assess potential determinants of discrimination. The levels and determinants of discrimination varied significantly between the nine countries. While one in ten students in Botswana, Malawi, South Africa and Swaziland would "avoid or shun" an HIV positive friend, the proportions in Lesotho, Mozambique, Zambia and Zimbabwe were twice as high (approximately 20%). A large proportion of students believed that HIV positive children should not be allowed to continue to attend school, particularly in Zambia (33%), Lesotho (37%) and Zimbabwe (42%). The corresponding figures for Malawi and Swaziland were significantly lower at 13% and 12% respectively. Small differences were found by gender. Children from rural areas and poorer schools were much more likely to discriminate than those from urban areas and wealthier schools. Importantly, we identified factors consistently associated with discrimination across the region: students with greater exposure to HIV information, better general HIV knowledge and fewer misconceptions about transmission of HIV via casual contact were less likely to report discrimination. Our study points toward the need for early interventions (grade six or before) to reduce stigma and discrimination among children, especially in schools situated in rural areas and poorer communities. In particular, interventions

Promotion of couples' voluntary HIV counseling and testing: a comparison of influence networks in Rwanda and Zambia.

PubMed

Kelley, April L; Hagaman, Ashley K; Wall, Kristin M; Karita, Etienne; Kilembe, William; Bayingana, Roger; Tichacek, Amanda; Kautzman, Michele; Allen, Susan A

2016-08-08

Many African adults do not know that partners in steady or cohabiting relationships can have different HIV test results. Despite WHO recommendations for couples' voluntary counseling and testing (CVCT), fewer than 10 % of couples have been jointly tested and counseled. We examine the roles and interactions of influential network leaders (INLs) and influential network agents (INAs) in promoting CVCT in Kigali, Rwanda and Lusaka, Zambia. INLs were identified in the faith-based, non-governmental, private, and health sectors. Each INL recruited and mentored several INAs who promoted CVCT. INLs and INAs were interviewed about demographic characteristics, promotional efforts, and working relationships. We also surveyed CVCT clients about sources of CVCT information. In Zambia, 53 INAs and 31 INLs were surveyed. In Rwanda, 33 INAs and 27 INLs were surveyed. Most (75 %-90 %) INAs believed that INL support was necessary for their promotional work. Zambian INLs reported being more engaged with their INAs than Rwandan INLs, with 58 % of Zambian INLs reporting that they gave a lot of support to their INAs versus 39 % in Rwanda. INAs in both Rwanda and Zambia reported promoting CVCT via group forums (77 %-97 %) and speaking to a community leader about CVCT (79 %-88 %) in the past month. More Rwandan INAs and INLs reported previous joint or individual HIV testing compared with their Zambian counterparts, of which more than half had not been tested. In Zambia and Rwanda, 1271 and 3895 CVCT clients were surveyed, respectively. Hearing about CVCT from INAs during one-on-one promotions was the most frequent source of information reported by clients in Zambia (71 %). In contrast, Rwandan couples who tested were more likely to have heard about CVCT from a previously tested couple (59 %). CVCT has long been endorsed for HIV prevention but few couples have been reached. Influential social networks can successfully promote evidence-based HIV prevention in Africa. Support from

Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016.

PubMed

Cheelo, Mweene; Brugha, Ruairi; Bijlmakers, Leon; Kachimba, John; McCauley, Tracey; Gajewski, Jakub

2018-05-21

Sub-Saharan Africa has one of the highest burdens of surgically treatable conditions in the world and the highest unmet need, especially in rural areas. Zambia is one of the countries in the region taking steps to improve surgical care for its rural populations. To demonstrate changes in surgical capacity in Zambia's district hospitals over a 3-year period and to provide a baseline from which future interventions in surgical care can be assessed. A cross-sectional assessment of surgical capacity, using a modified WHO questionnaire, was administered in first-level hospitals in nine of Zambia's ten provinces between November 2012 and February 2013 and again between February and April 2016. The two assessments allowed measurement of changes in surgical workforce, infrastructure, equipment, drugs and consumables; and numbers of major surgical procedures performed over two 12-month periods prior to the assessments. There was a significant increase, 2013-2016, in number of theatre staff, from 174 (mean 4.4; SD 1.7) to 235 (mean 6; SD 2.9), P = 0.02. However, the percentage of hospitals with functioning anaesthetic machines dropped from 64 to 41%. There was also a drop in hospitals reporting availability of instruments, drugs and consumables from 38 to 24 (97-62%) and from 28 to 24 (72-62%), respectively. The median number of caesarean sections in 2012 was 99 [interquartile range (IQR) 42-187] and 100 (IQR 42-126) in 2015 (P value =0.53). The median number of major surgical procedures in 2012 was 54 (IQR 10-113) and 66 (IQR 18-168) in 2015 (P = 0.45). An increase in the first-level hospital surgical workforce between 2013 and 2016 was accompanied by reductions in essential equipment and consumables for surgery, and no changes in surgical output. Periodic monitoring of resource availability is needed to address shortages and make safe surgery available to rural populations.

The Prevalence of Tuberculosis in Zambia: Results from the First National TB Prevalence Survey, 2013-2014.

PubMed

Kapata, Nathan; Chanda-Kapata, Pascalina; Ngosa, William; Metitiri, Mine; Klinkenberg, Eveline; Kalisvaart, Nico; Sunkutu, Veronica; Shibemba, Aaron; Chabala, Chishala; Chongwe, Gershom; Tembo, Mathias; Mulenga, Lutinala; Mbulo, Grace; Katemangwe, Patrick; Sakala, Sandra; Chizema-Kawesha, Elizabeth; Masiye, Felix; Sinyangwe, George; Onozaki, Ikushi; Mwaba, Peter; Chikamata, Davy; Zumla, Alimuddin; Grobusch, Martin P

2016-01-01

Tuberculosis in Zambia is a major public health problem, however the country does not have reliable baseline data on the TB prevalence for impact measurement; therefore it was among the priority countries identified by the World Health Organization to conduct a national TB prevalence survey. To estimate the prevalence of tuberculosis among the adult Zambian population aged 15 years and above, in 2013-2014. A cross-sectional population-based survey was conducted in 66 clusters across all the 10 provinces of Zambia. Eligible participants aged 15 years and above were screened for TB symptoms, had a chest x-ray (CXR) performed and were offered an HIV test. Participants with TB symptoms and/or CXR abnormality underwent an in-depth interview and submitted one spot- and one morning sputum sample for smear microscopy and liquid culture. Digital data collection methods were used throughout the process. Of the 98,458 individuals who were enumerated, 54,830 (55.7%) were eligible to participate, and 46,099 (84.1%) participated. Of those who participated, 45,633/46,099 (99%) were screened by both symptom assessment and chest x-ray, while 466/46,099 (1.01%) were screened by interview only. 6,708 (14.6%) were eligible to submit sputum and 6,154/6,708 (91.7%) of them submitted at least one specimen for examination. MTB cases identified were 265/6,123 (4.3%). The estimated national adult prevalence of smear, culture and bacteriologically confirmed TB was 319/100,000 (232-406/100,000); 568/100,000 (440-697/100,000); and 638/100,000 (502-774/100,000) population, respectively. The risk of having TB was five times higher in the HIV positive than HIV negative individuals. The TB prevalence for all forms was estimated to be 455 /100,000 population for all age groups. The prevalence of tuberculosis in Zambia was higher than previously estimated. Innovative approaches are required to accelerate the control of TB.

A study of malnourished children in children's hospital Lusaka (Zambia).

PubMed

Khan, A A; Gupta, B M

1979-01-01

The parents of 200 malnourished childred referred and admitted over the July-December 1976 period to the nutrition wing of the Children's University Teaching Hospital, Zambia, were interviewed in an effort to understand the home environment of malnourished children in Lusaka, Zambia. The 1974 incidence of malnutrition in Zambia was about 23% with higher prevalences of marasmus and moderate malnutrition. There were 9.4% severly malnourished children admitted in 1976 as compared with less than 1% in 1971. Many of these children were admitted very late in a hypothermic shocked state which is directly responsible for the increasing incidence of mortality over these years. Plasma or blood transfusion is a standard procedure in all shocked cases of kwashiorkor, yet many of the children still die within 24 hours of admission. Malnutrition incidence was found to be closely linked to the rise in price index. The majority of the children were admitted from the rainy months November to March, the time associated with a higher incidence of gastroenteritis, respiratory infections, and measles. 88% of the children were between 1-3 years old. Marasmus (33.5%) and marasmic kwashiorkor (40.5%) were more frequent. 63% of the malnourished childred had attended the child health clinics in their infancy and were immunized but discontinued attendance one vaccination was completed. The problem of malnutrition was in the toddler age group. 86% of the childred came from urban slums and periurban areas; 83% were from unitary families, living in 1 or 2 bedroom houses with no separate provision for a kitchen. Rural families (14%) were living as joint families. 32% of the children were from large families. 52% of the parents were employed as casual laborers and earning under US $35 per month. There were only 10 families with earnings in excess of US $125 per month and only 8 had good sources of income from farms. As many as 68.5% children were experiencing 1 or more adverse factors which

The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15-49) contraceptive users in Zambia: a cross-sectional study.

PubMed

Mutombo, Namuunda; Bakibinga, Pauline

2014-07-03

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. 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. 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. 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

Developing a community driven sustainable model of maternity waiting homes for rural Zambia.

PubMed

Lori, Jody R; Munro-Kramer, Michelle L; Mdluli, Eden Ahmed; Musonda Mrs, Gertrude K; Boyd, Carol J

2016-10-01

maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. the purpose of this study was to explore Zambian stakeholders' beliefs regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) to inform a model for rural Zambia. a qualitative design using a semi-structured interview guide for data collection was used. two rural districts in the Eastern province of Zambia. individual interviews were conducted with community leaders (n=46). Focus groups were held with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia (n=500). latent content analysis was used to analyze the data. participants were overwhelmingly in support of MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Data suggest that participants can describe features of high quality care, and the type of care they expect from a MWH. Stakeholders acknowledged the need to contribute to the maintenance of the MWH, and that community involvement was crucial to MWH sustainability. access to facility childbirth remains particularly challenging in rural Zambia and delays in seeking care exist. Maternity waiting homes offer a feasible and acceptable intervention to reduce delays in seeking care, thereby holding the potential to improve maternal outcomes. this study joins a growing literature on the acceptability, feasibility, and sustainability of MWHs. It is believed that MWHs, by addressing the distance and transportation barriers, will increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low resource areas of Zambia. We recommend that any initiative

Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction.

PubMed

Kruk, Margaret E; Vail, Daniel; Austin-Evelyn, Katherine; Atuyambe, Lynn; Greeson, Dana; Grépin, Karen Ann; Kibira, Simon P S; Macwan'gi, Mubiana; Masvawure, Tsitsi B; Rabkin, Miriam; Sacks, Emma; Simbaya, Joseph; Galea, Sandro

2016-03-01

Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients' receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers' knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers' clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers' knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program. Project HOPE—The People-to-People Health Foundation, Inc.

Cost analysis of routine immunisation in Zambia.

PubMed

Schütte, Carl; Chansa, Collins; Marinda, Edmore; Guthrie, Teresa A; Banda, Stanley; Nombewu, Zipozihle; Motlogelwa, Katlego; Lervik, Marita; Brenzel, Logan; Kinghorn, Anthony

2015-05-07

This study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. The exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. The total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. Total and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses. Copyright © 2015 Elsevier

Costing commodity and human resource needs for integrated community case management in thie differing community health strategies of Ethiopia, Kenya and Zambia.

PubMed

Nefdt, Rory; Ribaira, Eric; Diallo, Khassoum

2014-10-01

To ensure correct and appropriate funding is available, there is a need to estimate resource needs for improved planning and implementation of integrated Community Case Management (iCCM). To compare and estimate costs for commodity and human resource needs for iCCM, based on treatment coverage rates, bottlenecks and national targets in Ethiopia, Kenya and Zambia from 2014 to 2016. Resource needs were estimated using Ministry of Health (MoH) targets fronm 2014 to 2016 for implementation of case management of pneumonia, diarrhea and malaria through iCCM based on epidemiological, demographic, economic, intervention coverage and other health system parameters. Bottleneck analysis adjusted cost estimates against system barriers. Ethiopia, Kenya and Zambia were chosen to compare differences in iCCM costs in different programmatic implementation landscapes. Coverage treatment rates through iCCM are lowest in Ethiopia, followed by Kenya and Zambia, but Ethiopia had the greatest increases between 2009 and 2012. Deployment of health extension workers (HEWs) in Ethiopia is more advanced compared to Kenya and Zambia, which have fewer equivalent cadres (called commu- nity health workers (CHWs)) covering a smaller proportion of the population. Between 2014 and 2016, the propor- tion of treatments through iCCM compared to health centres are set to increase from 30% to 81% in Ethiopia, 1% to 18% in Kenya and 3% to 22% in Zambia. The total estimated cost of iCCM for these three years are USD 75,531,376 for Ethiopia, USD 19,839,780 for Kenya and USD 33,667,742 for Zambia. Projected per capita expen- diture for 2016 is USD 0.28 for Ethiopia, USD 0.20 in Kenya and USD 0.98 in Zambia. Commodity costs for pneumonia and diarrhea were a small fraction of the total iCCM budget for all three countries (less than 3%), while around 80% of the costs related to human resources. Analysis of coverage, demography and epidemiology data improves estimates of fimding requirements for iCCM. Bottleneck

An Evaluation of Trauma Focused Cognitive Behavioral Therapy for Children in Zambia

PubMed Central

Murray, Laura K; Familiar, Itziar; Skavenski, Stephanie; Jere, Elizabeth; Cohen, Judy; Imasiku, Mwiya; Mayeya, John; Bass, Judith K; Bolton, Paul

2013-01-01

Objectives 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). Methods 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. Results 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). Conclusions 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

Bismarck in the Bush: Year 12 Write Zambia's History for Zambian Students

ERIC Educational Resources Information Center

Gray, Peter

2011-01-01

Peter Gray explains how his Year 12 students came to research and write a resource on the history of Zambia, for history teachers "in" Zambia. The construction of the resource stretched the Year 12 students in new ways: the Internet was useless and there were no easy digests in A-Level textbooks to get them started. They would have to…

7 CFR 319.56-43 - Baby corn and baby carrots from Zambia.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false Baby corn and baby carrots from Zambia. 319.56-43... § 319.56-43 Baby corn and baby carrots from Zambia. (a) Immature, dehusked “baby” sweet corn (Zea mays L..., which is a field, where the corn has been grown must have been inspected at least once during the...

Mwabu: Interactive Education in Zambia

ERIC Educational Resources Information Center

Gordon, Jenny; Postlewhite, Kerry

2017-01-01

Africa has more people younger than 20 years old than anywhere in the world, and the continent's population is set to double to two billion by 2050. Asking whether that is a challenge or an opportunity isn't really the right question because it is both. For Mwabu, an education technology company born and bred in Zambia, the more important question…

Understanding the Psychosocial and Environmental Factors and Barriers Affecting Utilization of Maternal Healthcare Services in Kalomo, Zambia: A Qualitative Study

ERIC Educational Resources Information Center

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

2014-01-01

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…

An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study.

PubMed

Phiri, Sydney Chauwa; Prust, Margaret Lippitt; Chibawe, Caroline Phiri; Misapa, Ronald; van den Broek, Jan Willem; Wilmink, Nikhil

2017-06-24

In 2010 a public sector cadre of community health workers called Community Health Assistants (CHAs) was created in Zambia through the National Community Health Worker Strategy to expand access to health services. This cadre continues to be scaled up to meet the growing demands of Zambia's rural population. We summarize factors that have facilitated the scale-up of the CHA program into a nationwide CHW cadre and the challenges of introducing and institutionalizing the cadre within the Zambian health system. Semi-structured, individual interviews were held across 5 districts with 16 CHAs and 6 CHA supervisors, and 10 focus group discussions were held with 93 community members. Audio recordings of interviews and focus group discussions were transcribed and thematically coded using Dedoose web-based software. The study showed that the CHAs play a critical role in providing a wide range of services at the community level, as described by supervisors and community members. Some challenges still remain, that may inhibit the CHAs ability to provide health services effectively. In particular, the respondents highlighted infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system. The study shows that in order to optimize the impact of CHAs or other community health workers, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting. The Ministry of Health with support from partners are currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017-2021. This study contributes to the evidence base on the introduction of formalized community health worker cadres in developing countries.

The Role of Open and Distance Learning in the Implementation of the Right to Education in Zambia

ERIC Educational Resources Information Center

Siaciwena, Richard; Lubinda, Foster

2008-01-01

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…

Rotavirus landscape in Africa-Towards prevention and control: A report of the 8th African rotavirus symposium, Livingstone, Zambia.

PubMed

Rudd, Cheryl; Mwenda, Jason; Chilengi, Roma

2015-06-26

The 8th African Rotavirus Symposium was held in Livingstone, Zambia from the 12-13 June 2014. Over 130 delegates from 35 countries - 28 from African nations - participated in this symposium, which included scientists, clinicians, immunisation managers, public health officials, policymakers and vaccine manufacturers. The theme for the symposium was Rotavirus Landscape in Africa-Towards Prevention and Control. At the time of the symposium, a total of 21 African countries had introduced the rotavirus vaccine into their national immunisation schedules. This meeting was particularly timely and relevant to review early data on vaccine adoption and impact from these countries. The concluding panel discussion proposed several recommendations for areas of focus moving forward in rotavirus advocacy and research. Copyright © 2015. Published by Elsevier Ltd.. All rights reserved.

Measuring health system strengthening: application of the balanced scorecard approach to rank the baseline performance of three rural districts in Zambia.

PubMed

Mutale, Wilbroad; Godfrey-Fausset, Peter; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Chintu, Namwinga; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-01-01

There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasising the need for close monitoring using system-wide approaches. One recent method is the balanced scorecard system. There is limited application of this method in middle- and low-income countries. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia. The Better Health Outcome through Mentoring and Assessment (BHOMA) project is a randomised step-wedged community intervention that aims to strengthen the health system in three districts in the Republic of Zambia. To assess the baseline status of the participating districts we used a modified balanced scorecard approach following the domains highlighted in the MOH 2011 Strategic Plan. Differences in performance were noted by district and residence. Finance and service delivery domains performed poorly in all study districts. The proportion of the health workers receiving training in the past 12 months was lowest in Kafue (58%) and highest in Luangwa district (77%). Under service capacity, basic equipment and laboratory capacity scores showed major variation, with Kafue and Luangwa having lower scores when compared to Chongwe. The finance domain showed that Kafue and Chongwe had lower scores (44% and 47% respectively). Regression model showed that children's clinical observation scores were negatively correlated with drug availability (coeff -0.40, p = 0.02). Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) and service readiness (coeff 0.54, p = 0.03). The study applied the balanced scorecard to describe the baseline status of 42 health facilities in three districts of Zambia. Differences in performance were noted by district and residence in most domains with finance and service delivery performing poorly in all study districts. This tool could

The human resource for health situation in Zambia: deficit and maldistribution

PubMed Central

2011-01-01

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

The human resource for health situation in Zambia: deficit and maldistribution.

PubMed

Ferrinho, Paulo; Siziya, Seter; Goma, Fastone; Dussault, Gilles

2011-12-19

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. 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.

Restructuring of labor markets in the Philippines and Zambia: the gender dimension.

PubMed

Floro, M S; Schaefer, K

1998-01-01

This paper critically examines labor market changes accompanying the process of structural adjustment in the Philippines and Zambia and, in particular, the resulting impact on women's economic participation. The changes in the labor market occurring during the process of economic restructuring in Zambia and the Philippines are similar in some respects but very different in others. Zambia's economic performance has not been sufficient to generate wide-based employment and has been characterized by rising unemployment. The Philippines has also unfortunately been characterized by a growth in joblessness, specifically with regard to skilled and semiskilled employment. Global integration of labor markets in the Philippines give some employment opportunity to workers who are willing to seek jobs overseas but not to those in Zambia. Both in the Philippines and Zambia, the informal sector has shifted its agricultural reforms to female labor toward agricultural wage work (which is seasonal and low paid). In the Philippines, specifically in urban areas, certain export-oriented industries have created some jobs, predominantly for young women, but only a small proportion of total females are employed. Much of the female job growth has occurred in sales and service sectors, including sex work, domestic service, and petty trade. International labor migration in the Philippines has become more feminized, because a majority of overseas contract workers are women, who are employed in the service sector as entertainers and domestic helpers. Access to paid work in some cases may empower women, yet in other cases their power may be diminished. Both the specific character of labor market development and the nature of the accompanying economic reform alter the ability of the women and men to take advantage of the opportunity. Reform shifts patterns of production organization and location of employment and can either reinforce the prevailing distribution of power or provide tension

Patterns of Rift Valley fever activity in Zambia.

PubMed Central

Davies, F. G.; Kilelu, E.; Linthicum, K. J.; Pegram, R. G.

1992-01-01

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

The role of the law in reducing tuberculosis transmission in Botswana, South Africa and Zambia

PubMed Central

Emerson, Courtney N; Lederer, Philip; Lipke, Ginny; Kapata, Nathan; Lanje, Samson; Peters, Annatjie C; Zulu, Isaac; Marston, Barbara J; Miller, Bess

2016-01-01

Abstract Objective To determine whether laws and regulations in Botswana, South Africa and Zambia – three countries with a high tuberculosis and HIV infection burden – address elements of the World Health Organization (WHO) policy on tuberculosis infection control. Methods An online desk review of laws and regulations that address six selected elements of the WHO policy on tuberculosis infection control in the three countries was conducted in November 2015 using publicly available domestic legal databases. The six elements covered: (i) national policy and legal framework; (ii) health facility design, construction and use; (iii) tuberculosis disease surveillance among health workers; (iv) patients’ and health workers’ rights; (v) monitoring of infection control measures; and (vi) relevant research. Findings The six elements were found to be adequately addressed in the three countries’ laws and regulations. In all three, tuberculosis case-reporting is required, as is tuberculosis surveillance among health workers. Each country’s legal and regulatory framework also addresses the need to respect individuals’ rights and privacy while safeguarding public health. These laws and regulations create a strong foundation for tuberculosis infection control. Although the legal and regulatory frameworks thoroughly address tuberculosis infection control, their dissemination, implementation and enforcement were not assessed, nor was their impact on public health. Conclusion Laws and regulations in Botswana, South Africa and Zambia address all six selected elements of the WHO policy on tuberculosis infection control. However, the lack of data on their implementation is a limitation. Future research should assess the implementation and public health impact of laws and regulations. PMID:27274593

Health providers' opinions on provider-client relations: results of a multi-country study to test Health Workers for Change.

PubMed

Fonn, S; Mtonga, A S; Nkoloma, H C; Bantebya Kyomuhendo, G; daSilva, L; Kazilimani, E; Davis, S; Dia, R

2001-09-01

A multi-centre study in four African countries was undertaken to test the acceptability and effectiveness of Health Workers for Change, a methodology to explore provider-client relations within a gender-sensitive context. This intervention addresses the interpersonal component of quality of care. The methodology, consisting of six workshops, was implemented by research teams in Zambia, Senegal, Mozambique and Uganda. It was found to be acceptable within in a range of cultural and primary health care settings. The workshops allowed difficult issues such as prejudice and bribery to be discussed openly, fostered problem solving and the development of practical plans to address problems that could strengthen district health systems.

Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study.

PubMed

Mutale, Wilbroad; Bond, Virginia; Mwanamwenge, Margaret Tembo; Mlewa, Susan; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-08-01

The primary bottleneck to achieving the MDGs in low-income countries is health systems that are too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is one of the countries that are lagging behind in achieving millennium development targets. Several barriers have been identified as hindering the progress towards health related millennium development goals. Designing an intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship (BHOMA) project was designed to address the challenges in the Zambia's MOH using a system wide approach. We applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system strengthening. A qualitative study was conducted looking at the status of the Six WHO building blocks for health systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9. The study showed that building block specific weaknesses had cross cutting effect in other health system building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. Several barriers were identified as hindering access to health services by the local communities. These included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side barriers: Long distance to health facility, cost of transport and cultural practices. Participating communities seemed to lack the capacity

Report to UNESCO on Eleven Weeks as Consultant to the Governments of Kenya, Tanzania, Zambia and Malawi on Aspects of Biology Teaching, February to April, 1971.

ERIC Educational Resources Information Center

Meyer, Rex

This report describes the activities of a UNESCO consultant who visited Kenya, Tanzania, Zambia and Malawi for the purpose of assisting local education agencies in the Biology Teaching Pilot Project. The consultant's report briefly summarizes the status of the School Science Project (SSP) in these East African countries. Also listed are the…

OUTLINE OF VOCATIONAL TRAINING IN ZAMBIA.

ERIC Educational Resources Information Center

Australian Dept. of Labour and National Service, Perth.

THE 1963 POPULATION OF ZAMBIA WAS APPROXIMATELY 3.5 MILLION. THE 8-YEAR PRIMARY EDUCATION PROGRAM IS FOLLOWED BY SECONDARY, SECONDARY TECHNICAL, AND TRADE SCHOOL OPTIONS. THERE IS AN INCREASE IN ADULT EDUCATION AT THE PRIMARY AND SECONDARY LEVELS. CRAFT AND TECHNICIAN LEVEL PROGRAMS ARE CONDUCTED AT NORTHERN TECHNICAL COLLEGE AND ITS ANCILLARY…

The role of nurses and midwives in polio eradication and measles control activities: a survey in Sudan and Zambia

PubMed Central

Nkowane, Annette Mwansa; Boualam, Liliane; Haithami, Salah; El Sayed, El Tayeb Ahmed; Mutambo, Helen

2009-01-01

Background Nurses and midwives are the key providers of nursing and midwifery services; in many countries, they form the major category of frontline workers who provide both preventive and curative services in the community. When the skills and experience of nursing and midwifery personnel are maximized, they can contribute significantly to positive health outcomes. We conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes. Methods Nurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunization campaigns for polio and measles. Results Nurses and midwives were found to play significant roles in implementing immunization programme activities. The level of responsibilities of nurses and midwives in their routine work related more to existing opportunities than to their job descriptions. In Zambia, where nurses reported constraints in performing their tasks, the reasons cited were an increase in the burden of disease and the shortage of health personnel. Factors identified as key to improving work performance included written job descriptions, opportunities for staff and career development and opportunities to earn extra income through activities associated with their jobs. Other non-monetary incentives mentioned included reliable transport, resources and logistics to support routine work in the district. However, in both countries, during supplementary immunization activities or mass campaigns for polio eradication and measles control, nurses and midwives took on more management responsibilities. Conclusion This study shows that nurses and midwives play an important role in implementing immunization activities at the district level and that their roles can be

Violence and Abuse Among HIV-Infected Women and Their Children in Zambia

PubMed Central

Murray, Laura K.; Haworth, Alan; Semrau, Katherine; Singh, Mini; Aldrovandi, Grace M.; Sinkala, Moses; Thea, Donald M.; Bolton, Paul A.

2009-01-01

HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in developing countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa. PMID:16909070

Post-traumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia.

PubMed

Familiar, Itziar; Murray, Laura; Gross, Alden; Skavenski, Stephanie; Jere, Elizabeth; Bass, Judith

2014-11-01

Scant information exists on PTSD symptoms and structure in youth from developing countries. We describe the symptom profile and exposure to trauma experiences among 343 orphan and vulnerable children and adolescents from Zambia. We distinguished profiles of post-traumatic stress symptoms using latent class analysis. Average number of trauma-related symptoms (21.6; range 0-38) was similar across sex and age. Latent class model suggested 3 classes varying by level of severity: low (31% of the sample), medium (45% of the sample), and high (24% of the sample) symptomatology. Results suggest that PTSD is a continuously distributed latent trait.

Price, tax and tobacco product substitution in Zambia.

PubMed

Stoklosa, Michal; Goma, Fastone; Nargis, Nigar; Drope, Jeffrey; Chelwa, Grieve; Chisha, Zunda; Fong, Geoffrey T

2018-03-24

In Zambia, the number of cigarette users is growing, and the lack of strong tax policies is likely an important cause. When adjusted for inflation, levels of tobacco tax have not changed since 2007. Moreover, roll-your-own (RYO) tobacco, a less-costly alternative to factory-made (FM) cigarettes, is highly prevalent. We modelled the probability of FM and RYO cigarette smoking using individual-level data obtained from the 2012 and 2014 waves of the International Tobacco Control (ITC) Zambia Survey. We used two estimation methods: the standard estimation method involving separate random effects probit models and a method involving a system of equations (incorporating bivariate seemingly unrelated random effects probit) to estimate price elasticities of FM and RYO cigarettes and their cross-price elasticities. The estimated price elasticities of smoking prevalence are -0.20 and -0.03 for FM and RYO cigarettes, respectively. FM and RYO are substitutes; that is, when the price of one of the products goes up, some smokers switch to the other product. The effects are stronger for substitution from FM to RYO than vice versa. This study affirms that increasing cigarette tax with corresponding price increases could significantly reduce cigarette use in Zambia. Furthermore, reducing between-product price differences would reduce substitution from FM to RYO. Since RYO use is associated with lower socioeconomic status, efforts to decrease RYO use, including through tax/price approaches and cessation assistance, would decrease health inequalities in Zambian society and reduce the negative economic consequences of tobacco use experienced by the poor. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Climate Trends and Farmers' Perceptions of Climate Change in Zambia.

PubMed

Mulenga, Brian P; Wineman, Ayala; Sitko, Nicholas J

2017-02-01

A number of studies use meteorological records to analyze climate trends and assess the impact of climate change on agricultural yields. While these provide quantitative evidence on climate trends and the likely effects thereof, they incorporate limited qualitative analysis of farmers' perceptions of climate change and/or variability. The present study builds on the quantitative methods used elsewhere to analyze climate trends, and in addition compares local narratives of climate change with evidence found in meteorological records in Zambia. Farmers offer remarkably consistent reports of a rainy season that is growing shorter and less predictable. For some climate parameters-notably, rising average temperature-there is a clear overlap between farmers' observations and patterns found in the meteorological records. However, the data do not support the perception that the rainy season used to begin earlier, and we generally do not detect a reported increase in the frequency of dry spells. Several explanations for these discrepancies are offered. Further, we provide policy recommendations to help farmers adapt to climate change/variability, as well as suggestions to shape future climate change policies, programs, and research in developing countries.

Cultural humility and working with marginalized populations in developing countries.

PubMed

Kools, Susan; Chimwaza, Angela; Macha, Swebby

2015-03-01

Population health needs in developing countries are great and countries are scaling up health professional education to meet these needs. Marginalized populations, in particular, are vulnerable to poor health and health care. This paper presents a culturally appropriate diversity training program delivered to Global Health Fellows who are educators and leaders in health professions in Malawi and Zambia. The purpose of this interprofessional education experience was to promote culturally competent and humble care for marginalized populations. © The Author(s) 2014.

AIDS education for a low literate audience in Zambia.

PubMed

Msimuko, A K

1988-04-01

A workshop funded by the USA Program for Appropriate Technology in Health (PATH) was an effort by Zambia toward prevention and control of AIDS. The lack of educational materials about AIDS for a low-literate audience was the major problem addressed by the workshop. Other problems include the lack of collaborative effort in the development of materials on AIDS, and the lack of skills needed in the development of such materials in Zambia. 1 of the objectives of the workshop was to launch the Planned Parenthood Association of Zambia's (PPAZ) materials development project. The scope of this project includes the production of educational materials on AIDS for low-literate audiences and a counseling handbook for family planning workers. Print materials should be simply written, using words, idioms, and graphics that are familiar to the target audience. Other workshop objectives included the establishment of collaborative relationships between organizations involved in existing AIDS educational activities in Zambia, and the development of practical skills needed to produce print materials. Education was identified as the most important strategy for the prevention and control of AIDS, and PPAZ should be the executing agency of the print materials project. Audience research, using focus group techniques, focus group discussions, behavioral messages, and pretesting of messages, should be the most effective means of reaching targeted audiences. PPAZ is contracted by PATH to begin development of educational materials, and 2 committees have formed to implement the project and to establish interagency collaboration. Audience research was begun between January and March of 1988, focusing on people's beliefs, practices, and ideas about AIDS. The final phase of the project will be the printing, distribution, and use of the AIDS materials and the training of family planning field workers in the proper use of these materials.

Orphan/vulnerable child caregiving moderates the association between women's autonomy and their BMI in three African countries.

PubMed

Kanamori, Mariano; Carter-Pokras, Olivia; Madhavan, Sangeetha; Feldman, Robert; He, Xin; Lee, Sunmin

2014-01-01

Enhancement of women's autonomy is a key factor for improving women's health and nutrition. With nearly 12 million orphan and vulnerable children (OVC) in Africa due to HIV/AIDS, the study of OVC primary caregivers' nutrition is fundamental. We investigated the association between married women's autonomy and their nutritional status; explored whether this relationship was modified by OVC primary caregiving; and analyzed whether decision-making autonomy mediated the association between household wealth and body mass index (BMI). This cross-sectional study used the data from Demographic Health Surveys collected during 2006-2007 from 20- to 49-year-old women in Namibia (n = 2633), Swaziland (n = 1395), and Zambia (n = 2920). Analyses included logistic regression, Sobel, and Goodman tests. Our results indicated that women's educational attainment increased the odds for being overweight (Swaziland and Zambia) and decreased the odds for being underweight (Namibia). In Zambia, having at least primary education increased the odds for being overweight only among child primary caregivers regardless of the OVC status of the child, and having autonomy for buying everyday household items increased the odds for being overweight only among OVC primary caregivers. Decision-making autonomy mediated the association between household wealth and OVC primary caregivers' BMI in Zambia (Z = 2.13, p value = 0.03). We concluded that depending on each country's contextual characteristics, having education can decrease the odds for being an underweight woman or increase the odds for being an overweight woman. Further studies should explore why in Namibia education has an effect on women's overweight status only among women who are caring for a child.

Developing a nutrition and health education program for primary schools in Zambia.

PubMed

Sherman, Jane; Muehlhoff, Ellen

2007-01-01

School-based health and nutrition interventions in developing countries aim at improving children's nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in Basic Schools (NEBS) project, this article examines whether and to what extent school-based health and nutrition education can contribute directly to improving the health and nutrition behaviors of school children. Initial results suggest that gains in awareness, knowledge and behavior can be achieved among children and their families with an actively implemented classroom program backed by teacher training and parent involvement, even in the absence of school-based nutrition and health services.

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district.

PubMed

Mulipukwa, Carolyn Patricia; Mudenda, Boyd; Mbewe, Allan Rabson

2017-10-01

The current rabies control strategy in Zambia is based on dog vaccination, dog population control and dog movement restrictions. In Nyimba district of Zambia, dog vaccination coverage is low but the incidence of dog bites is high which places the community at risk of rabies infection. The renewed global interest eliminating rabies in developing countries has spurred interest to identify determinants and barriers of dog vaccination in an effort to reduce the overall disease burden. A mixed methods cross sectional design was used in the study. This consisted of three parts: Evaluation of medical records regarding dog bite injuries, implementation and analysis of a household survey and in-depth review of key informant interviews. Data was collected into a Microsoft Excel database and subsequently transferred to STATA for descriptive, inferential and thematic analysis. Dog vaccination coverage overall was 8.7% (57/655), with 3.4% (22/655) in urban areas, 1.8% (12/655) in peri-urban and 3.5 (23/655) in the rural regions. Financially stable households were more likely to have their dogs vaccinated. Only 10.3% (31/300) of the respondents had vaccinated their dogs and these had a reliable source of income as 6% (18/300) were peasant farmers, 2% (6/300) were dependants whose guardians were financially stable and 2.3% (7/300) were in steady employment. Important barriers to dog vaccination included cost, limited awareness of vaccination program and access. Current rabies control strategies in Nyimba district, Zambia, appear quite limited. Improvements in the regional dog vaccination program may provide benefits. Enhancement of educational efforts targeting behavioural factors may also prove useful. Finally, the cost of dog vaccination can be reduced with scaled up production of a local vaccine.

Insights and efforts to control rabies in Zambia: Evaluation of determinants and barriers to dog vaccination in Nyimba district

PubMed Central

Mudenda, Boyd; Mbewe, Allan Rabson

2017-01-01

Background The current rabies control strategy in Zambia is based on dog vaccination, dog population control and dog movement restrictions. In Nyimba district of Zambia, dog vaccination coverage is low but the incidence of dog bites is high which places the community at risk of rabies infection. The renewed global interest eliminating rabies in developing countries has spurred interest to identify determinants and barriers of dog vaccination in an effort to reduce the overall disease burden. Methodology A mixed methods cross sectional design was used in the study. This consisted of three parts: Evaluation of medical records regarding dog bite injuries, implementation and analysis of a household survey and in-depth review of key informant interviews. Data was collected into a Microsoft Excel database and subsequently transferred to STATA for descriptive, inferential and thematic analysis. Results Dog vaccination coverage overall was 8.7% (57/655), with 3.4% (22/655) in urban areas, 1.8% (12/655) in peri-urban and 3.5 (23/655) in the rural regions. Financially stable households were more likely to have their dogs vaccinated. Only 10.3% (31/300) of the respondents had vaccinated their dogs and these had a reliable source of income as 6% (18/300) were peasant farmers, 2% (6/300) were dependants whose guardians were financially stable and 2.3% (7/300) were in steady employment. Important barriers to dog vaccination included cost, limited awareness of vaccination program and access. Conclusion Current rabies control strategies in Nyimba district, Zambia, appear quite limited. Improvements in the regional dog vaccination program may provide benefits. Enhancement of educational efforts targeting behavioural factors may also prove useful. Finally, the cost of dog vaccination can be reduced with scaled up production of a local vaccine. PMID:28991898

The influence of gender and age on choice of flood adaptation strategies: A case study of Zambia and Namibia..

NASA Astrophysics Data System (ADS)

Mabuku, Monde

2017-04-01

It is reported that flood events will increase due to variability and change in climate, thus increasing the number of people exposed to flooding disasters. This exposure negatively impacts rural households' livelihoods. Women, men, young, old has distinctive vulnerability and this shapes the choice of flood adaptation strategies. This calls for a need to adopt group specific interventions to strengthen local adaptive capacity to flooding for the affected population. The purpose of this case study was to determine the adaptation strategies to floods adopted by rural households in the Zambezi region of Namibia and Mwandi district of Zambia. The study further examined how gender and age influenced the choice of different adaptation strategies. Six focus group meetings and a questionnaire survey of 207 randomly sampled households were conducted in the flood prone areas of the study. Descriptive statistics results on the adaptation strategies indicated that a majority of the households in Namibia learnt to live with floods (86%),practiced mafisa cattle trade (86%), flood water harvesting (68%), practiced early and late planting (63%), prayed (55%), practiced conservation agriculture (54%) and fish farming (53%). In Zambia the adaptation strategies were; conservation agriculture (91%), acquiring better skills on preparedness (66%), flood water harvesting (63%), praying (60%), and flood proofing (52%). Logistic regression analysis showed that age positively and significantly influenced the likelihood of taking up adaptation strategies such as tree planting, relocation to higher ground, flood water harvesting, early and late planting. The older the respondents the more likely they were to adopt the strategies mentioned. More young ones were more likely to adopt acquiring better skills on flood preparedness and mafisa cattle trading than the old ones. Gender positively and significantly influenced mafisa cattle trade (p<0.01), male headed households were more likely to

Gender equality and education: Increasing the uptake of HIV testing among married women in Kenya, Zambia and Zimbabwe.

PubMed

Singh, Kavita; Luseno, Winnie; Haney, Erica

2013-01-01

Gender equality and education are being promoted as strategies to combat the HIV epidemic in Africa, but few studies have looked at the role of gender equality and education in the uptake of a vital service - HIV testing. This study looks at the associations between education (a key input needed for gender equality) and key gender equality measures (financial decision making and attitudes toward violence) with ever tested for HIV and tested for HIV in the past year. The study focused on currently married women ages between15-24 and 25-34 in three countries - Kenya, Zambia, and Zimbabwe. The data came from the Demographic and Health Surveys. Logistic regression was used to study the role of gender equality and education on the HIV testing outcomes after controlling for both social and biological factors. Results indicated that education had a consistent positive relationship with testing for both age groups, and the associations were always significant for young women aged 15-24 years (p<0.01). The belief that gender-based violence is unacceptable was positively associated with testing for women aged 25-34 in all the three countries, although the associations were only significant in Kenya (among women reporting ever being tested: OR 1.58, p<0.00; among women reporting being tested in the past year: OR 1.34, p<0.05) and Zambia (among women reporting ever being tested: OR 1.24, p<0.10; among women reporting being tested in the past year: OR 1.29, p<0.05). High financial decision making was associated with testing for women aged 25-34 in Zimbabwe only (among women reporting ever being tested: OR 1.66, p<0.01). Overall, the findings indicate that the education and the promotion of gender equality are important strategies for increasing uptake of a vital HIV service, and thus are important tools for protecting girls and young women against HIV.

Factors Contributing to the Failure to Use Condoms among Students in Zambia

ERIC Educational Resources Information Center

Mbulo, Lazarous; Newman, Ian M.; Shell, Duane F.

2007-01-01

This study explored factors that may predict condom use among college and high school students in Zambia. Using the Social Cognitive Theory, this study examined the relationship of drinking behaviors, alcohol-sexual expectations, education level, and religion to condom use among 961 students. The results of the study show that condom use was low…

Preliminary Investigation of Trypanosomosis in Exotic Dog Breeds from Zambia's Luangwa and Zambezi Valleys Using LAMP

PubMed Central

Namangala, Boniface; Oparaocha, Elizabeth; Kajino, Kiichi; Hayashida, Kyoko; Moonga, Ladslav; Inoue, Noboru; Suzuki, Yasuhiko; Sugimoto, Chihiro

2013-01-01

Canine African trypanosomosis (CAT) is rarely reported in the literature. In this preliminary study, we evaluated the performance of loop-mediated isothermal amplification (LAMP) against microscopy to detect CAT in six exotic dog breeds naturally infected with trypanosomes from Zambia's South Luangwa National Park and Chiawa Game Management Area. To our knowledge, this is the first report of CAT in Zambia. The patients exhibited a variety of aspecific clinical signs. The LAMP did not only confirm all six parasitologically positive CAT cases detected passively between April 2010 and January 2012, but was also critical in trypanosome speciation. According to LAMP, the majority of the dogs had monolytic infections with either Trypanosoma congolense or Trypanosoma brucei rhodesiense. The LAMP is thus a potential simple and cost-effective tool for trypanosome diagnosis in endemic regions. The rare report of zoonotic trypanosomes in dogs in Zambia has public health implications and justifies further investigations of CAT. PMID:23716412

Content Analysis of Primary and Secondary School Textbooks Regarding Malaria Control: A Multi-Country Study

PubMed Central

Nonaka, Daisuke; Jimba, Masamine; Mizoue, Tetsuya; Kobayashi, Jun; Yasuoka, Junko; Ayi, Irene; Jayatilleke, Achini C.; Shrestha, Sabina; Kikuchi, Kimiyo; Haque, Syed E.; Yi, Siyan

2012-01-01

Background In tropical settings, malaria education at school is potentially useful, but textbook content related to malaria education has so far received little attention. This study aimed to examine whether school textbooks contain sufficient knowledge and skills to help children in primary and lower secondary schools and their family members to cope with malaria. Methodology/Principal Findings This was a descriptive, cross-country study. We collected textbooks that were used by children in grades one to nine from nine countries endemic for malaria: Laos, Cambodia, Nepal, Bangladesh, Sri Lanka, Zambia, Niger, Benin, and Ghana. Two reviewers per country identified descriptions about malaria by seeking the term “malaria” or a local word that corresponds to malaria in languages other than English. The authors categorized the identified descriptions according to the content of the descriptions. Additionally, the authors examined whether the identified contents addressed life skill messages. Of a total of 474 textbooks collected, 35 contained descriptions about malaria. The most commonly included content was transmission mode/vector (77.1%), followed by preventive measures (60.0%), epidemiology (57.1%), cause/agent (54.3%), signs/symptoms (37.1%) and treatment (22.9%). Treatment-related content was not included in any textbooks from four countries and textbooks failed to recommend the use of insecticide-treated bed nets in five countries. Very few textbooks included content that facilitated prompt treatment, protection of risk groups, and use of recommended therapy. Conclusion/Significance Textbooks rarely included knowledge and skills that are crucial to protect schoolchildren and their families from malaria. This study identified the need for improvement to textbook contents regarding malaria. PMID:22574203

Knowledge, attitudes and practice of final-year student pharmacists in public health in Namibia, Zambia and Zimbabwe: an exploratory survey.

PubMed

Law, Miranda G; Maposa, Prosper; Chambula, Elias; Steeb, David R; Eckel, Stephen F; Duncan, Gregory

2018-05-06

To explore the knowledge, attitudes and practice of final-year student pharmacists about public health. Knowledge, attitudes and practice of all final-year student pharmacists (N = 158) in Namibia, Zambia and Zimbabwe were assessed through a quantitative 12-item survey. The survey assessed personal interest and attitude towards public health activities, self-assessed ability to perform basic public health activities, perspectives towards current pharmacist practices within public health activities in their country, and student involvement in public health activities during pharmacy school. Eighty-two per cent of students responded to the survey (n = 129). The majority (95%) of all final-year student pharmacists are interested in contributing to public health activities in both health promotion and disease prevention and feel, as pharmacists, they have the responsibility to do so. Additionally, the majority of students would like more education during pharmacy school on health promotion (93%) and disease prevention (89%). Despite their interest, low numbers of student pharmacists feel that pharmacists are currently utilised in disease prevention (35%) and health promotion (42%). Final-year student pharmacists in Namibia, Zambia and Zimbabwe express strong interest in public health education and involvement in public health activities. This interest and enthusiasm can serve as evidence for advancing public health education in the pharmacy curricula and for developing pharmacist opportunities in public health efforts that match the needs of the country. © 2018 Royal Pharmaceutical Society.

A retrospective study of HIV, antiretroviral therapy, and pregnancy-associated hypertension among women in Lusaka, Zambia.

PubMed

Stoner, Marie C D; Vwalika, Bellington; Smid, Marcela C; George, Shalin; Chi, Benjamin H; Stringer, Elizabeth M; Stringer, Jeffrey S A

2016-09-01

To investigate the association between HIV, antiretroviral therapy (ART), and pregnancy-associated hypertension (PAH) in an HIV-endemic setting. A retrospective cohort study was undertaken of pregnant women for whom information was recorded between February 2006 and December 2012 in the Zambia Electronic Perinatal Record System, which captures data from 25 facilities in Lusaka, Zambia. PAH was defined as eclampsia, pre-eclampsia, hypertension, or elevated blood pressure (>140/80mm Hg) during delivery admission. Logistic regression estimated the odds of PAH among women by HIV serostatus, and by most recent CD4 T lymphocyte count and ART status among women with HIV infection. Among 249 771 women included in the analysis, 5354 (2.1%) had PAH. Compared with women without HIV infection, women with HIV infection not receiving ART had lower odds of PAH (adjusted odds ratio [AOR] 0.86, 95% confidence interval 0.78-0.95), whereas those with HIV infection who had initiated ART had higher odds of PAH (AOR 1.15, 95% CI 1.01-1.32). No association was found between PAH and timing of ART initiation or CD4 lymphocyte count. In a large African urban cohort, women with untreated HIV infection had the lowest odds of PAH. Treatment with ART could increase PAH risk beyond that of women without HIV infection and those with untreated infection. Published by Elsevier Ireland Ltd.

Remotely-sensed, nocturnal, dew point correlates with malaria transmission in Southern Province, Zambia: a time-series study.

PubMed

Nygren, David; Stoyanov, Cristina; Lewold, Clemens; Månsson, Fredrik; Miller, John; Kamanga, Aniset; Shiff, Clive J

2014-06-13

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. 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. 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. In this

Seroprevalence of Filovirus Infection of Rousettus aegyptiacus Bats in Zambia.

PubMed

Changula, Katendi; Kajihara, Masahiro; Mori-Kajihara, Akina; Eto, Yoshiki; Miyamoto, Hiroko; Yoshida, Reiko; Shigeno, Asako; Hang'ombe, Bernard; Qiu, Yongjin; Mwizabi, Daniel; Squarre, David; Ndebe, Joseph; Ogawa, Hirohito; Harima, Hayato; Simulundu, Edgar; Moonga, Ladslav; Kapila, Penjaninge; Furuyama, Wakako; Kondoh, Tatsunari; Sato, Masahiro; Takadate, Yoshihiro; Kaneko, Chiho; Nakao, Ryo; Mukonka, Victor; Mweene, Aaron; Takada, Ayato

2018-06-08

Bats are suspected to play important roles in the ecology of filoviruses, including ebolaviruses and marburgviruses. A cave-dwelling fruit bat, Rousettus aegyptiacus, has been shown to be a reservoir of marburgviruses. Using an enzyme-linked immunosorbent assay with the viral glycoprotein antigen, we detected immunoglobulin G antibodies specific to multiple filoviruses in 158 of 290 serum samples of R aegyptiacus bats captured in Zambia during the years 2014-2017. In particular, 43.8% of the bats were seropositive to marburgvirus, supporting the notion that this bat species continuously maintains marburgviruses as a reservoir. Of note, distinct peaks of seropositive rates were repeatedly observed at the beginning of rainy seasons, suggesting seasonality of the presence of newly infected individuals in this bat population. These data highlight the need for continued monitoring of filovirus infection in this bat species even in countries where filovirus diseases have not been reported.

Post-traumatic stress symptoms and structure among orphan and vulnerable children and adolescents in Zambia

PubMed Central

Familiar, Itziar; Murray, Laura; Gross, Alden; Skavenski, Stephanie; Jere, Elizabeth; Bass, Judith

2014-01-01

Background Scant information exists on PTSD symptoms and structure in youth from developing countries. Methods We describe the symptom profile and exposure to trauma experiences among 343 orphan and vulnerable children and adolescents from Zambia. We distinguished profiles of post-traumatic stress symptoms using latent class analysis. Results Average number of trauma-related symptoms (21.6; range 0-38) was similar across sex and age. Latent class model suggested 3 classes varying by level of severity: low (31% of the sample), medium (45% of the sample), and high (24% of the sample) symptomatology. Conclusions Results suggest that PTSD is a continuously distributed latent trait. PMID:25382359

Fire management assessment of Eastern Province, Zambia

Treesearch

L. T. Hollingsworth; D. Johnson; G. Sikaundi; S. Siame

2015-01-01

The mission that produced this assessment was prompted by requests from Forestry Department personnel in Zambia to the United States Agency for International Development (USAID) for formal fire management training. USAID contacted the United States Forest Service's (USFS) International Programs (IP) with the training request. Together, USFS, USAID, and Zambian...

Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia.

PubMed

Kalungia, Aubrey Chichonyi; Burger, Johanita; Godman, Brian; Costa, Juliana de Oliveira; Simuwelu, Chimwemwe

2016-12-01

In Zambia, antibiotics are categorized as prescription-only medicines. Antibiotics dispensed without a prescription pose a public health threat, which is a concern. Consequently, the aim is to ascertain the extent of non-prescription sales and dispensing of antibiotics in community pharmacies in Zambia. The practice of non-prescription sale and dispensing were assessed in 73 randomly selected community retail pharmacies, using a structured interviewer-administered questionnaire with simulated case scenarios. Majority (97%) stated that clients frequently requested non-prescribed antibiotics. Interviewees usually asked clients' indications (94%), counselled on dosing (96%) and suggested changes to antibiotic choices (97%). All (100%) dispensed non-prescribed antibiotics. Commonly dispensed antibiotics included amoxicillin (52%), cotrimoxazole (25%) and metronidazole (23%). Non-prescription sale and dispensing of antibiotics was significantly associated with interviewees' professional qualification in four out of five simulations. Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.

Lusaka, Zambia, during SAFARI-2000: Convergence of local and imported ozone pollution

NASA Astrophysics Data System (ADS)

Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tal; Phahlane, N. Agnes; Coetzee, Gert J. R.

2002-10-01

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 (15.5S, 28E) in early September 2000. Maximum surface ozone was over 90 ppbv and column tropospheric ozone exceeded 50 DU. These values are higher than concurrent measurements over Nairobi (1S, 38E) and Irene (25S, 28E, near Pretoria). At least 30% of Lusaka surface ozone appears to be from local sources. A layer at 800-500 hPa has ozone >120 ppbv and originates from trans-boundary recirculation. Starting out over Zambia, Angola, and Namibia, ozone-rich air travels east to the Indian Ocean, before heading back toward Mozambique, Zimbabwe and Zambia. Thus, Lusaka collects local and imported pollution, consistent with its location within the southern African gyre.

Development of Education and Research in Anesthesia and Intensive Care Medicine at the University Teaching Hospital in Lusaka, Zambia: A Descriptive Observational Study.

PubMed

Janowicz, Anna; Kasole, Tuma; Measures, Emily; Langley, Meg; Goma, Fastone M; Ismailova, Feruza; Kinnear, John A; Bould, M Dylan

2017-07-01

Data from 2006 show that the practice of anesthesia at the University Teaching Hospital in Lusaka, Zambia was underdeveloped by international standards. Not only was there inadequate provision of resources related to environment, equipment, and drugs, but also a severe shortage of staff, with no local capability to train future physician anesthetic providers. There was also no research base on which to develop the specialty. This study aimed to evaluate patient care, education and research to determine whether conditions had changed a decade later. A mix of qualitative data and quantitative data was gathered to inform the current state of anesthesia at the University Teaching Hospital, Lusaka, Zambia. Semistructured interviews were conducted with key staff identified by purposive sampling, including staff who had worked at the hospital throughout 2006 to 2015. Further data detailing conditions in the environment were collected by reviewing relevant departmental and hospital records spanning the study period. All data were analyzed thematically, using the framework described in the 2006 study, which described patient care, education, and research related to anesthetic practice at the hospital. There have been positive developments in most areas of anesthetic practice, with the most striking being implementation of a postgraduate training program for physician anesthesiologists. This has increased physician anesthesia staff in Zambia 6-fold within 4 years, and created an active research stream as part of the program. Standards of monitoring and availability of drugs have improved, and anesthetic activity has expanded out of operating theaters into the rest of the hospital. A considerable increase in the number of cesarean deliveries performed under spinal anesthetic may be a marker for safer anesthetic practice. Anesthesiologists have yet to take responsibility for the management of pain. The establishment of international partnerships to support postgraduate

Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia

PubMed Central

2012-01-01

Background A number of studies from countries with severe HIV epidemics have found gaps in condom availability, even in places where there is a substantial potential for HIV transmission. Although reported condom use has increased in many African countries, there are often big differences by socioeconomic background. The aim of this study was to assess equity aspects of condom availability and uptake in three African districts to evaluate whether condom programmes are given sufficient priority. Methods Data on condom availability and use was examined in one district in Kenya, one in Tanzania and one in Zambia. The study was based on a triangulation of data collection methods in the three study districts: surveys in venues where people meet new sexual partners, population-based surveys and focus group discussions. The data was collected within an overall study on priority setting in health systems. Results At the time of the survey, condoms were observed in less than half of the high risk venues in two of the three districts and in 60% in the third district. Rural respondents in the population-based surveys perceived condoms to be less available and tended to be less likely to report condom use than urban respondents. Although focus group participants reported that condoms were largely available in their district, they expressed concerns related to the accessibility of free condoms. Conclusion As late as thirty years into the HIV epidemic there are still important gaps in the availability of condoms in places where people meet new sexual partners in these three African districts. Considering that previous studies have found that improved condom availability and accessibility in high risk places have a potential to increase condom use among people with multiple partners, the present study findings indicate that substantial further efforts should be made to secure that condoms are easily accessible in places where sexual relationships are initiated. Although condom

Condom availability in high risk places and condom use: a study at district level in Kenya, Tanzania and Zambia.

PubMed

Sandøy, Ingvild Fossgard; Blystad, Astrid; Shayo, Elizabeth H; Makundi, Emmanuel; Michelo, Charles; Zulu, Joseph; Byskov, Jens

2012-11-26

A number of studies from countries with severe HIV epidemics have found gaps in condom availability, even in places where there is a substantial potential for HIV transmission. Although reported condom use has increased in many African countries, there are often big differences by socioeconomic background. The aim of this study was to assess equity aspects of condom availability and uptake in three African districts to evaluate whether condom programmes are given sufficient priority. Data on condom availability and use was examined in one district in Kenya, one in Tanzania and one in Zambia. The study was based on a triangulation of data collection methods in the three study districts: surveys in venues where people meet new sexual partners, population-based surveys and focus group discussions. The data was collected within an overall study on priority setting in health systems. At the time of the survey, condoms were observed in less than half of the high risk venues in two of the three districts and in 60% in the third district. Rural respondents in the population-based surveys perceived condoms to be less available and tended to be less likely to report condom use than urban respondents. Although focus group participants reported that condoms were largely available in their district, they expressed concerns related to the accessibility of free condoms. As late as thirty years into the HIV epidemic there are still important gaps in the availability of condoms in places where people meet new sexual partners in these three African districts. Considering that previous studies have found that improved condom availability and accessibility in high risk places have a potential to increase condom use among people with multiple partners, the present study findings indicate that substantial further efforts should be made to secure that condoms are easily accessible in places where sexual relationships are initiated. Although condom distribution in drinking places has been

Health worker shortages in Zambia: an assessment of government responses.

PubMed

Gow, Jeff; George, Gavin; Mutinta, Given; Mwamba, Sylvia; Ingombe, Lutungu

2011-11-01

A dire health worker shortage in Zambia's national health programs is adversely impacting the quantity and quality of health care and posing a serious barrier to achieving Millennium Development Goals to improve population health. In 2005, Zambia's Ministry of Health developed a 10-year strategic plan for human resources for health to address the crisis through improved training, hiring, and retention. The plan has neither arrested nor reduced the shortage. We review the causes of the shortage, present results from a health worker survey showing that safe work conditions, manageable workloads, and career advancement opportunities matter more to respondents than financial compensation. We comment on the adequacy of government efforts to address the health worker shortage.

Cholera Epidemic - Lusaka, Zambia, October 2017-May 2018.

PubMed

Sinyange, Nyambe; Brunkard, Joan M; Kapata, Nathan; Mazaba, Mazyanga Lucy; Musonda, Kunda G; Hamoonga, Raymond; Kapina, Muzala; Kapaya, Fred; Mutale, Lwito; Kateule, Ernest; Nanzaluka, Francis; Zulu, James; Musyani, Chileshe Lukwesa; Winstead, Alison V; Davis, William W; N'cho, Hammad S; Mulambya, Nelia L; Sakubita, Patrick; Chewe, Orbie; Nyimbili, Sulani; Onwuekwe, Ezinne V C; Adrien, Nedghie; Blackstock, Anna J; Brown, Travis W; Derado, Gordana; Garrett, Nancy; Kim, Sunkyung; Hubbard, Sydney; Kahler, Amy M; Malambo, Warren; Mintz, Eric; Murphy, Jennifer; Narra, Rupa; Rao, Gouthami G; Riggs, Margaret A; Weber, Nicole; Yard, Ellen; Zyambo, Khozya D; Bakyaita, Nathan; Monze, Namani; Malama, Kennedy; Mulwanda, Jabbin; Mukonka, Victor M

2018-05-18

On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018 (Figure). In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city's water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10-February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged ≥1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents.

Costs and financing of routine immunization: Approach and selected findings of a multi-country study (EPIC).

PubMed

Brenzel, Logan; Young, Darwin; Walker, Damian G

2015-05-07

Few detailed facility-based costing studies of routine immunization (RI) programs have been conducted in recent years, with planners, managers and donors relying on older information or data from planning tools. To fill gaps and improve quality of information, a multi-country study on costing and financing of routine immunization and new vaccines (EPIC) was conducted in Benin, Ghana, Honduras, Moldova, Uganda and Zambia. This paper provides the rationale for the launch of the EPIC study, as well as outlines methods used in a Common Approach on facility sampling, data collection, cost and financial flow estimation for both the routine program and new vaccine introduction. Costing relied on an ingredients-based approach from a government perspective. Estimating incremental economic costs of new vaccine introduction in contexts with excess capacity are highlighted. The use of more disaggregated System of Health Accounts (SHA) coding to evaluate financial flows is presented. The EPIC studies resulted in a sample of 319 primary health care facilities, with 65% of facilities in rural areas. The EPIC studies found wide variation in total and unit costs within each country, as well as between countries. Costs increased with level of scale and socio-economic status of the country. Governments are financing an increasing share of total RI financing. This study provides a wealth of high quality information on total and unit costs and financing for RI, and demonstrates the value of in-depth facility approaches. The paper discusses the lessons learned from using a standardized approach, as well as proposes further areas of methodology development. The paper discusses how results can be used for resource mobilization and allocation, improved efficiency of services at the country level, and to inform policies at the global level. Efforts at routinizing cost analysis to support sustainability efforts would be beneficial. Copyright © 2015 Elsevier Ltd. All rights reserved.

Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia

PubMed Central

Mutale, Wilbroad; Godfrey-Fausset, Peter; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Chintu, Namwinga; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-01-01

Introduction There is growing interest in health system performance and recently WHO launched a report on health systems strengthening emphasising the need for close monitoring using system-wide approaches. One recent method is the balanced scorecard system. There is limited application of this method in middle- and low-income countries. This paper applies the concept of balanced scorecard to describe the baseline status of three intervention districts in Zambia. Methodology The Better Health Outcome through Mentoring and Assessment (BHOMA) project is a randomised step-wedged community intervention that aims to strengthen the health system in three districts in the Republic of Zambia. To assess the baseline status of the participating districts we used a modified balanced scorecard approach following the domains highlighted in the MOH 2011 Strategic Plan. Results Differences in performance were noted by district and residence. Finance and service delivery domains performed poorly in all study districts. The proportion of the health workers receiving training in the past 12 months was lowest in Kafue (58%) and highest in Luangwa district (77%). Under service capacity, basic equipment and laboratory capacity scores showed major variation, with Kafue and Luangwa having lower scores when compared to Chongwe. The finance domain showed that Kafue and Chongwe had lower scores (44% and 47% respectively). Regression model showed that children's clinical observation scores were negatively correlated with drug availability (coeff −0.40, p = 0.02). Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) and service readiness (coeff 0.54, p = 0.03). Conclusion The study applied the balanced scorecard to describe the baseline status of 42 health facilities in three districts of Zambia. Differences in performance were noted by district and residence in most domains with finance and service delivery

Information Provision in Emergency Settings: The Experience of Refugee Communities in Zambia

ERIC Educational Resources Information Center

Kanyengo, Brendah Kakulwa; Kanyengo, Christine Wamunyima

2011-01-01

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…

Willingness to pay, borrow, and work for rural water service improvements in developing countries

NASA Astrophysics Data System (ADS)

Abramson, Adam; Becker, Nir; Garb, Yaakov; Lazarovitch, Naftali

2011-11-01

In many least developed countries, inadequate user willingness to pay (WTP) to achieve cost recovery for improvements to substandard rural water services is a major barrier to reaching targets such as the Millennium Development Goals. A meta-analysis of 21 contingent valuation studies conducted in least developed countries reveals that cost recovery from user demand is infeasible in most cases, and that rural areas are especially unwilling to pay enough to finance water service improvements. We argue that this is largely due to inability to pay cash rather than an absence of demand and propose two alternative financing approaches that may enable capital deficient communities to afford improvements. A discrete choice experiment, conducted in a rural catchment of Zambia, compares conventional cash-based WTP for different water service attributes with two alternative measures. (1) Willingness to borrow: Monthly payments in cash, with a no-interest loan given to the user. (2) Willingness to work: Instead of cash, payment in the form of contributing time devoted to unskilled labor. To different degrees, these alternatives elicit higher demand and enable cost recovery, providing evidence that demand-driven, economically sustainable water development efforts, as described here for Simango, Zambia, may be implemented for rural, resource-poor communities.

From end of life to chronic care: the provision of community home-based care for HIV and the adaptation to new health care demands in Zambia.

PubMed

Aantjes, Carolien J; Simbaya, Joseph; Quinlan, Tim K C; Bunders, Joske F G

2016-11-01

Aim We present the evolution of primary-level HIV and AIDS services, shifting from end of life to chronic care, and draw attention to the opportunities and threats for the future of Zambia's nascent chronic care system. Although African governments struggled to provide primary health care services in the context of a global economic crisis, civil society organisations (CSO) started mobilising settlement residents to respond to another crisis: the HIV and AIDS pandemic. These initiatives actively engaged patients, families and settlement residents to provide home-based care to HIV-infected patients. After 30 years, CHBC programmes continue to be appropriate in the context of changing health care needs in the population. The study took place in 2011 and 2012 and was part of a multi-country study. It used a mixed method approach involving semi-structured interviews, focus group discussions, structured interviews, service observations and a questionnaire survey. Findings Our research revealed long-standing presence of extensive mutual support amongst residents in many settlements, the invocation of cultural values that emphasise social relationships and organisation of people by CSO in care and support programmes. This laid the foundation for a locally conceived model of chronic care capable of addressing the new care demands arising from the country's changing burden of disease. However, this capacity has come under threat as the reduction in donor funding to community home-based care programmes and donor and government interventions, which have changed the nature of these programmes in the country. Zambia's health system risks losing valuable capacity for fulfilling its vision 'to bring health care as close to the family as possible' if government strategies do not acknowledge the need for transformational approaches to community participation and continuation of the brokering role by CSO in primary health care.

Lead intoxicated children in Kabwe, Zambia.

PubMed

Bose-O'Reilly, Stephan; Yabe, John; Makumba, Joseph; Schutzmeier, Paul; Ericson, Bret; Caravanos, Jack

2017-10-28

Kabwe is a lead contaminated mining town in Zambia. Kabwe has extensive lead contaminated soil and children in Kabwe ingest and inhale high quantities of this toxic dust. The aim of this paper is to analyze the health impact of this exposure for children. Health data from three existing studies were re-analyzed. Over 95% of children living in the most affected townships had high blood lead levels (BLLs) > 10µg/dL. Approximately 50% of those children had BLLs ≥ 45µg/dL. The existing data clearly establishes the presence of a severe environmental health crisis in Kabwe which warrants immediate attention. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of joint contraceptive decisions on the use of Injectables, Long-Acting and Permanent Methods (ILAPMs) among married female (15–49) contraceptive users in Zambia: a cross-sectional study

PubMed Central

2014-01-01

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

Changing Patterns of Access to Education in Anglophone and Francophone Countries in Sub Saharan Africa: Is Education for All Pro-Poor? CREATE Pathways to Access. Research Monograph No. 52

ERIC Educational Resources Information Center

Lewin, Keith M.; Sabates, Ricardo

2011-01-01

This paper explores patterns of growth in participation in six Anglophone and seven Francophone countries in SSA. The countries are Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, Benin, Burkina Faso, Cameroon, Madagascar, Mali, Niger and Senegal. These countries all have large scale Universal Primary Education programmes and all have…

Levels of zearalenone and its metabolites in sun-dried kapenta fish and water of Lake Kariba in Zambia - A preliminary study.

PubMed

Gonkowski, Slawomir; Obremski, Kazimierz; Makowska, Krystyna; Rytel, Liliana; Mwaanga, Edwell Siatambi

2018-10-01

Contamination of food with mycotoxins and the associated possibilities of human intoxication is a serious problem in Africa. One of the most widespread mycotoxins is zearalenone (ZEN), which usually occurs in food of vegetable origin. On the other hand, information about ZEN in products of animal origin in African countries is extremely scanty. During the present study, levels of ZEN and its analogs: α-zearalenol (α-ZEL) and β-zearalenol (β-ZEL) were measured by high performance liquid chromatography (HPLC) with fluorescence detection in sun-dried kapenta fish - traditional Zambian food, as well as in the water of Lake Kariba - the main source of kapenta fish in Zambia. This study revealed that levels of ZEN in sun-dried kapenta fish fluctuated from 27.2 μg·kg -1 to 53.9 μg·kg -1 , whereas the contamination of water from Lake Kariba with ZEN is rather minimally similar to the content of ZEN analogs in both kapenta fish and water. The obtained results have shown that sun-dried kapenta fish of Lake Kariba contain ZEN and may contribute to the exposure of consumers to this substance. Copyright © 2017 Elsevier B.V. All rights reserved.

Observation of the total solar eclipse on 21 June 2001 in Zambia

NASA Astrophysics Data System (ADS)

Takahashi, Noritsugu; Yumoto, Kiyohumi; Ichimoto, Kiyoshi

2002-04-01

On 21 June 2001, path of totality in Angola, Zambia, Zimbabwe, Mozambique, and Madagascar in Africa. The Japan Scientific Observation Team, consisting primarily of the members of the Solar Eclipse Subcommittee of the Committee for International Collaboration in Astronomy of the Science Council of JAPAN, visited Lusaka in Zambia to observe the total solar eclipse. Blessed with fine weather, the observation was successful. The outline of the influence of solar eclipse on the terrestrial magnetism, polarization of the flash spectrum, and other observation data, as well as the way educational activities were carried out, are reported.

Remotely-sensed, nocturnal, dew point correlates with malaria transmission in Southern Province, Zambia: a time-series study

PubMed Central

2014-01-01

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

Embers to Bonfires: An Analysis of Early Childhood Teacher Training in Zambia

ERIC Educational Resources Information Center

Evans-Palmer, Teri E.; Shen, Mei-Yi

2017-01-01

This study examined a five-year project initiated by the Women's Global Connection (WGC) to train pre-primary teachers in schools serving HIV/AIDS orphans in Zambia. The researchers evaluated the contextual factors of the training initiative to clarify why some teachers possess high self-efficacy, while others do not. The article analyses the…

Follow-Up Study to Assess the Use and Performance of Household Filters in Zambia

PubMed Central

Peletz, Rachel; Simuyandi, Michelo; Simunyama, Martin; Sarenje, Kelvin; Kelly, Paul; Clasen, Thomas

2013-01-01

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

Distance Learners' Perspective on User-Friendly Instructional Materials at the University of Zambia

ERIC Educational Resources Information Center

Simui, F.; Thompson, L. C.; Mundende, K.; Mwewa, G.; Kakana, F.; Chishiba, A.; Namangala, B.

2017-01-01

This case study focuses on print-based instructional materials available to distance education learners at the University of Zambia. Using the Visual Paradigm Software, we model distance education learners' voices into sociograms to make a contribution to the ongoing discourse on quality distance learning in poorly resourced communities. Emerging…

Responding to non-communicable diseases in Zambia: a policy analysis.

PubMed

Mukanu, Mulenga M; Zulu, Joseph Mumba; Mweemba, Chrispin; Mutale, Wilbroad

2017-04-24

Non-communicable diseases (NCDs) are an emerging global health concern. Reports have shown that, in Zambia, NCDs are also an emerging problem and the government has begun initiating a policy response. The present study explores the policy response to NCDs by the Ministry of Health in Zambia using the policy triangle framework of Walt and Gilson. A qualitative approach was used for the study. Data collected through key informant interviews with stakeholders who were involved in the NCD health policy development process as well as review of key planning and policy documents were analysed using thematic analysis. The government's policy response was as a result of international strategies from WHO, evidence of increasing disease burden from NCDs and pressure from interest groups. The government developed the NCD strategic plan based on the WHO Global Action Plan for NCDs 2013-2030. Development of the NCD strategic plan was driven by the government through the Ministry of Health, who set the agenda and adopted the final document. Stakeholders participated in the fine tuning of the draft document from the Ministry of Health. The policy development process was lengthy and this affected consistency in composition of the stakeholders and policy development momentum. Lack of representative research evidence for some prioritised NCDs and use of generic targets and indicators resulted in the NCD strategic plan being inadequate for the Zambian context. The interventions in the strategic plan also underutilised the potential of preventing NCDs through health education. Recent government pronouncements were also seen to be conflicting the risk factor reduction strategies outlined in the NCD strategic plan. The content of the NCD strategic plan inadequately covered all the major NCDs in Zambia. Although contextual factors like international strategies and commitments are crucial catalysts to policy development, there is need for domestication of international guidelines and

Agriculture expansion, wood energy and woody encroachment in the Miombo woodlands: striving towards sustainability in Zambia.

NASA Astrophysics Data System (ADS)

Pelletier, J.

2017-12-01

Agricultural expansion is mostly done at the expense of forests and woodlands in the tropics. In Sub-Saharan Africa, forests are also critical as providers of wood energy for domestic consumption with a clear majority of households depending on firewood and charcoal as primary source of energy. Using Zambia as a case study, we look at the link between agricultural expansion, wood energy and the sustainability of forest resources. Zambia has been identified as having one of the highest rates of deforestation in the world, but there is large uncertainty in these estimates. The government of Zambia has identified charcoal production as one of the main of drivers of forest cover loss and is targeting this practice in their national strategy for reducing emissions from deforestation and forest degradation (REDD+). Other assessment however indicate that agricultural expansion is by far the main driver of deforestation and charcoal production is sustainable in Zambia. These competing evaluations call for a better understanding of the drivers of change. Using two national-scale vegetation surveys and remote sensing data, we compare and validate historical forest cover loss estimates to improve their accuracy. We attribute the change and their associated emissions to specific drivers of deforestation. The ecological properties of areas under change are compared to stable areas over time. Our results from national permanent plots indicate a woody encroachment process in Zambia, a potential ecological response to rising CO2 levels. We found that despite large emissions from deforestation, forests and woodlands have been acting as a carbon sink. This research addresses directly the potential feedbacks and responses to competing demands on forests coming from different sectors, including for agriculture and energy, to set the baseline on which to evaluate forest sustainability now and in the future given potentially new ecological conditions. It provides policy relevant

Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia.

PubMed

Kane, Jeremy C; Murray, Laura K; Cohen, Judith; Dorsey, Shannon; Skavenski van Wyk, Stephanie; Galloway Henderson, Jennica; Imasiku, Mwiya; Mayeya, John; Bolton, Paul

2016-10-01

The effectiveness of mental health interventions such as trauma-focused cognitive behavioral therapy (TF-CBT) may vary by client, caregiver, and intervention-level variables, but few randomized trials in low- and middle-income countries (LMIC) have conducted moderation analyses to investigate these characteristics. This study explores moderating factors to TF-CBT treatment response among a sample of orphans and vulnerable children (OVC) in Zambia. Data were obtained from a completed randomized trial of TF-CBT among 257 OVC in Zambia. Trauma symptoms and functioning were measured at baseline and following the end of treatment. Mixed effects regression models were estimated for each moderator of interest: gender, age, number of trauma types experienced, history of sexual abuse, orphan status, primary caretaker, school status, and parental involvement in treatment. Treatment effectiveness was moderated by history of sexual abuse with greater reductions in both outcomes (trauma, p < .05; functioning, p < .01) for those that experienced sexual abuse. Primary caretaker was also a moderator with greater trauma reductions in those who identified their mother as the primary caretaker (p < .01), and better functioning in those that identified their father as the primary caretaker (p < .05). Nonorphans and single orphans (mother alive) showed greater reduction in functional impairment (p < .01) compared with double orphans. There was no significant moderator effect found by gender, age, number of trauma types, school status, or caregiver participation in treatment. This study suggests that TF-CBT was effective in reducing trauma symptoms and functional impairment among trauma-affected youth overall and that it may be particularly effective for survivors of child sexual abuse and children whose primary caretaker is a biological parent. Scale-up of TF-CBT is warranted given the wide range of effectiveness and prevalence of child sexual abuse. Future randomized

A 12-Month Study of Food Crops Contaminated by Heavy Metals, Lusaka, Zambia

NASA Astrophysics Data System (ADS)

Holden, J. A.; Malamud, B. D.; Chishala, B. H.; Kapungwe, E.; Volk, J.; Harpp, K. S.

2009-04-01

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.

Investment incentives and the implementation of the Framework Convention on Tobacco Control: evidence from Zambia.

PubMed

Lencucha, Raphael; Drope, Jeffrey; Labonte, Ronald; Zulu, Richard; Goma, Fastone

2016-07-01

Policy misalignment across different sectors of government serves as one of the pivotal barriers to WHO Framework Convention on Tobacco Control (FCTC) implementation. This paper examines the logic used by government officials to justify investment incentives to increase tobacco processing and manufacturing in the context of FCTC implementation in Zambia. We conducted qualitative semistructured interviews with key informants from government, civil society and intergovernmental economic organisations (n=23). We supplemented the interview data with an analysis of public documents pertaining to the policy of economic development in Zambia. We found gross misalignments between the policies of the economic sector and efforts to implement the provisions of the FCTC. Our interviews uncovered the rationale used by officials in the economic sector to justify providing economic incentives to bolster tobacco processing and manufacturing in Zambia: (1) tobacco is not consumed by Zambians/tobacco is an export commodity, (2) economic benefits outweigh health costs and (3) tobacco consumption is a personal choice. Much of the struggle Zambia has experienced in implementing the FCTC can be attributed to misalignments between the economic and health sectors. Zambia's development agenda seeks to bolster agricultural processing and manufacturing. Tobacco control proponents must recognise and work within this context in order to foster productive strategies with those working on tobacco supply issues. These findings are broadly applicable to the global context. It is important that the Ministry of Health monitors the tobacco policy of and engages with these sectors to find ways of harmonising FCTC implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Diabetes mellitus, hypertension and albuminuria in rural Zambia: a hospital-based survey.

PubMed

Rasmussen, Jon B; Thomsen, Jakúp A; Rossing, Peter; Parkinson, Shelagh; Christensen, Dirk L; Bygbjerg, Ib C

2013-09-01

To assess albuminuria in rural Zambia among patients with diabetes mellitus only (DM group), hypertension only (HTN group) and patients with combined DM and HTN (DM/HTN group). A cross-sectional survey was conducted at St. Francis Hospital in the Eastern province of Zambia. Albumin-creatinine ratio in one urine sample was used to assess albuminuria. Other information obtained included age, sex, body mass index (BMI), waist circumference (WC), blood pressure (BP), glycosylated haemoglobin (HbA1c ), random capillary glucose, time since diagnosis, medication and family history of DM or HTN. A total of 193 participants were included (DM group: n = 33; HTN group: n = 92; DM/HTN group: n = 68). The participants in the DM group used insulin more frequently as diabetes medication than the DM/HTN group (P < 0.05). Furthermore, the DM group was younger and had lower BMI, WC and BP than the two other groups. In the DM group, HTN group and DM/HTN group, microalbuminuria was found in 12.1%, 19.6% and 29.4% (P = 0.11), and macroalbuminuria was found in 0.0%, 3.3% and 13.2% (P = 0.014), respectively. The urine albumin (P = 0.014) and albumin-creatinine ratio (P = 0.0006) differed between the three groups. This hospital-based survey in rural Zambia found a lower frequency of albuminuria among the participants than in previous studies of patients with DM or HTN in urban sub-Saharan Africa. © 2013 John Wiley & Sons Ltd.

Do anti-malarials in Africa meet quality standards? The market penetration of non quality-assured artemisinin combination therapy in eight African countries.

PubMed

Newton, Paul N; Hanson, Kara; Goodman, Catherine

2017-05-25

Quality of artemisinin-based combination therapy (ACT) is important for ensuring malaria parasite clearance and protecting the efficacy of artemisinin-based therapies. The extent to which non quality-assured ACT (non-QAACT), or those not granted global regulatory approval, are available and used to treat malaria in endemic countries is poorly documented. This paper uses national and sub-national medicine outlet surveys conducted in eight study countries (Benin, Kinshasa and Kantanga [Democratic Republic of the Congo, DRC], Kenya, Madagascar, Nigeria, Tanzania, Uganda and Zambia) between 2009 and 2015 to describe the non-QAACT market and to document trends in availability and distribution of non-QAACT in the public and private sector. In 2014/15, non-QAACT were most commonly available in Kinshasa (83%), followed by Katanga (53%), Nigeria (48%), Kenya (42%), and Uganda (33%). Non-QAACT accounted for 20% of the market share in the private sector in Kenya, followed by Benin and Uganda (19%), Nigeria (12%) and Zambia (8%); this figure was 27% in Katanga and 40% in Kinshasa. Public sector non-QAACT availability and distribution was much lower, with the exception of Zambia (availability, 85%; market share, 32%). Diverse generics and formulations were available, but non-QAACT were most commonly artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHA PPQ), in tablet formulation, imported, and distributed in urban areas at either pharmacies or drug stores. The number of unique manufacturers supplying non-QAACT to each country ranged from 9 in Uganda to 92 in Nigeria. Addressing the availability and distribution of non-QAACT will require effective private sector engagement and evidence-based strategies to address provider and consumer demand for these products. Given the variation in non-QAACT markets observed across the eight study countries, active efforts to limit registration, importation and distribution of non-QAACT must be tailored to the country context

Mycobacterium bovis infection at the interface between domestic and wild animals in Zambia.

PubMed

Hang'ombe, Mudenda B; Munyeme, Musso; Nakajima, Chie; Fukushima, Yukari; Suzuki, Haruka; Matandiko, Wigganson; Ishii, Akihiro; Mweene, Aaron S; Suzuki, Yasuhiko

2012-11-14

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. 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. These results provide strong evidence of M. bovis strains transfer between cattle and lechwe, with the latter having developed into a sylvatic reservoir host.

Mycobacterium bovis infection at the interface between domestic and wild animals in Zambia

PubMed Central

2012-01-01

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

Underperformance of African protected area networks and the case for new conservation models: insights from Zambia.

PubMed

Lindsey, Peter A; Nyirenda, Vincent R; Barnes, Jonathan I; Becker, Matthew S; McRobb, Rachel; Tambling, Craig J; Taylor, W Andrew; Watson, Frederick G; t'Sas-Rolfes, Michael

2014-01-01

Many African protected areas (PAs) are not functioning effectively. We reviewed the performance of Zambia's PA network and provide insights into how their effectiveness might be improved. Zambia's PAs are under-performing in ecological, economic and social terms. Reasons include: a) rapidly expanding human populations, poverty and open-access systems in Game Management Areas (GMAs) resulting in widespread bushmeat poaching and habitat encroachment; b) underfunding of the Zambia Wildlife Authority (ZAWA) resulting in inadequate law enforcement; c) reliance of ZAWA on extracting revenues from GMAs to cover operational costs which has prevented proper devolution of user-rights over wildlife to communities; d) on-going marginalization of communities from legal benefits from wildlife; e) under-development of the photo-tourism industry with the effect that earnings are limited to a fraction of the PA network; f) unfavourable terms and corruption which discourage good practice and adequate investment by hunting operators in GMAs; g) blurred responsibilities regarding anti-poaching in GMAs resulting in under-investment by all stakeholders. The combined effect of these challenges has been a major reduction in wildlife densities in most PAs and the loss of habitat in GMAs. Wildlife fares better in areas with investment from the private and/or NGO sector and where human settlement is absent. There is a need for: elevated government funding for ZAWA; greater international donor investment in protected area management; a shift in the role of ZAWA such that they focus primarily on national parks while facilitating the development of wildlife-based land uses by other stakeholders elsewhere; and new models for the functioning of GMAs based on joint-ventures between communities and the private and/or NGO sector. Such joint-ventures should provide defined communities with ownership of land, user-rights over wildlife and aim to attract long-term private/donor investment. These

Drug Side Effects and Retention on HIV Treatment: a Regression Discontinuity Study of Tenofovir Implementation in South Africa and Zambia.

PubMed

Brennan, Alana T; Bor, Jacob; Davies, Mary-Ann; Wandeler, Gilles; Prozesky, Hans; Fatti, Geoffrey; Wood, Robin; Stinson, Kathryn; Tanser, Frank; Bärnighausen, Till; Boulle, Andrew; Sikazwe, Izukanji; Zanolini, Arianna; Fox, Matthew P

2018-05-15

Tenofovir is less toxic than other nucleoside reverse transcriptase inhibitors used in antiretroviral therapy (ART) and may improve retention of HIV-infected patients on ART. We assessed the impact of national guideline changes in South Africa (2010) and Zambia (2007) recommending tenofovir in first-line ART. We applied regression discontinuity in a prospective cohort of 52,294 HIV-infected adults initiating first-line ART within ±12-months of each guideline change. We compared outcomes in patients presenting just before/after the guideline changes using local linear regression and estimated intention-to-treat effects on initiation of tenofovir, retention in care, and other treatment outcomes at 24-months. We assessed complier causal effects among patients starting tenofovir. The new guidelines increased the percentage of patients initiating tenofovir in South Africa (risk difference (RD): 81%; 95% confidence interval (CI): 73, 89) and Zambia (RD: 42%; 95% CI: 38, 45). With the guideline change, single-drug substitutions decreased substantially in South Africa (RD: -15%; 95% CI:-18, -12). Starting tenofovir also reduced attrition in Zambia (intent-to-treat RD: -1.8%; 95% CI: -3.5, -0.1, complier relative risk = 0.74) but not in South Africa (RD: -0.9%; 95% CI: -5.9, 4.1, Complier Relative Risk = 0.94). These results highlight the importance of reducing side effects for increasing retention in care, as well as the differences in population impact of policies with heterogeneous treatment effects implemented in different contexts.

Catholic Education in Zambia: Mission Integrity and Politics

ERIC Educational Resources Information Center

Carmody, Brendan

2016-01-01

This article provides the history of Catholic state-aided schooling in Zambia for over a century. It notes how the Catholic Church came to view its school to be a pivotal means of church development. By cooperation with the state it entered more fully into the nation's future by offering high-quality state-sponsored schooling. This proved to…

Gender, British Administration and Mission Management of Education in Zambia 1900-1939

ERIC Educational Resources Information Center

Allen, Julia

2010-01-01

This article discusses the impact of including gender in the analytical framework in a study of the management and provision of education in Zambia from 1900 to 1939. It shows that a focus on gender allows females to enter the historical narrative and the leadership of women such as Mabel Shaw, Hannah Frances Davidson and Julia Smith can be given…

New Agricultural Settlement, Meheba River, Zambia, Africa

NASA Technical Reports Server (NTRS)

1990-01-01

This infra-red view of a new settlement along the Meheba River, Zambia, Africa (12.5S, 26.0E) resembles the resettlement clusters in the Amazon basin of Brazil. However, this settlement is on savanna land not a tropical forest region, so relatively little land clearing was required. The familiar pattern of small single family plots, no large commercial fields, along the branches of a herringbone road network is evident.

Retention in care, resource utilization, and costs for adults receiving antiretroviral therapy in Zambia: a retrospective cohort study

PubMed Central

2014-01-01

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/μL. 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

Callings, Work Role Fit, Psychological Meaningfulness and Work Engagement among Teachers in Zambia

ERIC Educational Resources Information Center

Rothmann, Sebastiaan; Hamukang'andu, Lukondo

2013-01-01

Our aim in this study was to investigate the relationships among a calling orientation, work role fit, psychological meaningfulness and work engagement of teachers in Zambia. A quantitative approach was followed and a cross-sectional survey was used. The sample (n = 150) included 75 basic and 75 secondary school teachers in the Choma district of…

Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study.

PubMed

Ndongmo, Therese Ntigwa; Ndongmo, Clement Bertin; Michelo, Charles

2017-01-01

As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.

Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study

PubMed Central

Ndongmo, Therese Ntigwa; Ndongmo, Clement Bertin; Michelo, Charles

2017-01-01

Introduction As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. Methods This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. Results A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). Conclusion The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV. PMID:28451048

Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia.

PubMed

Lencucha, Raphael; Reddy, Srikanth K; Labonte, Ronald; Drope, Jeffrey; Magati, Peter; Goma, Fastone; Zulu, Richard; Makoka, Donald

2018-04-01

Tobacco control norms have gained momentum over the past decade. To date 43 of 47 Sub-Saharan African countries are party to the Framework Convention on Tobacco Control (FCTC). The near universal adoption of the FCTC illustrates the increasing strength of these norms, although the level of commitment to implement the provisions varies widely. However, tobacco control is enmeshed in a web of international norms that has bearing on how governments implement and strengthen tobacco control measures. Given that economic arguments in favor of tobacco production remain a prominent barrier to tobacco control efforts, there is a continued need to examine how economic sectors frame and mobilize their policy commitments to tobacco production. This study explores the proposition that divergence of international norms fosters policy divergence within governments. This study was conducted in three African countries: Kenya, Malawi, and Zambia. These countries represent a continuum of tobacco control policy, whereby Kenya is one of the most advanced countries in Africa in this respect, whereas Malawi is one of the few countries that is not a party to the FCTC and has implemented few measures. We conducted 55 key informant interviews (Zambia = 23; Kenya = 17; Malawi = 15). Data analysis involved deductive coding of interview transcripts and notes to identify reference to international norms (i.e. commitments, agreements, institutions), coupled with an inductive analysis that sought to interpret the meaning participants ascribe to these norms. Our analysis suggests that commitments to tobacco control have yet to penetrate non-health sectors, who perceive tobacco control as largely in conflict with international economic norms. The reasons for this perceived conflict seems to include: (1) an entrenched and narrow conceptualization of economic development norms, (2) the power of economic interests to shape policy discourses, and (3) a structural divide between sectors in

Impact of inaccessible spaces on community participation of people with mobility limitations in Zambia

PubMed Central

Nitz, Jennifer C.; de Jonge, Desleigh

2014-01-01

Background The study investigated the perspective of people with mobility limitations (PWML) in Zambia, firstly of their accessibility to public buildings and spaces, and secondly of how their capacity to participate in a preferred lifestyle has been affected. Objectives Firstly to provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia. Secondly to establish how the Zambian disability context shape the experiences of participation by PWML. Method A qualitative design was used to gather data from 75 PWML in five of the nine provinces of Zambia. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family’s participation experiences. The nominal group technique was utilised to rank inaccessible buildings and facilities which posed barriers to opportunities in life areas and how this interfered with the whole family’s lifestyle. Results Inaccessibility of education institutions, workplaces and spaces have contributed to reduced participation with negative implications for personal, family, social and economic aspects of the lives of participants. Government buildings, service buildings, and transportation were universally identified as most important but least accessible. Conclusion Zambians with mobility limitations have been disadvantaged in accessing services and facilities provided to the public, depriving them and their dependants of full and equitable life participation because of reduced economic capacity. This study will assist in informing government of the need to improve environmental access to enable equal rights for all citizens. PMID:28729994

A rapid assessment of avoidable blindness in Southern Zambia.

PubMed

Lindfield, Robert; Griffiths, Ulla; Bozzani, Fiammetta; Mumba, Musonda; Munsanje, Joseph

2012-01-01

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. 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. 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%). 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.

CIDA funds AIDS counselling and care centre in Zambia.

PubMed

Meehan, S T

1993-12-01

In its fight against the spread of AIDS, which is inextricably linked to the issues of international development, the Canadian International Development Agency (CIDA) has focused support on strengthening existing health care systems, helping vulnerable groups gain control over their lives and health, promoting AIDS prevention measures, and building links to other related health services. Funding includes 1) a grant to Hope House in Zambia (counseling and support for persons with AIDS); 2) a contribution to the Canadian Public Health Association's $11 million Southern Africa AIDS Training Programme (helps regional organizations working in AIDS prevention and support through education, training, hospital outreach, peer education for vulnerable groups, assistance to women's shelters, and networking); 3) support for Laval University's Laval Centre for International Cooperation in Health and Development (runs a $22 million program in French-speaking West Africa that operates in over 10 countries and focuses on epidemiological surveillance, information, education, and communication, control of sexually transmitted diseases [STDs], and management of national AIDS programs); 4) support for the University of Manitoba's $3 million program with the University of Nairobi to slow the spread of HIV (strengthens local health care capabilities for STD/HIV diagnosis, treatment, and counseling, with special emphasis on training and education); 5) support in the past for a study of proposed AIDS legislation and its potential impact on the human rights of PLWHIV/AIDS in Thailand; 6) a contribution to help equip the office of the National Movement for Street Children, Rio de Janeiro (focuses on preventing the spread of AIDS among child prostitutes); and 7) long-term financial support to the Interagency Coalition on AIDS and Development, a coalition of Canadian development nongovernmental organizations responding to AIDS in developing countries. An address to obtain a pamphlet giving

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

PubMed Central

Parham, Groesbeck P.; Sahasrabuddhe, Vikrant V.; Mwanahamuntu, Mulindi H.; Shepherd, Bryan E.; Hicks, Michael L.; Stringer, Elizabeth M.; Vermund, Sten H.

2009-01-01

Objectives HIV-infected women living in resource-constrained nations like Zambia are now accessing antiretroviral therapy and thus may live long enough for HPV-induced cervical cancer to manifest and progress. We evaluated the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Zambia. Methods We screened 150 consecutive, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. We collected cervical specimens for cytological analysis by liquid-based monolayer cytology (ThinPrep Pap Test®) and HPV typing using the Roche Linear Array® PCR assay. Results The median age of study participants was 36 years (range 23-49 years) and their median CD4+ count was 165/μL (range 7-942). The prevalence of SIL on cytology was 76% (114/150), of which 23.3% (35/150) women had low-grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On univariate analyses, age of the participant, CD4+ cell count, and presence of any high-risk HPV type were significantly associated with the presence of severely abnormal cytological lesions (i.e., high-grade SIL and lesions suspicious for SCC). Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (adjusted OR: 12.4, 95% CI 2.62-58.1, p=0.02). Conclusions The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. Screening of HIV-infected women in resource-constrained settings like Zambia should be implemented to prevent development of HPV-induced SCC. PMID:16875716

Taenia solium from a community perspective: Preliminary costing data in the Katete and Sinda districts in Eastern Zambia.

PubMed

Hobbs, Emma C; Mwape, Kabemba E; Devleesschauwer, Brecht; Gabriël, Sarah; Chembensofu, Mwelwa; Mambwe, Moses; Phiri, Isaac K; Masuku, Maxwell; Zulu, Gideon; Colston, Angela; Willingham, Arve Lee; Berkvens, Dirk; Dorny, Pierre; Bottieau, Emmanuel; Speybroeck, Niko

2018-02-15

The tapeworm Taenia solium is endemic in Zambia, however its socioeconomic cost is unknown. During a large-scale interventional study conducted in Zambia, baseline economic costs of human and porcine T. solium infections were measured. Questionnaire surveys were conducted within three neighbourhoods in Zambia's Eastern province in 2015 and 2016. A human health questionnaire, capturing costs of clinical symptoms commonly attributable to human cysticercosis and taeniasis, was conducted in randomly selected households (n = 267). All pig-keeping households were administered a pig socioeconomic questionnaire (n = 271) that captured pig demographic data, costs of pig-keeping, and economic losses from porcine cysticercosis. Of all respondents 62% had reportedly experienced at least one of the surveyed symptoms. Seizure-like episodes were reported by 12%, severe chronic headaches by 36%, and vision problems by 23% of respondents. These complaints resulted in 147 health care consultations and 17 hospitalizations in the five years preceding the study, and an estimated productivity loss of 608 working days per year. Of all pigs 69% were bought within villages. Nearly all adult pigs were sold to local traders, and tongue palpation for detection of cysticerci was commonly performed. Reportedly, 95% of pig owners could not sell tongue-positive pigs, while infected pigs fetched only 45% of the normal sale value. These preliminary costing data indicate that human and porcine T. solium infections substantially impact endemic areas of Eastern Zambia. A full socioeconomic burden assessment may enable improved T. solium management in sub-Saharan Africa. Copyright © 2018 Ross University School of Veterinary Medicine. Published by Elsevier B.V. All rights reserved.

A Rural Implementation of a 52 Node Mixed Wireless Mesh Network in Macha, Zambia

NASA Astrophysics Data System (ADS)

Backens, Jonathan; Mweemba, Gregory; van Stam, Gertjan

In spite of increasing international and academic attention, there remains many challenges facing real world implementations of developing technologies. There has been considerable hype behind Wireless Mesh Networking as the ubiquitous solution for rural ICT in the developing world. In this paper, we present the real world rural mesh network implementation in the village of Macha, Zambia and draw both performance conclusions as well as overall experiential conclusions. The purpose of this paper is to introduce and analyze our low cost solution and extrapolate future trends for rural ICT implementations in Zambia.

Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.

PubMed

Fiedler, John L; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I; Jallier, Vincent; Guyondet, Christophe

2013-12-01

Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates ofmicronutrient deficiencies. Objective. To provide evidence-based fortification options with the hope of reinvigorating the Zambian fortification program. Methods. Zambia's 2006 Living Conditions Monitoring Survey is used to estimate the apparent intakes of vitamin A, iron, and zinc, as well as the apparent consumption levels and coverage of four fortification vehicles. Fourteen alternativefoodfortification portfolios are modeled, and their costs, impacts, average cost-effectiveness, and incremental cost-effectiveness are calculated using three alternative impact measures. Results. Alternative impact measures result in different rank orderings of the portfolios. The most cost-effective portfolio is vegetable oil, which has a cost per disability-adjusted life-year (DALY) saved ranging from 12% to 25% of that of sugar, depending on the impact measure used. The public health impact of fortified vegetable oil, however, is relatively modest. Additional criteria beyond cost-effectiveness are introduced and used to rank order the portfolios. The size of the public health impact, the total cost, and the incremental cost-effectiveness of phasing in multiple vehicle portfolios over time are analyzed. Conclusions. Assessing fortification portfolios by measuring changes in the prevalence of inadequate intakes underestimates impact. A more sensitive measure, which also takes into account change in the Estimated Average Requirement (EAR) gap, is provided by a dose-response-based approach to estimating the number ofDALYs saved. There exist highly cost-effective fortification intervention portfolios with substantial public health impacts and variable price tags that could help improve Zambians' nutrition status.

Cost Sharing in Zambia's Public Universities: Prospects and Challenges

ERIC Educational Resources Information Center

Masaiti, Gift; Shen, Hong

2013-01-01

This research paper explores the concept of "cost sharing" which became more prominent in Zambia education with the advent of democratic form of governance in 1991. As a way of responding to the ever diminishing tax revenues, government through the education policy of 1996, allowed higher education institutions including public…

Enhancing global health and education in Malawi, Zambia, and the United States through an interprofessional global health exchange program.

PubMed

Wilson, Lynda Law; Somerall, D'Ann; Theus, Lisa; Rankin, Sally; Ngoma, Catherine; Chimwaza, Angela

2014-05-01

This article describes participant outcomes of an interprofessional collaboration between health professionals and faculty in Malawi, Zambia, and the United States (US). One strategy critical for improving global health and addressing Millennium Development goals is promotion of interprofessional education and collaboration. Program participants included 25 health professionals from Malawi and Zambia, and 19 faculty/health professionals from Alabama and California. African Fellows participated in a 2 week workshop on Interprofessional Education in Alabama followed by 2 weeks working on individual goals with faculty collaborators/mentors. The US Fellows also spent 2 weeks visiting their counterparts in Malawi and Zambia to develop plans for sustainable partnerships. Program evaluations demonstrated participants' satisfaction with the program and indicated that the program promoted interprofessional and cross-cultural understanding; fostered development of long-term sustainable partnerships between health professionals and educators in Zambia and the US; and created increased awareness and use of resources for global health education. © 2014.

Lithostratigraphical correlation of the Neoproterozoic Roan Supergroup from Shaba (Zaire) and Zambia, in the central African copper-cobalt metallogenic province

NASA Astrophysics Data System (ADS)

Cailteux, J.; Binda, P. L.; Katekesha, W. M.; Kampunzu, A. B.; Intiomale, M. M.; Kapenda, D.; Kaunda, C.; Ngongo, K.; Tshiauka, T.; Wendorff, M.

1994-11-01

New data on the lower Katangan sequences in Shaba (Zaire) and Zambia, collected during the 1989 and 1990 UNESCO-sponsored Geotraverses, reveal an important development on friction breccias throughout the Zambian Copperbelt, which still remains poorly documented, and shows that the Zairean and Zambian facies of the Roan Supergroup can be correlated in detail. As in Zaire, the deformation of Katangan terranes during the Lufilian orogeny produced important friction breccias in Zambia. Such breccias occur mostly between the upper part of the Lower Roan Supergroup and the Mwashya Group (R-4): above the shale with grit (RL3) at Konkola and Mindola, or within the Upper Roan Dolomite at Chambishi South, Muliashi and Nchanga. At Mufulira, a typical fragment of Shaba Mines Group was observed within a major heterogeneous tectonic breccia. This situation is similar to that reported at Kipapila (Kimpe) and Lubembe in Zaire, both located on the same tectonic trend as Mufulira. However, a continuous stratigraphical succession can be observed in Zambia from the basal unconformity to the Mwashya Group. Strong lithological similarities were found, formation by formation, between the Roan sequences of Zambia and Zaire. In particular, the complete Mines Group of Zaire (R-2) and the units from the RL6 to the RL4 in Zambia were deposited under comparable conditions of sedimentation and show a similar and correlatable evolution of lithologies. Furthermore, the overlying Dipeta Group (R-3) of Zaire and the RL3, RU2/RU1 of Zambia, are equally comparable. Above the Upper Roan Dolomite, Lower Mwashya dolomitic rocks, identical with the ones of Shaba, have been noted to occur in Zambia in stratigraphical continuity with the typical black shales of the Upper Mwashya. The correlation between the coarse clastics of the Zambian footwall (RL7) and the red dolomitic argillites and sandstones of the Zairean R.A.T. (Roches Argillo Talqueuses: R-1) remains uncertain. However these two sequences show

Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in Zambia.

PubMed

Tuba, Mary; Sandoy, Ingvild F; Bloch, Paul; Byskov, Jens

2010-11-01

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. 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. 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. Poor status of the AFR

Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in zambia

PubMed Central

2010-01-01

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

Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia.

PubMed

Do, Mai; Hotchkiss, David

2013-01-04

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. 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. 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. 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.

Associations Between Orphan and Vulnerable Child Caregiving, Household Wealth Disparities, and Women's Overweight Status in Three Southern African Countries Participating in Demographic Health Surveys.

PubMed

Kanamori, Mariano J; Carter-Pokras, Olivia D; Madhavan, Sangeetha; Lee, Sunmin; He, Xin; Feldman, Robert H

2015-08-01

This study examines whether orphan and vulnerable children (OVC) primary caregivers are facing absolute household wealth (AWI) disparities, the association between AWI and women's overweight status, and the modifying role of OVC primary caregiving status on this relationship. Demographic Health Surveys data (2006-2007) from 20 to 49 year old women in Namibia (n = 6,305), Swaziland (n = 2,786), and Zambia (n = 4,389) were analyzed using weighted marginal means and logistic regressions. OVC primary caregivers in Namibia and Swaziland had a lower mean AWI than other women in the same country. In Zambia, OVC primary caregivers had a lower mean AWI score than non-primary caregivers living with an OVC but a higher mean AWI score than non-OVC primary caregivers. In Swaziland and Zambia, even small increases in household wealth were associated with higher odds for being overweight regardless of women's caregiving status. Only in Namibia, OVC primary caregiving modified the effect of the previous association. Among Namibian OVC primary caregivers, women who had at least medium household wealth (4 or more AWI items) were more likely to be overweight than their poorest counterparts (0 or 1 AWI items). OVC primary caregivers are facing household wealth disparities as compared to other women from their communities. Future studies/interventions should consider using population-based approaches to reach women from every household wealth level to curb overweight in Swaziland and Zambia and to focus on specific household wealth characteristics that are associated with OVC primary caregivers' overweight status in Namibia.

Mantle Structure Beneath East Africa and Zambia from Body Wave Tomography

NASA Astrophysics Data System (ADS)

Mulibo, G.; Nyblade, A.; Tugume, F.

2011-12-01

In this study, P and S travel time residuals from teleseismic earthquakes recorded on over 60 temporary AfricaArray seismic stations deployed in Uganda, Kenya, Tanzania and Zambia between 2007 and 2011 are being inverted, together with travel time residuals from previous deployments, for a 3D image of mantle wave speeds variations extending to a depth of 1200 km. Preliminary results show that at depths of 200 km of less, low wave speed anomalies are well developed beneath the Eastern and Western Branches of the East African Rift System. At deep depths, the low wave speed anomalies focus under the center and southern part of the East African Plateau and extend into the transition zone. At transition zone depths and within the top part of the lower mantle, the low wave speed anomaly shifts to the southwest beneath Zambia, indicating that the low wave speed anomaly is continuous across the transition zone and that it extends into the lower mantle. This result suggests that the upper mantle low wave speed anomaly beneath East Africa is connected to the African superplume anomaly in the lower mantle beneath southern Africa.

User and researcher collaborations in mental health in low and middle income countries: a case study of the EMPOWER project

PubMed Central

2014-01-01

Background Increasing recognition has been given to the interaction of users and researchers in shaping the perspective and practice of mental health care. However, there remains very little evidence exploring how this interaction works, particularly in low and middle income countries. The aim of this study was to explore experiences of how users and researchers worked together to communicate research, using a case study of the EMPOWER project. Methods The study followed a case-study approach. EMPOWER was a project that sought to strengthen the capacity of user organizations in India, Kenya, Nepal and Zambia by encouraging user-researcher collaborations to communicate research findings in the four countries. A qualitative research method was applied for this study, with semi-structured interviews conducted with seven people: two researchers, one communications developer, and four user group members (one from each of the four countries). Data were analyzed using thematic analysis. Results The findings indicated positive perceptions of the collaboration between researchers and users. Key themes were partnership and support, the value of the personal experience of users and their knowledge of the target audiences, and empowerment. Key challenges related to differences in levels of education and technical knowledge and the lack of payments to users. Conclusions This exploratory study provides insight to help understand collaborative processes for communicating mental health research. It highlights many positive outcomes from the EMPOWER collaboration but also highlights the need for more in-depth research on this issue. PMID:24423150

User and researcher collaborations in mental health in low and middle income countries: a case study of the EMPOWER project.

PubMed

Gupta, Esha; Roberts, Bayard

2014-01-14

Increasing recognition has been given to the interaction of users and researchers in shaping the perspective and practice of mental health care. However, there remains very little evidence exploring how this interaction works, particularly in low and middle income countries. The aim of this study was to explore experiences of how users and researchers worked together to communicate research, using a case study of the EMPOWER project. The study followed a case-study approach. EMPOWER was a project that sought to strengthen the capacity of user organizations in India, Kenya, Nepal and Zambia by encouraging user-researcher collaborations to communicate research findings in the four countries. A qualitative research method was applied for this study, with semi-structured interviews conducted with seven people: two researchers, one communications developer, and four user group members (one from each of the four countries). Data were analyzed using thematic analysis. The findings indicated positive perceptions of the collaboration between researchers and users. Key themes were partnership and support, the value of the personal experience of users and their knowledge of the target audiences, and empowerment. Key challenges related to differences in levels of education and technical knowledge and the lack of payments to users. This exploratory study provides insight to help understand collaborative processes for communicating mental health research. It highlights many positive outcomes from the EMPOWER collaboration but also highlights the need for more in-depth research on this issue.

Conceptualising Education Quality in Zambia: A Comparative Analysis across the Local, National and Global Discourses

ERIC Educational Resources Information Center

Lee, Jeongmin; Zuilkowski, Stephanie Simmons

2017-01-01

Building on the Education for All movement, the 2030 Agenda for Sustainable Development re-emphasises quality education as a discrete goal. Contextualising the discussion surrounding this goal in Zambia, this study examines how education quality is conceptualised by educational stakeholders at local, national, and global levels. Triangulating…

The Socio-economic Impact of Stroke on Households in Livingstone District, Zambia: A Cross-sectional Study.

PubMed

Mapulanga, M; Nzala, S; Mweemba, C

2014-07-01

Stroke is the leading cause of adult disability. Stroke, which affects mostly the productive age group, leaves about 65% of its victims disabled, leads to increased loss of manpower both at individual and national levels. Little is known about the socio-economic burden of the disease in terms of its impacts on the individual, family and community both directly and indirectly in Sub-Sahara Africa region and Zambia at large. The study was aimed at assessing the socio-economic impact of stroke households in Livingstone district, Zambia. A total of 50 households were randomly selected from the registers of Livingstone General Hospital. Self-administered questionnaires and focus group discussions were used to collect quantitative and qualitative data respectively. The data was analyzed using Statistical Package for Social Sciences version 16 (IBM Corporation) and content analysis. Chi-square test was used to make associations between variables. The social impacts on the victim were depression, difficult to get along with, resentfulness, apathy, needy, separation, divorce, general marital problems, neglect on the part of the victim and fear. The economic impacts were loss of employment, reduced business activity and loss of business on the part of the victim. Economic activities such as food provision, payment of school fees, accommodation were affected as a result of stroke and this led to financial insecurities in households with lost incomes in form of salaries and businesses. The activities forgone by stroke households were food provision, housing and education. The study also revealed an association between period of stroke and relationship changes (P < 0.001). Gender and family relationship changes were highly associated (P < 0.00), as more females than males experienced relationship changes. The results of the present study show that stroke has considerable socio-economic impact on households in Livingstone district, which can deter the victims' development as

Feasibility of using a World Health Organization-standard methodology for Sample Vital Registration with Verbal Autopsy (SAVVY) to report leading causes of death in Zambia: results of a pilot in four provinces, 2010.

PubMed

Mudenda, Sheila S; Kamocha, Stanley; Mswia, Robert; Conkling, Martha; Sikanyiti, Palver; Potter, Dara; Mayaka, William C; Marx, Melissa A

2011-08-05

Verbal autopsy (VA) can be used to describe leading causes of death in countries like Zambia where vital events registration does not produce usable data. The objectives of this study were to assess the feasibility of using verbal autopsy to determine age-, sex-, and cause-specific mortality in a community-based setting in Zambia and to estimate overall age-, sex-, and cause-specific mortality in the four provinces sampled. A dedicated census was conducted in regions of four provinces chosen by cluster-sampling methods in January 2010. Deaths in the 12-month period prior to the census were identified during the census. Subsequently, trained field staff conducted verbal autopsy interviews with caregivers or close relatives of the deceased using structured and unstructured questionnaires. Additional deaths were identified and respondents were interviewed during 12 months of fieldwork. After the interviews, two physicians independently reviewed each VA questionnaire to determine a probable cause of death. Among the four provinces (1,056 total deaths) assessed, all-cause mortality rate was 17.2 per 1,000 person-years (95% confidence interval [CI]: 12.4, 22). The seven leading causes of death were HIV/AIDS (287, 27%), malaria (111, 10%), injuries and accidents (81, 8%), diseases of the circulatory system (75, 7%), malnutrition (58, 6%), pneumonia (56, 5%), and tuberculosis (50, 5%). Those who died were more likely to be male, have less than or equal to a primary education, and be unmarried, widowed, or divorced compared to the baseline population. Nearly half (49%) of all reported deaths occurred at home. The 17.2 per 1,000 all-cause mortality rate is somewhat similar to modeled country estimates. The leading causes of death -- HIV/AIDS, malaria, injuries, circulatory diseases, and malnutrition -- reflected causes similar to those reported for the African region and by other countries in the region. Results can enable the targeting of interventions by region, disease

Confronting Crisis. A Comparative Study of Household Responses to Poverty and Vulnerability in Four Poor Urban Communities. Environmentally Sustainable Development Studies and Monographs Series No. 8.

ERIC Educational Resources Information Center

Moser, Caroline O. N.

This volume presents the main findings of a comparative study of four poor urban communities in countries experiencing economic difficulties during the late 1980s: Chawama (Zambia), Cisne Dos (Ecuador), Commonwealth (the Philippines), and Angyalfold (Hungary). The study extended a longitudinal community panel study begun in Ecuador by using a…

Moving malaria in pregnancy programs from neglect to priority: experience from Malawi, Senegal, and Zambia.

PubMed

Roman, Elaine; Wallon, Michelle; Brieger, William; Dickerson, Aimee; Rawlins, Barbara; Agarwal, Koki

2014-02-01

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. 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. 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. MIP programs should address all 8 interconnected MIP health systems areas holistically, in the context of a health systems approach to

Opt-out provider-initiated HIV testing and counselling in primary care outpatient clinics in Zambia

PubMed Central

Chipukuma, Julien M; Chiko, Matimba M; Wamulume, Chibesa S; Bolton-Moore, Carolyn; Reid, Stewart E

2011-01-01

Abstract Objective To increase case-finding of infection with human immunodeficiency virus (HIV) in Zambia and their referral to HIV care and treatment by supplementing existing client-initiated voluntary counselling and testing (VCT), the dominant mode of HIV testing in the country. Methods Lay counsellors offered provider-initiated HIV testing and counselling (PITC) to all outpatients who attended primary clinics and did not know their HIV serostatus. Data on counselling and testing were collected in registers. Outcomes of interest included HIV testing coverage, the acceptability of testing, the proportion testing HIV-positive (HIV+), the proportion enrolling in HIV care and treatment and the time between testing and enrolment. Findings After the addition of PITC to VCT, the number tested for HIV infection in the nine clinics was twice the number undergoing VCT alone. Over 30 months, 44 420 patients were counselled under PITC and 31 197 patients, 44% of them men, accepted testing. Of those tested, 21% (6572) were HIV+; 38% of these HIV+ patients (2515) enrolled in HIV care and treatment. The median time between testing and enrolment was 6 days. The acceptability of testing rose over time. Conclusion The introduction of routine PITC using lay counsellors into health-care clinics in Lusaka, Zambia, dramatically increased the uptake and acceptability of HIV testing. Moreover, PITC was incorporated rapidly into primary care outpatient departments. Maximizing the number of patients who proceed to HIV care and treatment remains a challenge and warrants further research. PMID:21556300

Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

PubMed Central

Masiye, Felix; Kaonga, Oliver

2016-01-01

Background: Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i) to examine the factors associated with healthcare choices among sick people, and (ii) to assess the determinants of the magnitude of out-of-pocket (OOP) payments related to a visit to a health provider. Methods: This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results: Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000). Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000) and (OR = 1.55, P = .01), for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002). The magnitude of OOP expenditure during a visit is significantly dependent on household economic well-being, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion: Despite the removal of user fees on public primary healthcare in Zambia, access to

Why pigs are free-roaming: Communities' perceptions, knowledge and practices regarding pig management and taeniosis/cysticercosis in a Taenia solium endemic rural area in Eastern Zambia.

PubMed

Thys, Séverine; Mwape, Kabemba E; Lefèvre, Pierre; Dorny, Pierre; Phiri, Andrew M; Marcotty, Tanguy; Phiri, Isaac K; Gabriël, Sarah

2016-07-30

Taenia solium cysticercosis is a neglected parasitic zoonosis in many developing countries including Zambia. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. Socio-cultural determinants related to free range pig management and their implications for control of T. solium remain unclear. The study objective was to assess the communities' perceptions, reported practices and knowledge regarding management of pigs and taeniosis/cysticercosis (including neurocysticercosis) in an endemic rural area in Eastern Zambia, and to identify possible barriers to pig related control measures such as pig confinement. A total of 21 focus group discussions on pig husbandry practices were organized separately with men, women and children, in seven villages from Petauke district. The findings reveal that the perception of pigs and their role in society (financial, agricultural and traditional), the distribution of the management tasks among the family members owning pigs (feeding, building kraal, seeking care) and environmental aspects (feed supply, presence of bush, wood use priorities, rainy season) prevailing in the study area affect pig confinement. People have a fragmented knowledge of the pork tapeworm and its transmission. Even if negative aspects/health risks of free-range pigs keeping are perceived, people are ready to take the risk for socio-economic reasons. Finally, gender plays an important role because women, and also children, seem to have a higher perception of the risks but lack power in terms of economic decision-making compared to men. Currently pig confinement is not seen as an acceptable method to control porcine cysticercosis by many farmers in Eastern Zambia, vaccination and treatment seemed to be more appropriate. Embedded in a One Health approach, disease control programs should therefore ensure a complementary appropriate set of control

Adherence to Point-of-Use Water Treatment over Short-Term Implementation: Parallel Crossover Trials of Flocculation-Disinfection Sachets in Pakistan and Zambia.

PubMed

Shaheed, A; Rathore, S; Bastable, A; Bruce, J; Cairncross, S; Brown, J

2018-06-05

The health benefits of point-of-use (POU) water treatment can only be realized through high adherence: correct, consistent, and sustained use. We conducted parallel randomized, longitudinal crossover trials measuring short-term adherence to two single-use flocculant-disinfectant sachets in Pakistan and Zambia. In both trials, adherence declined sharply for both products over the eight week surveillance periods, with overall lower adherence to both products in Zambia. There was no significant difference in adherence between the two products. Estimated median daily production of treated water dropped over the crossover period from 2.5 to 1.4 L person -1 day -1 (46% decline) in Pakistan and from 1.4 to 1.1 L person -1 day -1 (21% decline) in Zambia. The percentage of surveillance points with detectable total chlorine in household drinking water declined from 70% to 49% in Pakistan and rose marginally from 28% to 30% in Zambia. The relatively low and decreasing adherence observed in this study suggests that these products would have provided little protection from waterborne disease risk in these settings. Our findings underscore the challenge of achieving high adherence to POU water treatment, even under conditions of short-term adoption with intensive follow-up.

Water, sanitation, and hygiene in schools: Status and implications of low coverage in Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia.

PubMed

Morgan, Camille; Bowling, Michael; Bartram, Jamie; Lyn Kayser, Georgia

2017-08-01

Adequate access to water, sanitation, and hygiene (WaSH) in schools impacts health, educational outcomes, and gender disparities. Little multi-country research has been published on WaSH in rural schools in Sub-Saharan Africa. In this multi-national cross-sectional WaSH study, we document WaSH access, continuity, quality, quantity, and reliability in 2270 schools that were randomly sampled in rural regions of six Sub-Saharan African countries: Ethiopia, Kenya, Mozambique, Rwanda, Uganda, and Zambia. Data collection included: school WaSH surveys containing internationally established WaSH indicators, direct observation, and field- and laboratory-based microbiological water quality testing. We found 1% of rural schools in Ethiopia and Mozambique to 23% of rural schools in Rwanda had improved water sources on premises, improved sanitation, and water and soap for handwashing. Fewer than 23% of rural schools in the six countries studied met the World Health Organization's recommended student-to-latrine ratios for boys and for girls. Fewer than 20% were observed to have at least four of five recommended menstrual hygiene services (separate-sex latrines with doors and locks, water for use, waste bin). The low access to safe and adequate WaSH services in rural schools suggest opportunities for WaSH interventions that could have substantive impact on health, education, and gender disparities. Copyright © 2017 Elsevier GmbH. All rights reserved.

Local Perceptions, Cultural Beliefs and Practices That Shape Umbilical Cord Care: A Qualitative Study in Southern Province, Zambia

PubMed Central

Herlihy, Julie M.; Shaikh, Affan; Mazimba, Arthur; Gagne, Natalie; Grogan, Caroline; Mpamba, Chipo; Sooli, Bernadine; Simamvwa, Grace; Mabeta, Catherine; Shankoti, Peggy; Messersmith, Lisa; Semrau, Katherine; Hamer, Davidson H.

2013-01-01

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

The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey.

PubMed

Masiye, Felix; Rehnberg, Clas

2005-12-15

Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP) was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of USD 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed.

The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey

PubMed Central

Masiye, Felix; Rehnberg, Clas

2005-01-01

Background Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control. Aims and objectives This paper specifically seeks to elicit a measure of the economic benefits of an improved malaria treatment programme in Zambia. The paper also studies the equity implications in malaria treatment given that demand or malaria treatment is determined by household socio-economic status. Methods A contingent valuation survey of about 300 Zambian households was conducted in four districts. Willingness-to-pay (WTP) was elicited for an improved treatment programme for malaria in order to generate a measure of the economic benefits of the programme. The payment card method was used in eliciting WTP bids. Findings The study reports that malaria treatment has significant economic benefits to society. The total economic benefits of an improved treatment programme were estimated at an equivalent of US$ 77 million per annum, representing about 1.8% of Zambia's GDP. The study also reports the theoretically anticipated association between WTP and several socio-economic factors. Our income elasticity of demand is positive and similar in magnitude to estimates reported in similar studies. Finally, from an equity standpoint, the constraints imposed by income and socio-economic status are discussed. PMID:16356176

Women's knowledge and attitudes surrounding abortion in Zambia: a cross-sectional survey across three provinces

PubMed Central

Cresswell, Jenny A; Schroeder, Rosalyn; Dennis, Mardieh; Owolabi, Onikepe; Vwalika, Bellington; Musheke, Maurice; Campbell, Oona; Filippi, Veronique

2016-01-01

Objectives In Zambia, despite a relatively liberal legal framework, there remains a substantial burden of unsafe abortion. Many women do not use skilled providers in a well-equipped setting, even where these are available. The aim of this study was to describe women's knowledge of the law relating to abortion and attitudes towards abortion in Zambia. Setting Community-based survey in Central, Copperbelt and Lusaka provinces. Participants 1484 women of reproductive age (15–44 years). Primary and secondary outcome measures Correct knowledge of the legal grounds for abortion, attitudes towards abortion services and the previous abortions of friends, family or other confidants. Descriptive statistics and multivariable logistic regression were used to analyse how knowledge and attitudes varied according to sociodemographic characteristics. Results Overall, just 16% (95% CI 11% to 21%) of women of reproductive age correctly identified the grounds for which abortion is legal. Only 40% (95% CI 32% to 45% of women of reproductive age knew that abortion was legally permitted in the extreme situation where the pregnancy threatens the life of the mother. Even in urban areas of Lusaka province, only 55% (95% CI 41% to 67%) of women knew that an abortion could legally take place to save the mother's life. Attitudes remain conservative. Women with correct knowledge of abortion law in Zambia tended to have more liberal attitudes towards abortion and access to safe abortion services. Neither correct knowledge of the law nor attitudes towards abortion were associated with knowing someone who previously had an induced abortion. Conclusions Poor knowledge and conservative attitudes are important obstacles to accessing safe abortion services. Changing knowledge and attitudes can be challenging for policymakers and public health practitioners alike. Zambia could draw on its previous experience in dealing with its large HIV epidemic to learn cross-cutting lessons in effective mass

Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia.

PubMed

Chopra, Mickey; Doherty, Tanya; Mehatru, Saba; Tomlinson, Mark

2009-12-01

The possibility of mother-to-child transmission (MTCT) of HIV through breast-feeding has focused attention on how best to support optimal feeding practices especially in low-resource and high-HIV settings, which characterizes most of sub-Saharan Africa. To identify strategic opportunities to minimize late postnatal HIV transmission, we undertook a review of selected country experiences on HIV and infant feeding, with the aims of documenting progress over the last few years and determining the main challenges and constraints. Field teams conducted national-level interviews with key informants and visited a total of thirty-six facilities in twenty-one sites across the three countries--eighteen facilities in Malawi, eleven in Kenya and seven in Zambia. During these visits interviews were undertaken with key informants such as the district and facility management teams, programme coordinators and health workers. A rapid assessment of HIV and infant feeding counselling in Kenya, Malawi and Zambia, undertaken from February to May 2007. Infant feeding counselling has, until now, been given low priority within programmes aimed at prevention of MTCT (PMTCT) of HIV. This is manifest in the lack of resources - human, financial and time--for infant feeding counselling, leading to widespread misunderstanding of the HIV transmission risks from breast-feeding. It has also resulted in lack of space and time for proper counselling, poor support and supervision, and very weak monitoring and evaluation of infant feeding. Finally, there are very few examples of linkages with community-based infant feeding interventions. However, all three countries have started to revise their feeding policies and strategies and there are signs of increased resources. In order to sustain this momentum it will be necessary to continue the advocacy with the HIV community and stress the importance of child survival--not just minimization of HIV transmission - and hence the need for integrating MTCT

Practices of traditional beef farmers in their production and marketing of cattle in Zambia.

PubMed

Mumba, Chisoni; Häsler, Barbara; Muma, John B; Munyeme, Musso; Sitali, Doreen Chilolo; Skjerve, Eystein; Rich, Karl M

2018-01-01

Understanding the practices of traditional cattle farmers in developing countries is an important factor in the development of appropriate, pro-poor disease control policies, and in formulating regional-specific production incentives that can improve productivity. This paper describes the production, husbandry practices, economics, and constraints of traditional cattle farming in Zambia. A cross-sectional study design was used to obtain data from traditional cattle farmers (n = 699) using a structured questionnaire. Data analyses were carried out using SPSS and STATA statistical packages. The results revealed that the majority [65% (95% CI: 59.3-71.1)] of farmers practised a transhumant cattle herding system under communal grazing. In these transhumant herding systems, animal husbandry and management systems were found to be of poor quality, in terms of supplementary feeding, vaccination coverage, deworming, uptake of veterinary services, usage of artificial insemination, and dip tanks all being low or absent. East Coast Fever was the most common disease, affecting 60% (95% CI: 56.4-63.7) of farmers. Cattle sales were low, as farmers only sold a median of two cattle per household per year. Crop farming was found to be the main source of farm income (47%) in agro-pastoralist communities, followed by cattle farming (28%) and other sources (25%). The median cost of production in the surveyed provinces was reported at US$316, while that of revenue from cattle and cattle products sales was estimated at US$885 per herd per year. This translates to an estimated gross margin of US$569, representing 64.3% of revenue.There is considerable diversity in disease distribution, animal husbandry practices, economics, and challenges in traditional cattle production in different locations of Zambia. Therefore, to improve the productivity of the traditional cattle sub-sector, policy makers and stakeholders in the beef value chain must develop fit-for-purpose policies and

“All for some”: water inequity in Zambia and Zimbabwe

NASA Astrophysics Data System (ADS)

Robinson, Peter B.

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

Elites, Incrementalism and Educational Policy-Making in Post-Independence Zambia.

ERIC Educational Resources Information Center

Lungu, Gatian F.

1985-01-01

Examines the role of elite groups in Zambia educational policymaking in the postindependence era, using three major attempts at educational reform as illustrations. Concludes that well-to-do groups have dominated educational policy decisions to preserve their own interests and have obtained gradual reforms in spite of offically declared radical…

Distance Education Examination Management in a Lowly Resourced North-Eastern Region of Zambia: a Phenomenological Approach

ERIC Educational Resources Information Center

Simui, Francis; Chibale, Henry; Namangala, Boniface

2017-01-01

This paper focuses on the management of distance education examination in a lowly resourced North-Eastern region of Zambia. The study applies Hermeneutic Phenomenology approach to generate and make sense of the data. It is the lived experiences of 2 invigilators and 66 students purposively selected that the study draws its insights from. Meaning…

Exploring Understandings of Inclusion in Schools in Zambia and Tanzania Using Reflective Writing and Photography

ERIC Educational Resources Information Center

Miles, Susie

2011-01-01

In this article I explore insights gained from participating in an exploratory, small-scale study led by the Enabling Education Network (EENET) in 17 schools in northern Zambia and five schools in Tanzania. Facilitating South-based research, while based in a Northern university, raises complex ethical issues about voice and control which are…

School effects on non-verbal intelligence and nutritional status in rural Zambia

PubMed Central

Hein, Sascha; Tan, Mei; Reich, Jodi; Thuma, Philip E.; Grigorenko, Elena L.

2015-01-01

This study uses hierarchical linear modeling (HLM) to examine the school factors (i.e., related to school organization and teacher and student body) associated with non-verbal intelligence (NI) and nutritional status (i.e., body mass index; BMI) of 4204 3rd to 7th graders in rural areas of Southern Province, Zambia. Results showed that 23.5% and 7.7% of the NI and BMI variance, respectively, were conditioned by differences between schools. The set of 14 school factors accounted for 58.8% and 75.9% of the between-school differences in NI and BMI, respectively. Grade-specific HLM yielded higher between-school variation of NI (41%) and BMI (14.6%) for students in grade 3 compared to grades 4 to 7. School factors showed a differential pattern of associations with NI and BMI across grades. The distance to a health post and teacher’s teaching experience were the strongest predictors of NI (particularly in grades 4, 6 and 7); the presence of a preschool was linked to lower BMI in grades 4 to 6. Implications for improving access and quality of education in rural Zambia are discussed. PMID:27175053

Using intersectionality to explore experiences of disability and HIV among women and men in Zambia.

PubMed

Yoshida, Karen; Hanass-Hancock, Jill; Nixon, Stephanie; Bond, Virginia

2014-01-01

Little is known about the experiences of people with disabilities (PWD) who live with HIV. Existing research largely assumes a "double burden" approach, which views HIV as doubling the load for people already burdened by disability. Intersectionality (a dynamic process of converging systems of relationships) offers an alternative approach for understanding differences in experience. This study uses an intersectional approach to explore the experiences of PWD in Zambia who have become HIV-positive. We conducted semi-structured, in depth interviews with 21 PWD who live with HIV in Zambia (12 women, 9 men). Participants had various impairments (visual, hearing, mobility, intellectual). Interviews were conducted to meet participants' accessibility preferences. Our intersectional analysis demonstrates the dynamic and situational emergent meanings and consequences for PWD who are living with HIV related to: (1) meanings of HIV and disability linked with time and trajectory; (2) oppression and negotiation related to accessing health services and (3) social roles and relationships. Three case studies illustrate these circumstances. Intersectionality offers a complementary approach for examining the complex interrelationship among HIV, disability, gender and time among PWD living with HIV. Findings illustrate directions for improved services and policies for this important group. Rehabilitation services need to take a cross-disability (multiple disabilities) approach working with people living with HIV and disability. Rehabilitation, as illustrated by a CBR approach, needs to include services that will facilitate not only health, but education, jobs and housing for people living with HIV and disability. Rehabilitation needs to make more direct connections with Zambia social service sector to help address the fluctuating experience of living with HIV and disability.

Developmental assessment, cultural context, gender, and schooling in Zambia.

PubMed

Serpell, Robert; Jere-Folotiya, Jacqueline

2008-04-01

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.

Evaluation of recruitment and retention strategies for health workers in rural Zambia.

PubMed

Goma, Fastone M; Tomblin Murphy, Gail; MacKenzie, Adrian; Libetwa, Miriam; Nzala, Selestine H; Mbwili-Muleya, Clara; Rigby, Janet; Gough, Amy

2014-01-01

In response to Zambia's critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia. Using a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers' self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district. Nineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers' job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and

Changing individual-level risk factors for malaria with declining transmission in southern Zambia: a cross-sectional study

PubMed Central

2011-01-01

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

Liver fibrosis in treatment-naïve HIV-infected and HIV/HBV co-infected patients: Zambia and Switzerland compared.

PubMed

Wandeler, Gilles; Mulenga, Lloyd; Vinikoor, Michael J; Kovari, Helen; Battegay, Manuel; Calmy, Alexandra; Cavassini, Matthias; Bernasconi, Enos; Schmid, Patrick; Bolton-Moore, Carolyn; Sinkala, Edford; Chi, Benjamin H; Egger, Matthias; Rauch, Andri

2016-10-01

To examine the association between hepatitis B virus (HBV) infection and liver fibrosis in HIV-infected patients in Zambia and Switzerland. HIV-infected adults starting antiretroviral therapy in two clinics in Zambia and Switzerland were included. Liver fibrosis was evaluated using the aspartate aminotransferase-to-platelet-ratio index (APRI), with a ratio >1.5 defining significant fibrosis and a ratio >2.0 indicating cirrhosis. The association between hepatitis B surface antigen (HBsAg) positivity, HBV replication, and liver fibrosis was examined using logistic regression. In Zambia, 96 (13.0%) of 739 patients were HBsAg-positive compared to 93 (4.5%) of 2058 in Switzerland. HBsAg-positive patients were more likely to have significant liver fibrosis than HBsAg-negative ones: the adjusted odds ratio (aOR) was 3.25 (95% confidence interval (CI) 1.44-7.33) in Zambia and 2.50 (95% CI 1.19-5.25) in Switzerland. Patients with a high HBV viral load (≥20000 IU/ml) were more likely to have significant liver fibrosis compared to HBsAg-negative patients or patients with an undetectable viral load: aOR 3.85 (95% CI 1.29-11.44) in Zambia and 4.20 (95% CI 1.64-10.76) in Switzerland. In both settings, male sex was a strong risk factor for significant liver fibrosis. Despite the differences in HBV natural history between Sub-Saharan Africa and Europe, the degree of liver fibrosis and the association with important risk factors were similar. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

7 CFR 319.56-43 - Baby corn and baby carrots from Zambia.

Code of Federal Regulations, 2010 CFR

2010-01-01

... § 319.56-43 Baby corn and baby carrots from Zambia. (a) Immature, dehusked “baby” sweet corn (Zea mays L... consignments only. (b) Immature “baby” carrots (Daucus carota L. ssp. sativus) for consumption measuring 10 to...

The Impact of an Unconditional Cash Transfer on Early Child Development: The Zambia Child Grant Program

ERIC Educational Resources Information Center

Seidenfeld, David; Prencipe, Leah; Handa, Sudhanshu; Hawkinson, Laura

2015-01-01

Little research has been conducted on unconditional cash transfers (UCTs) despite their growing prevalence in Africa, including South Africa, Zambia, Zimbabwe, Kenya, Malawi, Lesotho, and Uganda. In this study, researchers implemented a randomized control trial with over 2,500 households to investigate the impact of Africa's child grant program on…

HIV Testing among Adolescents in Ndola, Zambia: How Individual, Relational, and Environmental Factors Relate to Demand

ERIC Educational Resources Information Center

Denison, Julie A.; McCauley, Ann P.; Dunnett-Dagg, Wendy A.; Lungu, Nalakwanji; Sweat, Michael D.

2009-01-01

This study examined how individual, relational and environmental factors related to adolescent demand for HIV voluntary counseling and testing (VCT). A cross-sectional survey among randomly selected 16-19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed…

Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis

PubMed Central

Alam, Nazmul; Hajizadeh, Mohammad; Dumont, Alexandre; Fournier, Pierre

2015-01-01

To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in

Is the Bangweulu Basin in Zambia the Eroded Remnant of a Large, Multiring Impact Crater?

NASA Astrophysics Data System (ADS)

Master, S.

1993-07-01

The Bangweulu Basin (BB) (ca. 29 degrees-31 degrees E, 10 degrees-12 degrees S) is a roughly circular depression, ~150 km in diameter, on the Bangweulu Block of Zambia. The basin, about 1148 m ASL, is occupied by Lakes Bangweulu (~85 km long) and Kampolombo (~20 km long) and the Bangweulu Swamps [1,2]. The basement consists partly of granitoids (~1.8 Ga) together with ~1.1-Ga Katangan cover rocks. To the north, cover rocks of the Mporokoso Group (~1.8-1.3 Ga) form the arcuate Luongo Fold Belt [3], partly defining the perimeter of the outermost ring (R = 125 km) of the Bangweulu structure. Drainage into the BB is centripetal, with one outlet in the south, draining into a tributary of the Luapula River, which then curves in a broad arc toward the north, along the Zambia-Zaire border, before entering Lake Mweru. Rivers entering the BB include the Luansenshi, which rises in the north and flows in an arc to the southeast and south before joining the Chambeshi River, which flows southwest, west, and northwest before entering Lake Bangweulu. There is an arcuate watershed in the west (at R = 100 km), to the west of which rivers drain to the southwest and west into the Luapula River. Several elongate curved sliver-like islands, including Mbawala (~30 x 4 km) and Chisi, are present in Lake Bangweulu. The curvature of the islands follows the arcuate northwest boundary of the lake in a concentric manner. Unlike all the other major lakes in Zambia and surrounding areas (Mweru, Tanganyika, Rukwa, Malawi, and Kariba), which occupy seismically active rift structures [4,5], the Bangweulu Basin is generally aseismic, and is unrelated to rifting. There is a positive aeromagnetic intensity anomaly over the central Bangweulu depression, and there is also a magnetic anomaly density high over the central part of the BB, surrounded by a concentric low [6]. A roughly circular anomaly, outlined by the -140 mgal contour, of the regional Bouguer gravity field is centerd on Lake Bangweulu

The Catholic School in Zambia 1964-2014: Catholic and Catholic?

ERIC Educational Resources Information Center

Carmody, Brendan

2015-01-01

This article sketches the history of the Catholic school in Zambia over a 50-year period noting how for reasons of political acceptability it increasingly became less at home with its religious mission thereby finding itself with an unclear sense of purpose. In order to redeem its identity, this article argues that there is need for the school to…

Aflatoxin contamination of groundnut and maize in Zambia: observed and potential concentrations

USDA-ARS?s Scientific Manuscript database

Maize and groundnut, important staples in Zambia, are susceptible to aflatoxin-producing fungi. Aflatoxins are potent human carcinogens also associated with stunting and immunosuppression. Although health and economic burdens of aflatoxins are well known, patterns of contamination in maize and grou...

Investment Incentives and the Implementation of the Framework Convention on Tobacco Control: Evidence from Zambia

PubMed Central

Drope, Jeffrey; Labonte, Ronald; Zulu, Richard; Goma, Fastone

2016-01-01

Purpose Policy misalignment across different sectors of government serves as one of the pivotal barriers to WHO Framework convention on Tobacco Control (FCTC) implementation. This paper examines the logic used by government officials to justify providing investment incentives to increase tobacco processing and manufacturing in the context of FCTC implementation in Zambia. Methods We conducted qualitative semi-structured interviews with key informants from government, civil society and intergovernmental economic organizations (n=23). We supplemented the interview data with an analysis of public documents pertaining to economic development policy in Zambia. Results We found gross misalignments between the policies of the economic sector and efforts to implement the provisions of the FCTC. Our interviews uncovered the rationale used by officials in the economic sector to justify providing economic incentives to bolster tobacco processing and manufacturing in Zambia: 1) tobacco is not consumed by Zambians/tobacco is an export commodity, 2) economic benefits outweigh health costs, and 3) tobacco consumption is a personal choice. Conclusions Much of the struggle Zambia has experienced implementing the FCTC can be attributed to misalignments between the economic and health sectors. Zambia’s development agenda seeks to bolster agricultural processing and manufacturing. Tobacco control proponents must understand and work within this context of economic development in order to foster productive strategies with those working on tobacco supply issues. These findings are broadly applicable to the global analysis on the barriers and facilitators of FCTC implementation. It is important that the Ministry of Health monitors the tobacco policy of other sectors and engages with these sectors to find ways of harmonizing FCTC implementation across sectors. PMID:26135987

Outbreak of Plague in a High Malaria Endemic Region - Nyimba District, Zambia, March-May 2015.

PubMed

Sinyange, Nyambe; Kumar, Ramya; Inambao, Akatama; Moonde, Loveness; Chama, Jonathan; Banda, Mapopa; Tembo, Elliot; Nsonga, Beron; Mwaba, John; Fwoloshi, Sombo; Musokotwane, Kebby; Chizema, Elizabeth; Kapin'a, Muzala; Hang'ombe, Benard Mudenda; Baggett, Henry C; Hachaambwa, Lottie

2016-08-12

Outbreaks of plague have been recognized in Zambia since 1917 (1). On April 10, 2015, Zambia's Ministry of Health was notified by the Eastern Provincial Medical Office of possible bubonic plague cases in Nyimba District. Eleven patients with acute fever and cervical lymphadenopathy had been evaluated at two rural health centers during March 28-April 9, 2015; three patients died. To confirm the outbreak and develop control measures, the Zambia Ministry of Health's Field Epidemiology Training Program (ZFETP) conducted epidemiologic and laboratory investigations in partnership with the University of Zambia's schools of Medicine and Veterinary Medicine and the provincial and district medical offices. Twenty-one patients with clinically compatible plague were identified, with symptom onset during March 26-May 5, 2015. The median age was 8 years, and all patients were from the same village. Blood specimens or lymph node aspirates from six (29%) patients tested positive for Yersinia pestis by polymerase chain reaction (PCR). There is an urgent need to improve early identification and treatment of plague cases. PCR is a potential complementary tool for identifying plague, especially in areas with limited microbiologic capacity. Twelve (57%) patients, including all six with PCR-positive plague and all three who died, also tested positive for malaria by rapid diagnostic test (RDT). Plague patients coinfected with malaria might be misdiagnosed as solely having malaria, and appropriate antibacterial treatment to combat plague might not be given, increasing risk for mortality. Because patients with malaria might be coinfected with other pathogens, broad spectrum antibiotic treatment to cover other pathogens is recommended for all children with severe malaria, until a bacterial infection is excluded.

Human growth in southern Zambia: a first study of Tonga children predating the Kariba Dam (1957-1958).

PubMed

Gillet, Rhonda M; Tobias, Phillip V

2002-01-01

During the late 1950s the Kariba hydro-electric dam was constructed on the border of Zambia and Zimbabwe forcing the relocation of 57,000 people, mainly Tonga. As part of a larger study to assess the effects of the relocation, research into the human biology of the Tonga people was conducted. The research reported here provides a basis for comparison with long-term follow-up data on growth and physical status of Gwembe Tonga to determine the effects of resettlement. The sample consists of 303 schoolchildren, 7 to 13 years, from two schools that were not relocated and three schools that were to be relocated. Homogeneity of the two groups led us to combine them as a single baseline sample before relocation. Comparisons with NCHS (National Center for Health Statistics) reference data and with contemporary urban data from southern Zambia indicate sub-optimal nutritional status. After ages 6 and 7, height-for-age and weight-for-age Z-scores of boys decline steadily towards -2.0 SD throughout the 12th year, whereas mean Z-scores of girls decline markedly from 8 years on. Mean HAZ (Height-for-age-Z-score) of girls falls below -2.0 SD by 11 years and approaches -3.0 SD by 13 years. Thirty-nine percent of males and 47% of females in the baseline sample showed effects of moderate or severe protein energy malnutrition at the time of relocation. Because these children were from a school sample, gender differences in opportunity to attend school may be a factor in what appears to be gender bias, favoring the status of boys. This sample provides a baseline for assessing the long-term impact of forced relocation on the Gwembe Tonga.

Promotion of couples’ voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents

PubMed Central

Wall, Kristin M; Kilembe, William; Nizam, Azhar; Vwalika, Cheswa; Kautzman, Michelle; Chomba, Elwyn; Tichacek, Amanda; Sardar, Gurkiran; Casanova, Deborah; Henderson, Faith; Mulenga, Joseph; Kleinbaum, David; Allen, Susan

2012-01-01

delivery (aOR=1.3; 95% CI 1.1 to 1.5) versus elsewhere; and easy invitation delivery (aOR=1.8; 95% CI 1.4 to 2.2) versus difficult as reported by the INA. Conclusions This study demonstrated the ability of influential people to promote CVCT and identified agent, couple and context-level factors associated with CVCT uptake in Lusaka, Zambia. We encourage the development of CVCT promotions in other sub-Saharan African countries to support sustained CVCT dissemination. PMID:22956641

Redressing Gender Inequalities in Education. A Review of Constraints and Priorities in Malawi, Zambia, and Zimbabwe.

ERIC Educational Resources Information Center

Swainson, Nicola

The causes and manifestations of gender inequalities in education in Malawi, Zambia, and Zimbabwe and policy options for redressing them were examined through a review of literature on the causes, nature, and extent of gender disparities in education in the study region and information on efforts to eliminate gender inequality. Special attention…

The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies.

PubMed

Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J; Brenzel, Logan; Resch, Stephen C

2017-10-06

Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. We developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume. Across countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely-on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0-32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training

e-Government for Development Information Exchange (DIE): Zambia

NASA Astrophysics Data System (ADS)

Joseph, Bwalya Kelvin

In most parts of the world, political systems which utilize authoritative rule and mostly employ top-down decision-making processes are slowly transcending towards democratic norms. Information Technology Systems have been identified and adopted as one of the most efficient vehicles for appropriate, transparent and inclusive / participatory decision making. Zambia has shown a higher propensity to indigenous knowledge systems which are full of inefficiencies, a lot of red tape in public service delivery, and prone to corrupt practices. Despite that being the case, it is slowly trying to implement e-government. The adoption of e-government promises a sharp paradigm shift where public institutions will be more responsive and transparent, promote efficient PPP (Public Private Partnerships), and empower citizens by making knowledge and other resources more directly accessible. This paper examines three cases from Zambia where ICT in support of e-government has been implemented for Development Information Exchange (DIE) - knowledge-based decision making. The paper also assesses the challenges, opportunities, and issues together with e-government adoption criteria regarding successful encapsulation of e-government into the Zambian contextual environment. I propose a conceptual model which offers balanced e-government adoption criteria involving a combination of electronic and participatory services. This conceptual e-government adoption model can later be replicated to be used at the Southern African Development Community (SADC) level given the similarity in the contextual environment.

Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients

PubMed Central

2012-01-01

Background Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. Methods This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence. Results Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%). Conclusions The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after

The Current Availability of Antiepileptic Drugs in Zambia: Implications for the ILAE/WHO “Out of the Shadows” Campaign

PubMed Central

Chomba, Elwyn Nachanya; Haworth, Alan; Mbewe, Edward; Atadzhanov, Masharip; Ndubani, Philimon; Kansembe, Henry; Birbeck, Gretchen Lano

2010-01-01

Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%). Available AEDs were phenobarbitone (21; 18.9%), carbamazepine (27; 24.3%), valproic acid (4; 3.6%), and phenytoin (3; 2.7%). Adult out-of-pocket monthly costs ranged from US $7 to $30. Pediatric syrups were universally unavailable. Interviews revealed several barriers to AED provision, including that handling phenobarbitone (historically the most affordable AED) has become increasingly difficult because of newly enforced regulatory requirements. Personal communications with epilepsy-care providers in other low income countries suggest that this problem may be widespread. Improved enforcement of existing drug regulations may be contributing to the AED shortage. Social programs aimed at encouraging people with epilepsy to come “out of the shadows” must be preceded by improved AED access. PMID:20810822

Exploring SWAp's contribution to the efficient allocation and use of resources in the health sector in Zambia.

PubMed

Chansa, Collins; Sundewall, Jesper; McIntyre, Di; Tomson, Göran; Forsberg, Birger C

2008-07-01

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.

`WORSE THAN HIV' OR `NOT AS SERIOUS AS OTHER DISEASES'? CONCEPTUALIZATION OF CERVICAL CANCER AMONG NEWLY SCREENED WOMEN IN ZAMBIA

PubMed Central

White, Heather L.; Mulambia, Chishimba; Sinkala, Moses; Mwanahamuntu, Mulindi H.; Parham, Groesbeck P.; Moneyham, Linda; Grimley, Diane M.; Chamot, Eric

2012-01-01

Invasive cervical cancer is the second most common cancer among women worldwide, with approximately 85% of the disease burden occurring in developing countries. To date, there have been few systematic efforts to document African women's conceptualization of cervical cancer after participation in a visual inspection with acetic acid (VIA)-based “see and treat” cervical cancer prevention program. In this study, conducted between September, 2009-July, 2010, focus groups and in-depth interviews were conducted with 60 women who had recently undergone cervical cancer screening at a government-operated primary health care clinic in Lusaka, Zambia. Interviewers elicited participants' causal representations of cervical cancer, associated physical signs and symptoms, perceived physical and psychological effects, and social norms regarding the disease. The lay model of illness causation portrayed by participants after recent exposure to program promotion messages departed in several ways from causal models described in other parts of the world. However, causal conceptualizations included both lay and biomedical elements, suggesting a possible shift from a purely traditional causal model to one that incorporates both traditional concepts and recently promoted biomedical concepts. Most, but not all, women still equated cervical cancer with death, and perceived it to be a highly stigmatized disease in Zambia because of its anatomic location, dire natural course, connections to socially-condemned behaviors, and association with HIV/AIDS. No substantive differences of disease conceptualization existed according to HIV serostatus, though HIV positive women acknowledged that their immune status makes them more aware of their health and more likely to seek medical attention. Further attention should be dedicated to the processes by which women incorporate new knowledge into their representations of cervical cancer. PMID:22459188

Theileria parva epidemics: a case study in eastern Zambia.

PubMed

Billiouw, M; Vercruysse, J; Marcotty, T; Speybroeck, N; Chaka, G; Berkvens, D

2002-07-29

This paper presents the results of the follow-up of three sentinel herds between 1994 and 2000 during an East Coast fever (ECF) epidemic in eastern Zambia. The animals of the sentinel herds were closely monitored clinically and serologically together with detailed Rhipicephalus appendiculatus counts. Peaks of disease incidence occurred in the rainy season (December-February) and the dry months of May-July with nymph-to-adult tick transmission dominating the infection dynamics. A second wave of adult R. appendiculatus at the start of the dry season is essential for the occurrence of a full-blown epidemic while the size of the susceptible cattle population acts as a most important limiting factor. The majority of adult cattle of the sentinel herds became infected less than 2 years after the introduction of the disease. The median age at first contact for calves born towards the end of the study (1999) was about 6 months. The case-fatality ratio (including sub-clinical cases) is estimated at 60%. It is argued that part of the so-called 'natural mortality' is actually due to ECF and that ECF occurrence and mortality are systematically underestimated. The direct financial cost of the epidemic, based on loss of animals and cost of treatment only and calculated over 4 years running, is estimated at about 6 US dollars per year per animal at risk. The value of the traditional seroprevalence survey as a tool for monitoring ECF epidemiology is put in question and the prevalence of maternal antibodies in new-born calves, reflecting the immune status of the dam population, is introduced as an alternative. It is demonstrated that an efficient immunisation campaign should concentrate its efforts in the period of low adult R. appendiculatus abundance (July-October).

Decentralization in Zambia: resource allocation and district performance.

PubMed

Bossert, Thomas; Chitah, Mukosha Bona; Bowser, Diana

2003-12-01

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or

"Distance Learning" or "Learning at a Distance"? Case Study of an Education Initiative to Deliver an In-Service Bachelors Degree in Zambia

ERIC Educational Resources Information Center

Smith, Christopher J.

2010-01-01

In 1998, as part of what was then Zambia's Department of Technical Education and Vocational Training's (DTEVT) human resources capacity building initiative, under the Ministry of Science, Technology and Vocational Training (MSTVT), donor funding was secured to provide degree-level training for key teachers and managers within the technical…

Insecticide resistance and role in malaria transmission of Anopheles funestus populations from Zambia and Zimbabwe.

PubMed

Choi, Kwang S; Christian, Riann; Nardini, Luisa; Wood, Oliver R; Agubuzo, Eunice; Muleba, Mbanga; Munyati, Shungu; Makuwaza, Aramu; Koekemoer, Lizette L; Brooke, Basil D; Hunt, Richard H; Coetzee, Maureen

2014-10-08

Two mitochondrial DNA clades have been described in Anopheles funestus populations from southern Africa. Clade I is common across the continent while clade II is known only from Mozambique and Madagascar. The specific biological status of these clades is at present unknown. We investigated the possible role that each clade might play in the transmission of Plasmodium falciparum and the insecticide resistance status of An. funestus from Zimbabwe and Zambia. Mosquitoes were collected inside houses from Nchelenge District, Zambia and Honde Valley, Zimbabwe in 2013 and 2014. WHO susceptibility tests, synergist assays and resistance intensity tests were conducted on wild females and progeny of wild females. ELISA was used to detect Plasmodium falciparum circumsporozoite protein. Specimens were identified to species and mtDNA clades using standard molecular methods. The Zimbabwean samples were all clade I while the Zambian population comprised 80% clade I and 20% clade II in both years of collection. ELISA tests gave an overall infection rate of 2.3% and 2.1% in 2013, and 3.5% and 9.2% in 2014 for Zimbabwe and Zambia respectively. No significant difference was observed between the clades. All populations were resistant to pyrethroids and carbamates but susceptible to organochlorines and organophosphates. Synergist assays indicated that pyrethroid resistance is mediated by cytochrome P450 mono-oxygenases. Resistance intensity tests showed high survival rates after 8-hrs continuous exposure to pyrethroids but exposure to bendiocarb gave the same results as the susceptible control. This is the first record of An. funestus mtDNA clade II occurring in Zambia. No evidence was found to suggest that the clades are markers of biologically separate populations. The ability of An. funestus to withstand prolonged exposure to pyrethroids has serious implications for the use of these insecticides, either through LLINs or IRS, in southern Africa in general and resistance management

Provisioning of Game Meat to Rural Communities as a Benefit of Sport Hunting in Zambia

PubMed Central

White, Paula A.; Belant, Jerrold L.

2015-01-01

Sport hunting has reportedly multiple benefits to economies and local communities; however, few of these benefits have been quantified. As part of their lease agreements with the Zambia Wildlife Authority, sport hunting operators in Zambia are required to provide annually to local communities free of charge i.e., provision a percentage of the meat obtained through sport hunting. We characterized provisioning of game meat to rural communities by the sport hunting industry in Zambia for three game management areas (GMAs) during 2004–2011. Rural communities located within GMAs where sport hunting occurred received on average > 6,000 kgs per GMA of fresh game meat annually from hunting operators. To assess hunting industry compliance, we also compared the amount of meat expected as per the lease agreements versus observed amounts of meat provisioned from three GMAs during 2007–2009. In seven of eight annual comparisons of these GMAs, provisioning of meat exceeded what was required in the lease agreements. Provisioning occurred throughout the hunting season and peaked during the end of the dry season (September–October) coincident with when rural Zambians are most likely to encounter food shortages. We extrapolated our results across all GMAs and estimated 129,771 kgs of fresh game meat provisioned annually by the sport hunting industry to rural communities in Zambia at an approximate value for the meat alone of >US$600,000 exclusive of distribution costs. During the hunting moratorium (2013–2014), this supply of meat has halted, likely adversely affecting rural communities previously reliant on this food source. Proposed alternatives to sport hunting should consider protein provisioning in addition to other benefits (e.g., employment, community pledges, anti-poaching funds) that rural Zambian communities receive from the sport hunting industry. PMID:25693191

Provisioning of game meat to rural communities as a benefit of sport hunting in Zambia.

PubMed

White, Paula A; Belant, Jerrold L

2015-01-01

Sport hunting has reportedly multiple benefits to economies and local communities; however, few of these benefits have been quantified. As part of their lease agreements with the Zambia Wildlife Authority, sport hunting operators in Zambia are required to provide annually to local communities free of charge i.e., provision a percentage of the meat obtained through sport hunting. We characterized provisioning of game meat to rural communities by the sport hunting industry in Zambia for three game management areas (GMAs) during 2004-2011. Rural communities located within GMAs where sport hunting occurred received on average > 6,000 kgs per GMA of fresh game meat annually from hunting operators. To assess hunting industry compliance, we also compared the amount of meat expected as per the lease agreements versus observed amounts of meat provisioned from three GMAs during 2007-2009. In seven of eight annual comparisons of these GMAs, provisioning of meat exceeded what was required in the lease agreements. Provisioning occurred throughout the hunting season and peaked during the end of the dry season (September-October) coincident with when rural Zambians are most likely to encounter food shortages. We extrapolated our results across all GMAs and estimated 129,771 kgs of fresh game meat provisioned annually by the sport hunting industry to rural communities in Zambia at an approximate value for the meat alone of >US$600,000 exclusive of distribution costs. During the hunting moratorium (2013-2014), this supply of meat has halted, likely adversely affecting rural communities previously reliant on this food source. Proposed alternatives to sport hunting should consider protein provisioning in addition to other benefits (e.g., employment, community pledges, anti-poaching funds) that rural Zambian communities receive from the sport hunting industry.

Limited potential of school textbooks to prevent tobacco use among students grade 1-9 across multiple developing countries: a content analysis study.

PubMed

Saito, Junko; Nonaka, Daisuke; Mizoue, Tetsuya; Kobayashi, Jun; Jayatilleke, Achini C; Shrestha, Sabina; Kikuchi, Kimiyo; Haque, Syed E; Yi, Siyan; Ayi, Irene; Jimba, Masamine

2013-01-01

To evaluate the content of school textbooks as a tool to prevent tobacco use in developing countries. Content analysis was used to evaluate if the textbooks incorporated the following five core components recommended by the WHO: (1) consequences of tobacco use; (2) social norms; (3) reasons to use tobacco; (4) social influences and (5) resistance and life skills. Nine developing countries: Bangladesh, Cambodia, Laos, Nepal, Sri Lanka, Benin, Ghana, Niger and Zambia. TEXTBOOKS ANALYSED: Of 474 textbooks for primary and junior secondary schools in nine developing countries, 41 were selected which contained descriptions about tobacco use prevention. Of the 41 textbooks, the consequences of tobacco use component was covered in 30 textbooks (73.2%) and the social norms component was covered in 19 (46.3%). The other three components were described in less than 20% of the textbooks. A rather limited number of school textbooks in developing countries contained descriptions of prevention of tobacco use, but they did not fully cover the core components for tobacco use prevention. The chance of tobacco prevention education should be seized by improving the content of school textbooks.

Evaluation of service quality in family planning clinics in Lusaka, Zambia.

PubMed

Hancock, Nancy L; Vwalika, Bellington; Sitali, Elizabeth Siyama; Mbwili-Muleya, Clara; Chi, Benjamin H; Stuart, Gretchen S

2015-10-01

To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach. We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up. Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%). This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability. Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement. Copyright © 2015

Lusaka, Zambia during SAFARI-2000: A Collection Point for Ozone Pollution

NASA Technical Reports Server (NTRS)

Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tal; Phahlane, N. Agnes; Coetzee, G. J. R.; Bhartia, P. K. (Technical Monitor)

2002-01-01

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.

Prevalence and species distribution of caprine trypanosomosis in Sinazongwe and Kalomo districts of Zambia.

PubMed

Nyimba, P H; Komba, E V G; Sugimoto, C; Namangala, B

2015-06-15

African animal trypanosomosis is one of the key livestock diseases hindering full exploitation of livestock production potential covering 37 countries across sub-Saharan Africa. Many studies have been carried out to investigate the prevalence of the disease in cattle and humans in many tropical African countries but very little attention has been directed towards generating the disease prevalence rates in goats. The current study was conducted between December 2013 and January 2014 to establish the prevalence of caprine trypanosomosis in Sinazongwe and Kalomo districts, southern Zambia. It involved 422 goats which were first examined by palpation for possible enlargement of superficial lymph nodes. Blood samples were then collected from the goats and subjected to laboratory diagnosis using the microscope and Loop Mediated Isothermal Amplification (LAMP). None of the examined goats displayed enlargement of superficial lymph nodes. On microscopy only one goat was found to be positive. The results of investigation using the LAMP method showed that 100 goats were infected with trypanosomes giving an overall prevalence rate of 23.7%. The prevalence of infection in Sinazongwe was 22.4% (n=183) while in Kalomo it was 24.7% (n=239); and the difference between the two districts was statistically significant at 95% CL (x(2)=4.4, df=1, p<0.05). Trypanosoma brucei, Trypanasoma vivax and Trypanasoma congolense were detected in 82.0%, 31.0% and 23.0% of the infected goats, respectively. Mixed infections were detected among 33.0% of the positive samples. The high prevalence rate of trypanosomes detected in the study area confirms the earlier reports that trypanosomosis is re-emerging in the areas previously aerial sprayed by Government. The detection of trypanosomes in naturally infected goats outlines the important role goats play in the epidemiology of African animal trypanosomosis. Copyright © 2015 Elsevier B.V. All rights reserved.

Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting.

PubMed

Pigoga, Jennifer L; Cunningham, Charmaine; Kafwamfwa, Muhumpu; Wallis, Lee A

2017-12-10

Community members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia. The EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic. This study was conducted based on data collected in Kasama, a rural region of Zambia's Northern Province. An expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development. The range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased. Discrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues. © Article author

Estimating the force of measles virus infection from hospitalised cases in Lusaka, Zambia.

PubMed

Scott, Susana; Mossong, Joel; Moss, William J; Cutts, Felicity T; Kasolo, Francis; Sinkala, Moses; Cousens, Simon

2004-12-21

Estimates of the force of infection (the rate at which susceptible individuals acquire infection) are essential for modelling the transmission dynamics of infectious diseases and can be a useful tool in evaluating mass vaccination strategies. Few estimates exist of the force of infection of measles virus in sub-Saharan Africa. A mathematical model was applied to age-specific recorded hospital admissions between September 1996 and September 1999 to estimate the force of measles virus infection in Lusaka, Zambia. The average force of infection was estimated to be 20% per year (95% confidence intervals (CI) 16.5, 23.5) which was insensitive to varying assumptions about vaccine coverage. The force of infection varied from year to year (P < 0.001) reflecting the cyclic pattern of measles incidence. The estimated probability of a case being hospitalised decreased with age, consistent with less severe disease in older children. Estimates of the force of infection using routinely available data were consistent with those based upon serological surveys in other sub-Saharan African countries.

Inquiry-Based Science Education: A Scenario on Zambia's High School Science Curriculum

ERIC Educational Resources Information Center

Chabalengula, Vivien M.; Mumba, Frackson

2012-01-01

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…

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia.

PubMed

Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M

2018-05-02

Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.

Detection of Human Herpes Virus 8 in Kaposi's sarcoma tissues at the University Teaching Hospital, Lusaka, Zambia.

PubMed

Tembo, Rabecca; Kaile, Trevor; Kafita, Doris; Chisanga, Chrispin; Kalonda, Annie; Zulu, Ephraim; Samutela, Mulemba; Polepole, Pascal; Kwenda, Geoffrey

2017-01-01

Human herpes virus-8, a γ2-herpes virus, is the aetiological agent of Kaposi sarcoma. Recently, Kaposi's sarcoma cases have increased in Zambia. However, the diagnosis of this disease is based on morphological appearance of affected tissues using histological techniques, and the association with its causative agent, Human Herpes virus 8 is not sought. This means poor prognosis for affected patients since the causative agent is not targeted during diagnosis and KS lesions may be mistaken for other reactive and neoplastic vascular proliferations when only histological techniques are used. Therefore, this study was aimed at providing evidence of Human Herpes virus 8 infection in Kaposi's sarcoma tissues at the University Teaching Hospital in Lusaka, Zambia. One hundred and twenty suspected Kaposi's sarcoma archival formalin-fixed paraffin-wax embedded tissues stored from January 2013 to December 2014 in the Histopathology Laboratory at the University Teaching Hospital, Lusaka, Zambia were analysed using histology and Polymerase Chain Reaction targeting the ORF26 gene of Human Herpes virus 8. The predominant histological type of Kaposi's sarcoma detected was the Nodular type (60.7%) followed by the plaque type (22.6%) and patch type (16.7%). The nodular lesion was identified mostly in males (40.5%, 34/84) than females (20.2%, 17/84) (p=0.041). Human Herpes virus 8 DNA was detected in 53.6% (45/84) and mostly in the nodular KS lesions (60%, 27/84) (p=0.035). The findings in this study show that the Human Herpes virus-8 is detectable in Kaposi's sarcoma tissues, and, as previously reported in other settings, is closely associated with Kaposi's sarcoma. The study has provided important baseline data for use in the diagnosis of this disease and the identification of the virus in the tissues will aid in targeted therapy.

Limited potential of school textbooks to prevent tobacco use among students grade 1–9 across multiple developing countries: a content analysis study

PubMed Central

Saito, Junko; Nonaka, Daisuke; Mizoue, Tetsuya; Kobayashi, Jun; Jayatilleke, Achini C; Shrestha, Sabina; Kikuchi, Kimiyo; Haque, Syed E; Yi, Siyan; Ayi, Irene; Jimba, Masamine

2013-01-01

Objective To evaluate the content of school textbooks as a tool to prevent tobacco use in developing countries. Design Content analysis was used to evaluate if the textbooks incorporated the following five core components recommended by the WHO: (1) consequences of tobacco use; (2) social norms; (3) reasons to use tobacco; (4) social influences and (5) resistance and life skills. Setting Nine developing countries: Bangladesh, Cambodia, Laos, Nepal, Sri Lanka, Benin, Ghana, Niger and Zambia. Textbooks analysed Of 474 textbooks for primary and junior secondary schools in nine developing countries, 41 were selected which contained descriptions about tobacco use prevention. Results Of the 41 textbooks, the consequences of tobacco use component was covered in 30 textbooks (73.2%) and the social norms component was covered in 19 (46.3%). The other three components were described in less than 20% of the textbooks. Conclusions A rather limited number of school textbooks in developing countries contained descriptions of prevention of tobacco use, but they did not fully cover the core components for tobacco use prevention. The chance of tobacco prevention education should be seized by improving the content of school textbooks. PMID:23430601

Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions.

PubMed

Aantjes, Carolien J; Quinlan, Tim K C; Bunders, Joske F G

2014-07-08

The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions. Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites. A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition. The reorientation of Zambia's health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.

Perceptions of HIV-related health services in Zambia for people with disabilities who are HIV-positive

PubMed Central

Nixon, Stephanie A; Cameron, Cathy; Hanass-Hancock, Jill; Simwaba, Phillimon; Solomon, Patricia E; Bond, Virginia A; Menon, Anitha; Richardson, Emma; Stevens, Marianne; Zack, Elisse

2014-01-01

Introduction Despite the emerging body of literature on increased vulnerability to HIV among people with disabilities (PWDs), there is a dearth of evidence related to experiences of PWDs who have become HIV-positive. This priority was identified by a disability advocacy organization in Lusaka, Zambia, where the prevalence of HIV and of disability is each approximately 15%. The purpose of this study was to explore perceptions and experiences of HIV-related health services for PWDs who are also living with HIV in Lusaka, Zambia. Methods This qualitative, interpretive study involved in-depth, semi-structured, one-on-one interviews with two groups of participants in Lusaka, Zambia: 21 PWDs who had become HIV-positive, and 11 people working in HIV and/or disability. PWDs had physical, hearing, visual and/or intellectual impairments. Interviews were conducted in English, Nyanja, Bemba or Zambian sign language. Descriptive and thematic analyses were conducted by a multidisciplinary, international research team. Results Participants described their experiences with HIV-related health services in terms of the challenges they faced. In particular, they encountered three main challenges while seeking care and treatment: (1) disability-related discrimination heightened when seeking HIV services, (2) communication barriers and related concerns with confidentiality, and (3) movement and mobility challenges related to seeking care and collecting antiretroviral therapy. These experiences were further shaped by participants’ profound concerns about poverty and unmet basic needs. Discussion This study demonstrates how PWDs who are HIV-positive have the same HIV care, treatment and support needs as able-bodied counterparts, but face avoidable barriers to care. Many challenges mirror concerns identified with HIV prevention, suggesting that efforts to promote inclusion and reduce stigma could have widespread benefits. Conclusions Despite the growing body of literature on increased

An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.

PubMed

Chama-Chiliba, Chitalu Miriam; Koch, Steven Fredric

2016-12-07

Improving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth. Data from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006. The difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born. The removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.

'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa

PubMed Central

2010-01-01

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

'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa.

PubMed

Kingori, Patricia; Muchimba, Maureen; Sikateyo, Bornwell; Amadi, Beatrice; Kelly, Paul

2010-09-17

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. 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. 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

Community intervention improves knowledge of HIV status of adolescents in Zambia: findings from HPTN 071-PopART for youth study

PubMed Central

Shanaube, Kwame; Schaap, Ab; Chaila, Mwate Joseph; Floyd, Sian; Mackworth-Young, Constance; Hoddinott, Graeme; Hayes, Richard; Fidler, Sarah; Ayles, Helen

2017-01-01

Objective: To determine the uptake of home-based HIV counselling and testing (HCT) in four communities of the HPTN 071 (PopART) trial in Zambia among adolescents aged 15–19 years and explore factors associated with HCT uptake. Design: The PopART for youth study is a three-arm community-randomized trial in 12 communities in Zambia and nine communities in South Africa which aims to evaluate the acceptability and uptake of a HIV prevention package, including universal HIV testing and treatment, among young people. The study is nested within the HPTN 071 (PopART) trial. Methods: Using a door-to-door approach that includes systematically revisiting households, all adolescents enumerated were offered participation in the intervention and verbal consent was obtained. Data were analysed from October 2015 to September 2016. Results: Among 15 456 enumerated adolescents, 11 175 (72.3%) accepted the intervention. HCT uptake was 80.6% (8707/10 809) and was similar by sex. Adolescents that knew their HIV-positive status increased almost three-fold, from 75 to 210. Following visits from community HIV care providers, knowledge of HIV status increased from 27.6% (3007/10 884) to 88.5% (9636/10 884). HCT uptake was associated with community, age, duration since previous HIV test; other household members accepting HCT, having an HIV-positive household member, circumcision, and being symptomatic for STIs. Conclusion: Through a home-based approach of offering a combination HIV prevention package, the proportion of adolescents who knew their HIV status increased from ∼28 to 89% among those that accepted the intervention. Delivering a community-level door-to-door combination, HIV prevention package is acceptable to many adolescents and can be effective if done in combination with targeted testing. PMID:28665880

Linguistic Landscapes and the Sociolinguistics of Language Vitality in Multilingual Contexts of Zambia

ERIC Educational Resources Information Center

Banda, Felix; Jimaima, Hambaba

2017-01-01

The article illustrates a sociolinguistics of language vitality that accounts for "minority" and unofficial languages across multiple localities in dispersed communities of multilingual speakers of Zambia where only seven out of seventy-three indigenous languages have been designated official and "zoned" for use in specified…

Seasonality, Blood Feeding Behavior, and Transmission of Plasmodium Falciparum by Anopheles Arabiensis after an Extended Drought In Southern Zambia

PubMed Central

Thuma, Philip E.; Mharakurwa, Sungano; Norris, Douglas E.

2014-01-01

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

Biochar effect on maize yield and soil characteristics in five conservation farming sites in Zambia

USGS Publications Warehouse

Cornelissen, Gerard; Martinsen, Vegard; Shitumbanuma, Victor; Alling, Vanja; Breedveld, Gijs D.; Rutherford, David W.; Sparrevik, Magnus; Hale, Sarah E.; Obia, Alfred; Mulder, Jan

2013-01-01

Biochar addition to agricultural soils can improve soil fertility, with the added bonus of climate change mitigation through carbon sequestration. Conservation farming (CF) is precision farming, often combining minimum tillage, crop rotation and residue retention. In the present farmer-led field trials carried out in Zambia, the use of a low dosage biochar combined with CF minimum tillage was tested as a way to increase crop yields. Using CF minimum tillage allows the biochar to be applied to the area where most of the plant roots are present and mirrors the fertilizer application in CF practices. The CF practice used comprised manually hoe-dug planting 10-L sized basins, where 10%–12% of the land was tilled. Pilot trials were performed with maize cob biochar and wood biochar on five soils with variable physical/chemical characteristics. At a dosage as low as 4 tons/ha, both biochars had a strong positive effect on maize yields in the coarse white aeolian sand of Kaoma, West-Zambia, with yields of 444% ± 114% (p = 0.06) and 352% ± 139% (p = 0.1) of the fertilized reference plots for maize and wood biochar, respectively. Thus for sandy acidic soils, CF and biochar amendment can be a promising combination for increasing harvest yield. Moderate but non-significant effects on yields were observed for maize and wood biochar in a red sandy clay loam ultisol east of Lusaka, central Zambia (University of Zambia, UNZA, site) with growth of 142% ± 42% (p > 0.2) and 131% ± 62% (p > 0.2) of fertilized reference plots, respectively. For three other soils (acidic and neutral clay loams and silty clay with variable cation exchange capacity, CEC), no significant effects on maize yields were observed (p > 0.2). In laboratory trials, 5% of the two biochars were added to the soil samples in order to study the effect of the biochar on physical and chemical soil characteristics. The large increase in crop yield in Kaoma soil was tentatively explained by a combination of an

Aspergillus section Flavi community structure in Zambia influences aflatoxin contamination of Maize and Groundnut

USDA-ARS?s Scientific Manuscript database

Aflatoxins are cancer-causing, immuno-suppressive mycotoxins that frequently contaminate important staples in Zambia including maize and groundnut. Several species within Aspergillus section Flavi have been implicated as causal agents of aflatoxin contamination in Africa. However, Aspergillus popula...

Report from the Field: Education under Structural Adjustment in Nigeria and Zambia.

ERIC Educational Resources Information Center

Babalola, Joel B.; Lungwangwa, Geoffrey; Adeyinka, Augustus A.

1999-01-01

Investigates the effects of the Structural Adjustment Program (SAP) on the educational systems in Nigeria and Zambia. Reports that SAP impacted the public expenditure on education, the purchasing power of the incomes earned by both learning institutions and their staff, and on access, equity, and quality indicators in education at all levels. (CMK)

Prevalence and characterization of Staphylococcus aureus and Staphylococcus pseudintermedius isolated from companion animals and environment in the veterinary teaching hospital in Zambia, Africa.

PubMed

Youn, Jung-Ho; Park, Yong Ho; Hang'ombe, Bernard; Sugimoto, Chihiro

2014-03-01

The Republic of Zambia consists of only one veterinary teaching school at the University of Zambia (UNZA) where students and veterinarians are exposed to many bacterial pathogens including Staphylococcus aureus (SA) and Staphylococcus pseudintermedius (SP). The aim of this study was the characterization and antimicrobial susceptibility profile of eleven SA and 48 SP isolates from the veterinary hospitals' in- and outpatients and the environment. No isolate was resistant to cefoxitin by disk diffusion test and the corresponding resistance gene mecA was not found. In contrast, the resistance rates of SA to penicillin (63.6%) and trimethoprim-sulfamethoxazole (36.4%) and SP to penicillin (52.1%) and tetracycline (25.0%) were the highest. A variety of sequence types (STs) without a predominant type including numerous novel types were determined, especially for SP (39.6%). The spa typing provided a clonal assignment for all SAs (100%) and 24 SPs (50%) with three and two novel types, respectively. This study has provided an overview of SA and SP in the veterinary teaching hospital at UNZA. However, for a better understanding of these species regarding pathogenesis and transmission, further studies on the prevalence and characterization of SA and SP from veterinary staff, pet owners, and farm animals in Zambia is needed. Copyright © 2014 Elsevier Ltd. All rights reserved.

A Preliminary Assessment of Rotavirus Vaccine Effectiveness in Zambia.

PubMed

Beres, Laura K; Tate, Jacqueline E; Njobvu, Lungowe; Chibwe, Bertha; Rudd, Cheryl; Guffey, M Brad; Stringer, Jeffrey S A; Parashar, Umesh D; Chilengi, Roma

2016-05-01

Diarrhea is the third leading cause of child death in Zambia. Up to one-third of diarrhea cases resulting in hospitalization and/or death are caused by vaccine-preventable rotavirus. In January 2012, Zambia initiated a pilot introduction of the Rotarix live, oral rotavirus vaccine in all public health facilities in Lusaka Province. Between July 2012 and October 2013, we conducted a case-control study at 6 public sector sites to estimate rotavirus vaccine effectiveness (VE) in age-eligible children presenting with diarrhea. We computed the odds of having received at least 1 dose of Rotarix among children whose stool was positive for rotavirus antigen (cases) and children whose stool was negative (controls). We adjusted the resulting odds ratio (OR) for patient age, calendar month of presentation, and clinical site, and expressed VE as (1 - adjusted OR) × 100. A total of 91 rotavirus-positive cases and 298 rotavirus-negative controls who had under-5 card-confirmed vaccination status and were ≥6 months of age were included in the case-control analysis. Among rotavirus-positive children who were age-eligible to be vaccinated, 20% were hospitalized. Against rotavirus diarrhea of all severity, the adjusted 2-dose VE was 26% (95% confidence interval [CI], -30% to 58%) among children ≥6 months of age. VE against hospitalized children ≥6 months of age was 56% (95% CI, -34% to 86%). We observed a higher point estimate for VE against increased severity of illness compared with milder disease, but were not powered to detect a low level of VE against milder disease. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Tuberculosis Infection in Zambia: The Association with Relative Wealth

PubMed Central

Boccia, Delia; Hargreaves, James; Ayles, Helen; Fielding, Katherine; Simwinga, Musonda; Godfrey-Faussett, Peter

2013-01-01

This study aimed to assess the association between household socioeconomic position and tuberculosis (TB) infection in two communities of Zambia. For this purpose we implemented a cross-sectional investigation, nested within a larger case control study. Infection was assessed using Quantiferon-TB Gold. A socioeconomic position index was constructed through principal component analysis combining data on human resources, food availability, housing quality, and access to services and infrastructures. In this study, higher socioeconomic position, rather than lower, was associated with significantly higher risk of TB infection. None of the traditional risk factors for TB infection mediated this association, suggesting that in these two communities TB transmission may occur through exposure to as yet undefined risk factors that are associated with higher socioeconomic position. Although further studies are needed, these results suggest emerging new patterns of TB transmission and a role of socioeconomic position on the risk of TB infection opposite to that expected. PMID:19478266

Isolation and molecular characterization of Mycobacterium tuberculosis from humans and cattle in Namwala District, Zambia.

PubMed

Malama, Sydney; Muma, John; Munyeme, Musso; Mbulo, Grace; Muwonge, Adrian; Shamputa, Isdore Chola; Djønne, Berit; Godfroid, Jacques; Johansen, Tone Bjordal

2014-12-01

Mycobacterium tuberculosis, the causative agent of tuberculosis in humans, is considered primarily a human pathogen. It has, however, been reported in a wide range of domestic and wild animals, often living in close prolonged contact with humans. Sputum samples in which acid fast bacteria were detected in smears were collected from patients at three health facilities in Namwala district, Zambia. Samples from cattle presenting gross lesions compatible with bovine tuberculosis were collected at a local abattoir in the same district. Isolated mycobacteria were identified and genotyped using classical molecular methods. From a total of 33 isolates of M. tuberculosis detected (30 from humans and 3 from cattle), two cattle isolates shared the same spoligotype and MIRU-VNTR pattern with a human patient. This study has for the first time documented the isolation of M. tuberculosis from cattle in Zambia and provides molecular evidence of an epidemiological link between M. tuberculosis isolates from humans and cattle in Namwala district. A possible spill back of M. tuberculosis to humans cannot be excluded and therefore further studies documenting to what extent M. tuberculosis is shed in cattle milk are needed. This finding further suggests that veterinary public health measures to control human TB, should also take into account the bovine reservoir.

Perception of cattle farmers of the efficacy of east coast fever immunization in southern Zambia.

PubMed

Fandamu, P; Thys, E; Duchateau, L; Berkvens, D

2006-01-01

A study using a structured questionnaire was conducted to assess the perception of cattle farmers of the efficacy of East Coast fever (ECF) immunization in southern Zambia. One hundred and seventy-nine farmers from five districts in southern Zambia were interviewed. The majority of farmers (85%) perceived ECF immunization as being very effective and about half of them (51.4%) preferred immunization to other ECF control strategies. The study showed that the number of calves immunized was strongly associated with the farmer's perception of the benefits of immunization. There was no association between the number of calves immunized and the number of veterinary assistants in a given district or their transport situation. Overall mortality in ECF-immunized calves from various causes stood at 4.2%. Based on farmers' reports, the majority of these deaths seemed to have been caused by anaplasmosis, another tick-borne disease, and might have resulted from relaxation of tick control after ECF immunization. The reasons identified by farmers for not immunizing their animals included failure by immunizing teams to reach certain areas, not having calves of immunization age, and lack of money. These findings provide valuable information on how livestock farmers perceive and adopt new animal disease control strategies and the information could be useful in their planning and implementation.

Detection of Human Herpes Virus 8 in Kaposi’s sarcoma tissues at the University Teaching Hospital, Lusaka, Zambia

PubMed Central

Tembo, Rabecca; Kaile, Trevor; Kafita, Doris; Chisanga, Chrispin; Kalonda, Annie; Zulu, Ephraim; Samutela, Mulemba; Polepole, Pascal; Kwenda, Geoffrey

2017-01-01

Introduction Human herpes virus-8, a γ2-herpes virus, is the aetiological agent of Kaposi sarcoma. Recently, Kaposi's sarcoma cases have increased in Zambia. However, the diagnosis of this disease is based on morphological appearance of affected tissues using histological techniques, and the association with its causative agent, Human Herpes virus 8 is not sought. This means poor prognosis for affected patients since the causative agent is not targeted during diagnosis and KS lesions may be mistaken for other reactive and neoplastic vascular proliferations when only histological techniques are used. Therefore, this study was aimed at providing evidence of Human Herpes virus 8 infection in Kaposi's sarcoma tissues at the University Teaching Hospital in Lusaka, Zambia. Methods One hundred and twenty suspected Kaposi's sarcoma archival formalin-fixed paraffin-wax embedded tissues stored from January 2013 to December 2014 in the Histopathology Laboratory at the University Teaching Hospital, Lusaka, Zambia were analysed using histology and Polymerase Chain Reaction targeting the ORF26 gene of Human Herpes virus 8. Results The predominant histological type of Kaposi's sarcoma detected was the Nodular type (60.7%) followed by the plaque type (22.6%) and patch type (16.7%). The nodular lesion was identified mostly in males (40.5%, 34/84) than females (20.2%, 17/84) (p=0.041). Human Herpes virus 8 DNA was detected in 53.6% (45/84) and mostly in the nodular KS lesions (60%, 27/84) (p=0.035). Conclusion The findings in this study show that the Human Herpes virus-8 is detectable in Kaposi's sarcoma tissues, and, as previously reported in other settings, is closely associated with Kaposi's sarcoma. The study has provided important baseline data for use in the diagnosis of this disease and the identification of the virus in the tissues will aid in targeted therapy. PMID:28904666

Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia

PubMed Central

Cremers, Anne Lia; de Laat, Myrthe Manon; Kapata, Nathan; Gerrets, Rene; Klipstein-Grobusch, Kerstin; Grobusch, Martin Peter

2015-01-01

Background Stigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma. Study Aim To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients’ experiences of stigma in order to point out recommendations to improve TB policy. Methods We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings. Results We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men. Conclusions The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content

Factors Associated with School Teachers' Perceived Needs and Level of Adoption of HIV Prevention Education in Lusaka, Zambia

ERIC Educational Resources Information Center

Henning, Margaret; Chi, Chunheui; Khanna, Sunil K.

2011-01-01

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…

Evaluation of the educational impact of the WHO Essential Newborn Care course in Zambia.

PubMed

McClure, E M; Carlo, W A; Wright, L L; Chomba, E; Uxa, F; Lincetto, O; Bann, C

2007-08-01

To evaluate the effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) course in improving knowledge and skills of nurse midwives in low-risk delivery clinics in a developing country. The investigators identified the content specifications of the training material, developed both written and performance evaluations and administered the evaluations both before and after training clinical nurse midwives in Zambia. Based on these evaluations, both the knowledge and skills of the nurse midwives improved significantly following the course (from a mean of 65% correct pretraining to 84% correct post-training and from 65% to 77% correct on the performance and written evaluations, respectively). The ENC course written evaluation was validated and both tools allowed evaluation of the ENC course training. We found significant improvements in trainees' knowledge and skills in essential newborn care following the WHO ENC course; however, lack of basic resources may have limited the application of the ENC guidelines. Implementation of the ENC course should be undertaken in consideration with the local conditions available for newborn care.

Zambian Peer Educators for HIV Self-Testing (ZEST) study: rationale and design of a cluster randomised trial of HIV self-testing among female sex workers in Zambia.

PubMed

Oldenburg, Catherine E; Ortblad, Katrina F; Chanda, Michael M; Mwanda, Kalasa; Nicodemus, Wendy; Sikaundi, Rebecca; Fullem, Andrew; Barresi, Leah G; Harling, Guy; Bärnighausen, Till

2017-04-20

HIV testing and knowledge of status are starting points for HIV treatment and prevention interventions. Among female sex workers (FSWs), HIV testing and status knowledge remain far from universal. HIV self-testing (HIVST) is an alternative to existing testing services for FSWs, but little evidence exists how it can be effectively and safely implemented. Here, we describe the rationale and design of a cluster randomised trial designed to inform implementation and scale-up of HIVST programmes for FSWs in Zambia. The Zambian Peer Educators for HIV Self-Testing (ZEST) study is a 3-arm cluster randomised trial taking place in 3 towns in Zambia. Participants (N=900) are eligible if they are women who have exchanged sex for money or goods in the previous 1 month, are HIV negative or status unknown, have not tested for HIV in the previous 3 months, and are at least 18 years old. Participants are recruited by peer educators working in their communities. Participants are randomised to 1 of 3 arms: (1) direct distribution (in which they receive an HIVST from the peer educator directly); (2) fixed distribution (in which they receive a coupon with which to collect the HIVST from a drug store or health post) or (3) standard of care (referral to existing HIV testing services only, without any offer of HIVST). Participants are followed at 1 and 4 months following distribution of the first HIVST. The primary end point is HIV testing in the past month measured at the 1-month and 4-month visits. This study was approved by the Institutional Review Boards at the Harvard T.H. Chan School of Public Health in Boston, USA and ERES Converge in Lusaka, Zambia. The findings of this trial will be presented at local, regional and international meetings and submitted to peer-reviewed journals for publication. Pre-results; NCT02827240. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study.

PubMed

Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C

2015-09-11

Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women's preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia. We conducted ten focus group discussions (n = 100) with women of reproductive age (15-45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored. Our findings show that women's lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them. Our findings suggest a need to empower women with decision-making skills

Understanding private sector antimalarial distribution chains: a cross-sectional mixed methods study in six malaria-endemic countries.

PubMed

Palafox, Benjamin; Patouillard, Edith; Tougher, Sarah; Goodman, Catherine; Hanson, Kara; Kleinschmidt, Immo; Rueda, Sergio Torres; Kiefer, Sabine; O'Connell, Kathryn A; Zinsou, Cyprien; Phok, Sochea; Akulayi, Louis; Arogundade, Ekundayo; Buyungo, Peter; Mpasela, Felton; Chavasse, Desmond

2014-01-01

Private for-profit outlets are important treatment sources for malaria in most endemic countries. However, these outlets constitute only the last link in a chain of businesses that includes manufacturers, importers and wholesalers, all of which influence the availability, price and quality of antimalarials patients can access. We present evidence on the composition, characteristics and operation of these distribution chains and of the businesses that comprise them in six endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia). We conducted nationally representative surveys of antimalarial wholesalers during 2009-2010 using an innovative sampling approach that captured registered and unregistered distribution channels, complemented by in-depth interviews with a range of stakeholders. Antimalarial distribution chains were pyramidal in shape, with antimalarials passing through a maximum of 4-6 steps between manufacturer and retailer; however, most likely pass through 2-3 steps. Less efficacious non-artemisinin therapies (e.g. chloroquine) dominated weekly sales volumes among African wholesalers, while volumes for more efficacious artemisinin-based combination therapies (ACTs) were many times smaller. ACT sales predominated only in Cambodia. In all countries, consumer demand was the principal consideration when selecting products to stock. Selling prices and reputation were key considerations regarding supplier choice. Business practices varied across countries, with large differences in the proportions of wholesalers offering credit and delivery services to customers, and the types of distribution models adopted by businesses. Regulatory compliance also varied across countries, particularly with respect to licensing. The proportion of wholesalers possessing any up-to-date licence from national regulators was lowest in Benin and Nigeria, where vendors in traditional markets are important antimalarial supply sources. The structure

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia

PubMed Central

Kapata, Nathan; Maboshe, Mwendaweli; Michelo, Charles; Babaniyi, Olusegun

2015-01-01

Background Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates. Aim We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB. Setting This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. Methods We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities. Results Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications. Conclusion Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS). PMID:26245591

"These things are dangerous": Understanding induced abortion trajectories in urban Zambia.

PubMed

Coast, Ernestina; Murray, Susan F

2016-03-01

Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather

Effectiveness of a girls' empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial.

PubMed

Sandøy, Ingvild Fossgard; Mudenda, Mweetwa; Zulu, Joseph; Munsaka, Ecloss; Blystad, Astrid; Makasa, Mpundu C; Mæstad, Ottar; Tungodden, Bertil; Jacobs, Choolwe; Kampata, Linda; Fylkesnes, Knut; Svanemyr, Joar; Moland, Karen Marie; Banda, Richard; Musonda, Patrick

2016-12-09

Adolescent pregnancies pose a risk to the young mothers and their babies. In Zambia, 35% of young girls in rural areas have given birth by the age of 18 years. Pregnancy rates are particularly high among out-of-school girls. Poverty, low enrolment in secondary school, myths and community norms all contribute to early childbearing. This protocol describes a trial aiming to measure the effect on early childbearing rates in a rural Zambian context of (1) economic support to girls and their families, and (2) combining economic support with a community intervention to enhance knowledge about sexual and reproductive health and supportive community norms. This cluster randomized controlled trial (CRCT) will have three arms. The clusters are rural schools with surrounding communities. Approximately 4900 girls in grade 7 in 2016 will be recruited from 157 schools in 12 districts. In one intervention arm, participating girls and their guardians will be offered cash transfers and payment of school fees. In the second intervention arm, there will be both economic support and a community intervention. The interventions will be implemented for approximately 2 years. The final survey will be 4.5 years after recruitment. The primary outcomes will be "incidence of births within 8 months of the end of the intervention period", "incidence of births before girls' 18th birthday" and "proportion of girls who sit for the grade 9 exam". Final survey interviewers will be unaware of the intervention status of respondents. Analysis will be by intention-to-treat and adjusted for cluster design and confounders. Qualitative process evaluation will be conducted. This is the first CRCT to measure the effect of combining economic support with a community intervention to prevent adolescent childbearing in a low- or middle-income country. We have designed a programme that will be sustainable and feasible to scale up. The findings will be relevant for programmes for adolescent reproductive health in

An Audit of Skills and Qualifications in Preservation and Conservation Techniques: The Case of the University of Zambia Libraries

ERIC Educational Resources Information Center

Shameenda, Kimbo Lemmy; Kanyengo, Christine Wamunyima

2012-01-01

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…

How we implemented an analytical support clinic to strengthen student research capacity in Zambia.

PubMed

Andrews, Ben; Musonda, Patrick; Simuyemba, Moses; Wilson, Craig M; Nzala, Selestine; Vermund, Sten H; Michelo, Charles

2014-12-11

Abstract Background: Research outputs in sub-Saharan Africa may be limited by a scarcity of clinical research expertise. In Zambia, clinical and biomedical postgraduate students are often delayed in graduation due to challenges in completing their research dissertations. We sought to strengthen institutional research capacity by supporting student and faculty researchers through weekly epidemiology and biostatistics clinics. Methods: We instituted a weekly Analytical Support Clinic at the University of Zambia, School of Medicine. A combination of biostatisticians, clinical researchers and epidemiologists meet weekly with clients to address questions of proposal development, data management and analysis. Clinic sign-in sheets were reviewed. Results: 109 students and faculty members accounted for 197 visits to the Clinic. Nearly all clients (107/109, 98.2%) were undergraduate or postgraduate students. Reasons for attending the Clinic were primarily for proposal development (46.7%) and data management/analysis (42.1%). The most common specific reasons for seeking help were data analysis and interpretation (36.5%), development of study design and research questions (26.9%) and sample size calculation (21.8%). Conclusions: The Analytical Support Clinic is an important vehicle for strengthening postgraduate research through one-on-one and small group demand-driven interactions. The clinic approach supplements mentorship from departmental supervisors, providing specific expertise and contextual teaching.

Early Childhood Care and Education in Zambia: An Integral Part of Educational Provision?

ERIC Educational Resources Information Center

Thomas, Carolyn M.; Thomas, Matthew A. M.

2009-01-01

The field of international development has recently been consumed by a shift in contemporary educational discourse, one that moves Early Childhood Care and Education (ECCE) closer to the forefront of what is considered progressive policy formation. In Zambia, the current educational environment seems to indicate that the creation and continued…

Factors Related to Pre-Service Teachers' Attitudes towards Inclusion: A Case for Zambia

ERIC Educational Resources Information Center

Muwana, Florence Chuzu; Ostrosky, Michaelene M.

2014-01-01

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…

Further evidence for geographic differentiation in R. appendiculatus (Acari: Ixodidae) from Eastern and Southern provinces of Zambia.

PubMed

Mtambo, Jupiter; Madder, Maxime; Van Bortel, Wim; Chaka, George; Berkvens, Dirk; Backeljau, Thierry

2007-01-01

Studies in the biology, ecology and behaviour of R. appendiculatus in Zambia have shown considerable variation within and between populations often associated with their geographical origin. We studied variation in the mitochondrial COI (mtCOI) gene of adult R. appendiculatus ticks originating from the Eastern and Southern provinces of Zambia. Rhipicephalus appendiculatus ticks from the two provinces were placed into two groups on the mtCOI sequence data tree. One group comprised all haplotypes of specimens from the Eastern province plateau districts of Chipata and Petauke. The second group consisted of a single haplotype of specimens from the Southern province districts and Nyimba, an Eastern province district on the fringes of the valley. This variation provides additional evidence to the earlier observations in the 12S rDNA and ITS2 data for the geographic subdivision of R. appendiculatus from Southern province and Eastern province plateau. The geographic subdivision further corresponds with differences in body size and diapause between R. appendiculatus from these geographic areas. The possible implications of these findings on the epidemiology of East Coast fever (ECF) the disease for which R. appendiculatus is one of the vectors are discussed.

A survey of pre-harvest ear rot diseases of maize and associated mycotoxins in south and central Zambia.

PubMed

Mukanga, Mweshi; Derera, John; Tongoona, Pangirayi; Laing, Mark D

2010-07-15

Maize ear rots reduce grain yield and quality with implication on food security and health. Some of the pathogenic fungi produce mycotoxins in maize grain posing a health risk to humans and livestock. Unfortunately, the levels of ear rot and mycotoxin infection in grain produced by subsistence farmers in sub-Saharan countries are not known. A survey was thus conducted to determine the prevalence of the ear rot problem and levels of mycotoxins in maize grain. A total of 114 farmsteads were randomly sampled from 11 districts in Lusaka and southern provinces in Zambia during 2006. Ten randomly picked cobs were examined per farmstead and the ear rot disease incidence and severity were estimated on site. This was followed by the standard seed health testing procedures for fungal isolation in the laboratory. Results indicated that the dominant ear rots were caused by Fusarium and Stenocarpella. Incidence of Fusarium verticillioides ranged from 2 to 21%, whereas that of Stenocarpella maydis reached 37% on ear rot diseased maize grain. In addition, 2-7% F. verticillioides, and 3-18% Aspergillus flavus, respectively, were recovered from seemingly healthy maize grain. The mean rank of fungal species, from highest to lowest, was F. verticillioides, S. maydis, A. flavus, Fusarium graminearum, Aspergillus niger, Penicillium spp., Botrydiplodia spp., and Cladosporium spp. The direct competitive ELISA-test indicated higher levels of fumonisins than aflatoxins in pre-harvest maize grain samples. The concentration of fumonisins from six districts, and aflatoxin from two districts, was 10-fold higher than 2 ppm and far higher than 2 ppb maximum daily intake recommended by the FAO/WHO. The study therefore suggested that subsistence farmers and consumers in this part of Zambia, and maybe also in similar environments in sub-Saharan Africa, might be exposed to dangerous levels of mycotoxins due to the high levels of ear rot infections in maize grain. 2010 Elsevier B.V. All rights

Overburden, Stigma, and Perceived Agency: Teachers as HIV Prevention Educators in Urban Zambia

PubMed Central

Henning, Margaret; Khanna, Sunil K.

2016-01-01

Sub-Saharan Africa is home to more than 70% of the global HIV-positive population. In Zambia, as well as in other parts of Africa, deaths from AIDS and associated infections have created a generation of households headed by children, a situation that negatively affects the chances for economic and health improvements in the region. In contemplating possible public health interventions around HIV prevention, we found that a growing body of research advocates for school-based HIV programs as an effective strategy to stop the spread of the disease. This work is critical because it explores schoolteachers' perspectives on their potential roles as HIV prevention educators. Semi-structured interviews (n = 12) were conducted among schoolteachers in the Lusaka province of Zambia to collect qualitative data. Analysis of qualitative data revealed three broad and interconnected themes related to the roles and concerns of the participating teachers: 1) the role of overburden; 2) fear of stigma; and 3) perceived lack of agency. These themes are further discussed in the context of the results that focused on the teachers and the adoption of HIV education. Little is known about teachers' perceptions of themselves as HIV educators. Our study suggests that understanding teachers' perceptions and the contextual factors is crucial to the adoption of school-based HIV programs. PMID:29546161

Examining Specific Effects of Context on Adaptive Behavior and Achievement in Rural Africa: Six Case Studies from Southern Province, Zambia

PubMed Central

Reich, Jodi; Hart, Lesley; Thuma, Philip E.

2011-01-01

Generally accepted as universal, the construct of adaptive behavior differs in its manifestations across different cultures and settings. The Vineland-II 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

Zambia : long-term generation expansion study - executive summary.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conzelmann, G.; Koritarov, V.; Buehring, W.

2008-02-28

The objective of this study is to analyze possible long-term development options of the Zambian electric power system in the period up to 2015. The analysis involved the hydro operations studies of the Zambezi river basin and the systems planning studies for the least-cost generation expansion planning. Two well-known and widely accepted computer models were used in the analysis: PC-VALORAGUA model for the hydro operations and optimization studies and the WASP-III Plus model for the optimization of long-term system development. The WASP-III Plus model is a part of the Argonne National Laboratory's Energy and Power Evaluation Model (ENPEP). The analysismore » was conducted in close collaboration with the Zambia Electricity Supply Corporation (ZESCO). On the initiative from The World Bank, the sponsor of the study, ZESCO formed a team of experts that participated in the analysis and were trained in the use of computer models. Both models were transferred to ZESCO free of charge and installed on several computers in the ZESCO corporate offices in Lusaka. In September-October 1995, two members of the ZESCO National Team participated in a 4-week training course at Argonne National Laboratory near Chicago, U.S.A., focusing on the long-term system expansion planning using the WASP and VALORAGUA models. The hydropower operations studies were performed for the whole Zambezi river basin, including the full installation of the Kariba power station, and the Cahora Bassa hydro power station in Mozambique. The analysis also included possible future projects such as Itezhi-Tezhi, Kafue Gorge Lower, and Batoka Gorge power stations. As hydropower operations studies served to determine the operational characteristics of the existing and future hydro power plants, it was necessary to simulate the whole Zambezi river basin in order to take into account all interactions and mutual influences between the hydro power plants. In addition, it allowed for the optimization of reservoir

Socio-economic gradients in prevalent tuberculosis in Zambia and the Western Cape of South Africa.

PubMed

Yates, Tom A; Ayles, Helen; Leacy, Finbarr P; Schaap, A; Boccia, Delia; Beyers, Nulda; Godfrey-Faussett, Peter; Floyd, Sian

2018-04-01

To describe the associations between socio-economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era. The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio-economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients. The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33-0.92) times and 0.70 (95% CI 0.54-0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university-educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12-0.54) and 0.42 (95% CI 0.25-0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status. These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics. © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Vocational Guidance for Equal Access and Opportunity for Girls and Women in Technical and Vocational Education. UNEVOC Studies in Technical and Vocational Education 6.

ERIC Educational Resources Information Center

Miller, Juliet V.; Vetter, Louise

A study examined the relevance of vocational information and guidance for the equal access of girls and women to technical/vocational education in the following countries: Argentina; India; Mexico; Republic of Korea; South Africa; Spain; Sweden; Turkey; United Arab Emirates; and Zambia. Case studies were conducted by using a multiple-strategy…

Scarcity of protective items against HIV and other bloodborne infections in 13 low- and middle-income countries.

PubMed

Gupta, Shailvi; Wong, Evan G; Kushner, Adam L

2014-11-01

To assess protection of surgical healthcare workers against HIV and other bloodborne infections in low- and middle-income countries (LMICs). Literature review based on recent studies assessing baseline surgical capacity in LMICs using the WHO Situational Analysis of Access to Emergency and Essential Surgical Care, the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey and the Harvard Humanitarian Initiative survey tools. The availability of protective eyewear, sterile gloves and sterilisers was assessed. Thirteen individual country studies with relevant data were identified documenting items from 399 hospitals. The countries included Afghanistan, Bolivia, Gambia, Ghana, Liberia, Mongolia, Nigeria, Sierra Leone, Solomon Islands, Somalia, Sri Lanka, Tanzania and Zambia. Overall, only 29% (79/270) of hospitals always had eye protection. Sterilisers were only available at 64% (244/383) of facilities. Sterile gloves were the most available item, available at 75% of facilities (256/340). Surgical healthcare worker protection for bloodborne infections continues to be deficient in LMICs. Improved documentation of these items should be incorporated into future surgical capacity studies. Policy makers and clinicians should work together to secure resources and interventions that will protect this vital workforce. © 2014 John Wiley & Sons Ltd.

Assessing the consequences of stigma for tuberculosis patients in urban Zambia.

PubMed

Cremers, Anne Lia; de Laat, Myrthe Manon; Kapata, Nathan; Gerrets, Rene; Klipstein-Grobusch, Kerstin; Grobusch, Martin Peter

2015-01-01

Stigma is one of the many factors hindering tuberculosis (TB) control by negatively affecting hospital delay and treatment compliance. In Zambia, the morbidity and mortality due to TB remains high, despite extended public health attempts to control the epidemic and to diminish stigma. To enhance understanding of TB-related stigmatizing perceptions and to describe TB patients' experiences of stigma in order to point out recommendations to improve TB policy. We conducted a mixed method study at Kanyama clinic and surrounding areas, in Lusaka, Zambia; structured interviews with 300 TB patients, multiple in-depth interviews with 30 TB patients and 10 biomedical health workers, 3 focus group discussions with TB patients and treatment supporters, complemented by participant observation and policy analysis of the TB control program. Predictors of stigma were identified by use of multivariate regression analyses; qualitative analysis of the in-depth interviews, focus group discussions and participant observation was used for triangulation of the study findings. We focused on the 138/300 patients that described TB-related perceptions and attitudes, of whom 113 (82%) reported stigma. Stigma provoking TB conceptions were associated with human immunodeficiency virus (HIV)-infection, alleged immoral behaviour, (perceived) incurability, and (traditional) myths about TB aetiology. Consequences of stigma prevailed both among children and adults and included low self-esteem, insults, ridicule, discrimination, social exclusion, and isolation leading to a decreased quality of life and social status, non-disclosure, and/or difficulties with treatment compliance and adherence. Women had significantly more stigma-related problems than men. The findings illustrate that many TB patients faced stigma-related issues, often hindering effective TB control and suggesting that current efforts to reduce stigma are not yet optimal. The content and implementation of sensitization programs should

Organization of Distance Education at the University of Zambia: An Analysis of the Practice.

ERIC Educational Resources Information Center

Nyirenda, Juma E.

1989-01-01

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…

Diabetes mellitus and comorbid depression in Zambia.

PubMed

Hapunda, G; Abubakar, A; Pouwer, F; van de Vijver, F

2015-06-01

To replicate, in Zambia, a recent global study by the WHO, which reported that the odds of depression were not increased in African people with diabetes, and to explore the sociodemographic and clinical factors associated with depression. A total of 773 control subjects and 157 Zambian patients with diabetes completed the Major Depression Inventory and a list of demographic indicators. Compared with control subjects (mean ± sd Major Depression Inventory score 15.10 ± 9.19), depressive symptoms were significantly more common in patients with diabetes (mean ± sd Major Depression Inventory score 19.12 ± 8.95; P < 0.001). ancova showed that having diabetes [F(1,698) = 16.50, P < 0.001], being female [F(1,698) = 7.35, P < 0.01] and having low socio-economic status (F(1,698) = 13.35, P < 0.001) were positive predictors of depression. Contrary to the WHO study, we found that depression was a common comorbid health problem among Zambian people with diabetes. Clinicians should consider patients' health status, sex and socio-economic status as potential factors predicting depression. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.

PubMed

Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí

2010-09-17

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. 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. 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. 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

What Can We Learn About the Processes of Regulation of Tuberculosis Medicines From the Experiences of Health Policy and System Actors in India, Tanzania, and Zambia?

PubMed

Sheikh, Kabir; Uplekar, Mukund

2016-03-09

The unregulated availability and irrational use of tuberculosis (TB) medicines is a major issue of public health concern globally. Governments of many low- and middle-income countries (LMICs) have committed to regulating the quality and availability of TB medicines, but with variable success. Regulation of TB medicines remains an intractable challenge in many settings, but the reasons for this are poorly understood. The objective of this paper is to elaborate processes of regulation of quality and availability of TB medicines in three LMICs - India, Tanzania, and Zambia - and to understand the factors that constrain and enable these processes. We adopted the action-centred approach of policy implementation analysis that draws on the experiences of relevant policy and health system actors in order to understand regulatory processes. We drew on data from three case studies commissioned by the World Health Organization (WHO), on the regulation of TB medicines in India, Tanzania, and Zambia. Qualitative research methods were used, including in-depth interviews with 89 policy and health system actors and document review. Data were organized thematically into accounts of regulators' authority and capacity; extent of policy implementation; and efficiency, transparency, and accountability. In India, findings included the absence of a comprehensive policy framework for regulation of TB medicines, constraints of authority and capacity of regulators, and poor implementation of prescribing and dispensing norms in the majority private sector. Tanzania had a policy that restricted import, prescribing and dispensing of TB medicines to government operators. Zambia procured and dispensed TB medicines mainly through government services, albeit in the absence of a single policy for restriction of medicines. Three cross-cutting factors emerged as crucially influencing regulatory processes - political and stakeholder support for regulation, technical and human resource capacity of

Place of Delivery Associated With Postnatal Care Utilization Among Childbearing Women in Zambia.

PubMed

Chungu, Charles; Makasa, Mpundu; Chola, Mumbi; Jacobs, Choolwe Nkwemu

2018-01-01

Postnatal care (PNC) utilization is critical to the prevention of maternal morbidity and mortality. Despite its importance, the proportion of women utilizing this service is still low in Zambia. We investigated if place of delivery was associated with PNC utilization in the first 48 h among childbearing women in Zambia. Data from the 2013/14 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported giving birth in the 2 years preceding the survey was used. The data comprised of sociodemographic and other obstetric data, which were cleaned, recoded, and analyzed using STATA version 13 (Stata Corporation, College Station, TX, USA). Multivariate logistic regression was used to examine the association of place of delivery and other background variables. Women who delivered in a health facility were more likely to utilize PNC in the first 48 h compared to those who did not deliver in a health facility: government hospital (AOR 7.24, 95% CI 4.92-11.84), government health center/clinic (AOR 7.15 95% CI 4.79-10.66), other public sector (AOR 23.2 95% CI 3.69-145.91), private hospital/clinic (AOR 10.08 95% CI 3.35-30.35), and Mission hospital/clinic (AOR 8.56 95% CI 4.71-15.53). Additionally, women who were attended to by a skilled personnel during delivery of the baby were more likely to utilize PNC (AOR 2.30, 95% CI 1.57-3.37). Women from rural areas were less likely to utilize PNC in the first 48 h (AOR 0.70, 95% CI 0.53-0.90). Place of delivery was found to be linked with PNC utilization in this population although access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the rural and poor groups, interventions should aim to reach this group. The study results will help program managers to increase access to health facility delivery and direct interventional efforts toward the affected subpopulations, such as the young and rural women. Furthermore, results will help

Gastrointestinal pathology in the University Teaching Hospital, Lusaka, Zambia: review of endoscopic and pathology records.

PubMed

Kelly, Paul; Katema, Mwamba; Amadi, Beatrice; Zimba, Lameck; Aparicio, Sylvia; Mudenda, Victor; Baboo, K Sridutt; Zulu, Isaac

2008-02-01

There is a shortage of information on the epidemiology of digestive disease in developing countries. In the belief that such information will inform public health priorities and epidemiological comparisons between different geographical regions, we analysed 2132 diagnostic upper gastrointestinal endoscopy records from 1999 to 2005 in the University Teaching Hospital, Lusaka, Zambia. In order to clarify unexpected impressions about the age distribution of cancers, a retrospective analysis of pathology records was also undertaken. No abnormality was found in 31% of procedures, and in 42% of procedures in children. In patients with gastrointestinal haemorrhage, the common findings were oesophageal varices (26%), duodenal ulcer (17%) and gastric ulcer (12%). Gastrointestinal malignancy was found in 8.8% of all diagnostic procedures, in descending order of frequency: gastric adenocarcinoma, oesophageal squamous carcinoma, Kaposi's sarcoma, oesophageal adenocarcinoma. Data from endoscopy records and pathology records strongly suggest that the incidence in adults under the age of 45 years is higher than in the USA or UK, and pathology records suggest that this effect is particularly marked for colorectal carcinoma.

A population-based cohort study of stillbirth among twins in Lusaka, Zambia.

PubMed

Stringer, Elizabeth M; Chibwesha, Carla; Stoner, Marie; Vwalika, Bellington; Joseph, Jessica; Chi, Benjamin H; Kaunda, Eugene; Goodnight, William; Stringer, Jeffrey S A

2015-07-01

To determine rates of stillbirth and the associated risk factors for stillbirth among twins delivered in Lusaka, Zambia. A retrospective cohort analysis was conducted of singletons and twins delivered at 26 public sector facilities between February 1, 2006, and May 31, 2013. Data were obtained from the Zambian Electronic Perinatal Record System. Risk of stillbirth was estimated using logistic regression. Overall, 260 657 singletons and 4021 twin pairs were included. There were 5105 stillbirths; 317 twins were stillborn. The crude stillbirth rate for twins was 39.4 per 1000 births (95% confidence interval [CI] 35.2-43.7) whereas the rate for singletons was 18.4 per 1000 births (95% CI 17.9-18.9; P<0.001). Factors associated with stillbirth among twins were increased interval between delivery (>60 minutes), low birth weight (<2500 g), birth order (being the second-born), and difference in birth weights (>30% discordance). Twins were at an increased risk of stillbirth. Improved understanding of factors associated with stillbirth in this population could help to improve perinatal outcomes globally. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Incentives to change: effects of performance-based financing on health workers in Zambia.

PubMed

Shen, Gordon C; Nguyen, Ha Thi Hong; Das, Ashis; Sachingongu, Nkenda; Chansa, Collins; Qamruddin, Jumana; Friedman, Jed

2017-02-28

Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before-after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program. Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role

Estimating Loss to Follow-Up in HIV-Infected Patients on Antiretroviral Therapy: The Effect of the Competing Risk of Death in Zambia and Switzerland

PubMed Central

Mwango, Albert; Stringer, Jeffrey; Ledergerber, Bruno; Mulenga, Lloyd; Bucher, Heiner C.; Westfall, Andrew O.; Calmy, Alexandra; Boulle, Andrew; Chintu, Namwinga; Egger, Matthias; Chi, Benjamin H.

2011-01-01

Background Loss to follow-up (LTFU) is common in antiretroviral therapy (ART) programmes. Mortality is a competing risk (CR) for LTFU; however, it is often overlooked in cohort analyses. We examined how the CR of death affected LTFU estimates in Zambia and Switzerland. Methods and Findings HIV-infected patients aged ≥18 years who started ART 2004–2008 in observational cohorts in Zambia and Switzerland were included. We compared standard Kaplan-Meier curves with CR cumulative incidence. We calculated hazard ratios for LTFU across CD4 cell count strata using cause-specific Cox models, or Fine and Gray subdistribution models, adjusting for age, gender, body mass index and clinical stage. 89,339 patients from Zambia and 1,860 patients from Switzerland were included. 12,237 patients (13.7%) in Zambia and 129 patients (6.9%) in Switzerland were LTFU and 8,498 (9.5%) and 29 patients (1.6%), respectively, died. In Zambia, the probability of LTFU was overestimated in Kaplan-Meier curves: estimates at 3.5 years were 29.3% for patients starting ART with CD4 cells <100 cells/µl and 15.4% among patients starting with ≥350 cells/µL. The estimates from CR cumulative incidence were 22.9% and 13.6%, respectively. Little difference was found between naïve and CR analyses in Switzerland since only few patients died. The results from Cox and Fine and Gray models were similar: in Zambia the risk of loss to follow-up and death increased with decreasing CD4 counts at the start of ART, whereas in Switzerland there was a trend in the opposite direction, with patients with higher CD4 cell counts more likely to be lost to follow-up. Conclusions In ART programmes in low-income settings the competing risk of death can substantially bias standard analyses of LTFU. The CD4 cell count and other prognostic factors may be differentially associated with LTFU in low-income and high-income settings. PMID:22205933

Health and agricultural productivity: Evidence from Zambia.

PubMed

Fink, Günther; Masiye, Felix

2015-07-01

We evaluate the productivity effects of investment in preventive health technology through a randomized controlled trial in rural Zambia. In the experiment, access to subsidized bed nets was randomly assigned at the community level; 516 farmers were followed over a one-year farming period. We find large positive effects of preventative health investment on productivity: among farmers provided with access to free nets, harvest value increased by US$ 76, corresponding to about 14.7% of the average output value. While only limited information was collected on farming inputs, shifts in the extensive and the intensive margins of labor supply appear to be the most likely mechanism underlying the productivity improvements observed. Copyright © 2015 Elsevier B.V. All rights reserved.

The zoonotic potential of avian influenza viruses isolated from wild waterfowl in Zambia.

PubMed

Simulundu, Edgar; Nao, Naganori; Yabe, John; Muto, Nilton A; Sithebe, Thami; Sawa, Hirofumi; Manzoor, Rashid; Kajihara, Masahiro; Muramatsu, Mieko; Ishii, Akihiro; Ogawa, Hirohito; Mweene, Aaron S; Takada, Ayato

2014-10-01

Whilst remarkable progress in elucidating the mechanisms governing interspecies transmission and pathogenicity of highly pathogenic avian influenza viruses (AIVs) has been made, similar studies focusing on low-pathogenic AIVs isolated from the wild waterfowl reservoir are limited. We previously reported that two AIV strains (subtypes H6N2 and H3N8) isolated from wild waterfowl in Zambia harbored some amino acid residues preferentially associated with human influenza virus proteins (so-called human signatures) and replicated better in the lungs of infected mice and caused more morbidity than a strain lacking such residues. To further substantiate these observations, we infected chickens and mice intranasally with AIV strains of various subtypes (H3N6, H3N8, H4N6, H6N2, H9N1 and H11N9) isolated from wild waterfowl in Zambia. Although some strains induced seroconversion, all of the tested strains replicated poorly and were nonpathogenic for chickens. In contrast, most of the strains having human signatures replicated well in the lungs of mice, and one of these strains caused severe illness in mice and induced lung injury that was characterized by a severe accumulation of polymorphonuclear leukocytes. These results suggest that some strains tested in this study may have the potential to infect mammalian hosts directly without adaptation, which might possibly be associated with the possession of human signature residues. Close monitoring and evaluation of host-associated signatures may help to elucidate the prevalence and emergence of AIVs with potential for causing zoonotic infections.

Enhancing Harmonization to Ensure Alignment of Partners, Implementation and Priorities for Provision of Quality Primary Healthcare to Communities in Rural Zambia.

PubMed

Goma, Fastone M

2017-01-01

This paper discusses the processes of harmonization of various approaches by partners that have been implemented in Zambia, in an attempt to overcome the fragmented implementation of Community based primary healthcare (CBPHC) systems strengthening, facilitated by multiple non-governmental organizations (NGOs) and donors, impeding country ownership and nationalization. To achieve equitable and sustained improvements in health, social and economic development outcomes for all, there is evidence that governments should consider building CBPHC systems based on three legs namely: 1. Front-line health workers trained, supervised and able to deliver services; 2. Community engagement through interactions to enhance community participation and Social Accountability for delivery of healthcare services; 3. Enabling environments through strengthening of community health systems. To realize a harmonized approach and alignments, the government and key stakeholders must uphold a common vision ensuring that all the three legs of CBPHC systems are implemented to scale. In evaluating the health system in Zambia and the related healthcare provision at community level, gaps were identified in the available mechanisms for the provision of quality CBPHC thus necessitating processes of harmonization, that include capacity building and orientations at all levels on importance of taking to scale the three legs of CBPHC systems, revision of the Community Health Strategy, and elaboration of Operational Guide for Neighbourhood Health Committees, clarifying the role of NHC as platform for community engagement and Community-Based Volunteers (CBVs). There is need for harmonization of health systems at national, provincial, district, zonal and communal levels to ensure the delivery of quality, cost-effective healthcare as close to the family as possible.

Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study.

PubMed

Berrueta, Mabel; Cafferata, Maria Luisa; Mwenechanya, Musaku; Nkamba Mukadi, Dalau; Althabe, Fernando; Bergel, Eduardo; Gibbons, Luz; Ciganda, Alvaro; Klein, Karen; Mwapule Tembo, Abigail; Habulembe Mwanakalanga, Friday; Banda, Ernest; Mavila Kilonga, Arlette; Lusamba Dikassa, Paul; Xiong, Xu; Chomba, Elwyn; Tshefu, Antoinette K; Buekens, Pierre

2017-12-08

Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women's characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers' practices to increase screening and treatment rates when supplies are available.

Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study

PubMed Central

Berrueta, Mabel; Cafferata, Maria Luisa; Mwenechanya, Musaku; Nkamba Mukadi, Dalau; Althabe, Fernando; Bergel, Eduardo; Gibbons, Luz; Ciganda, Alvaro; Klein, Karen; Mwapule Tembo, Abigail; Habulembe Mwanakalanga, Friday; Banda, Ernest; Mavila Kilonga, Arlette; Lusamba Dikassa, Paul; Xiong, Xu; Chomba, Elwyn; Tshefu, Antoinette K.; Buekens, Pierre

2017-01-01

Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women’s characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers’ practices to increase screening and treatment rates when supplies are available. PMID:29355227

An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia

PubMed Central

2011-01-01

Background Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. Methods The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. Results All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. Conclusions Six gaps which could impact on the policies' effect

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis

PubMed Central

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-01

Objectives Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Setting Women's experience of user fees in 5 African countries. Primary and secondary outcome measures Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities’ births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries’ choice. Participants We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). Results User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Conclusions Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. PMID:26823178

Innovative approaches to promoting cervical health and raising cervical cancer awareness by use of existing cultural structures in resource-limited countries: experiences with traditional marriage counseling in Zambia.

PubMed

Kapambwe, Sharon; Parham, Groesbeck; Mwanahamuntu, Mulindi; Chirwa, Susan; Mwanza, Jacob; Amuyunzu-Nyamongo, Mary

2013-12-01

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.

Analysis of the study skills of undergraduate pharmacy students of the University of Zambia School of Medicine.

PubMed

Ezeala, Christian Chinyere; Siyanga, Nalucha

2015-01-01

It aimed to compare the study skills of two groups of undergraduate pharmacy students in the School of Medicine, University of Zambia using the Study Skills Assessment Questionnaire (SSAQ), with the goal of analysing students' study skills and identifying factors that affect study skills. A questionnaire was distributed to 67 participants from both programs using stratified random sampling. Completed questionnaires were rated according to participants study skill. The total scores and scores within subscales were analysed and compared quantitatively. Questionnaires were distributed to 37 students in the regular program, and to 30 students in the parallel program. The response rate was 100%. Students had moderate to good study skills: 22 respondents (32.8%) showed good study skills, while 45 respondents (67.2%) were found to have moderate study skills. Students in the parallel program demonstrated significantly better study skills (mean SSAQ score, 185.4±14.5), particularly in time management and writing, than the students in the regular program (mean SSAQ score 175±25.4; P<0.05). No significant differences were found according to age, gender, residential or marital status, or level of study. The students in the parallel program had better time management and writing skills, probably due to their prior work experience. The more intensive training to students in regular program is needed in improving time management and writing skills.

An Investigation into Challenges Faced by Secondary School Teachers and Pupils in Algebraic Linear Equations: A Case of Mufulira District, Zambia

ERIC Educational Resources Information Center

Samuel, Koji; Mulenga, H. M.; Angel, Mukuka

2016-01-01

This paper investigates the challenges faced by secondary school teachers and pupils in the teaching and learning of algebraic linear equations. The study involved 80 grade 11 pupils and 15 teachers of mathematics, drawn from 4 selected secondary schools in Mufulira district, Zambia in Central Africa. A descriptive survey method was employed to…

Two new planthopper species (Hemiptera, Fulgoroidea, Caliscelidae) collected in pitfall traps in Zambia.

PubMed

Chmurova, Lucia; Webb, Michael D

2016-08-22

Two new species of planthoppers in the family Caliscelidae (Hemiptera: Fulgoroidea) are described from Zambia, i.e., Afronaso spinosa sp. n. and Calampocus zambiaensis sp. n. All specimens are flightless males and nearly all were collected from baited pitfall traps (except for one specimen collected from a yellow pan trap), suggesting that they live near to or on the ground.

Population-Level Scale-Up of Cervical Cancer Prevention Services in a Low-Resource Setting: Development, Implementation, and Evaluation of the Cervical Cancer Prevention Program in Zambia

PubMed Central

Parham, Groesbeck P.; Mwanahamuntu, Mulindi H.; Kapambwe, Sharon; Muwonge, Richard; Bateman, Allen C.; Blevins, Meridith; Chibwesha, Carla J.; Pfaendler, Krista S.; Mudenda, Victor; Shibemba, Aaron L.; Chisele, Samson; Mkumba, Gracilia; Vwalika, Bellington; Hicks, Michael L.; Vermund, Sten H.; Chi, Benjamin H.; Stringer, Jeffrey S. A.; Sankaranarayanan, Rengaswamy; Sahasrabuddhe, Vikrant V.

2015-01-01

Background Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries. Methods In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Findings Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25–49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women. Interpretation We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment

Population-level scale-up of cervical cancer prevention services in a low-resource setting: development, implementation, and evaluation of the cervical cancer prevention program in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Kapambwe, Sharon; Muwonge, Richard; Bateman, Allen C; Blevins, Meridith; Chibwesha, Carla J; Pfaendler, Krista S; Mudenda, Victor; Shibemba, Aaron L; Chisele, Samson; Mkumba, Gracilia; Vwalika, Bellington; Hicks, Michael L; Vermund, Sten H; Chi, Benjamin H; Stringer, Jeffrey S A; Sankaranarayanan, Rengaswamy; Sahasrabuddhe, Vikrant V

2015-01-01

Very few efforts have been undertaken to scale-up low-cost approaches to cervical cancer prevention in low-resource countries. In a public sector cervical cancer prevention program in Zambia, nurses provided visual-inspection with acetic acid (VIA) and cryotherapy in clinics co-housed with HIV/AIDS programs, and referred women with complex lesions for histopathologic evaluation. Low-cost technological adaptations were deployed for improving VIA detection, facilitating expert physician opinion, and ensuring quality assurance. Key process and outcome indicators were derived by analyzing electronic medical records to evaluate program expansion efforts. Between 2006-2013, screening services were expanded from 2 to 12 clinics in Lusaka, the most-populous province in Zambia, through which 102,942 women were screened. The majority (71.7%) were in the target age-range of 25-49 years; 28% were HIV-positive. Out of 101,867 with evaluable data, 20,419 (20%) were VIA positive, of whom 11,508 (56.4%) were treated with cryotherapy, and 8,911 (43.6%) were referred for histopathologic evaluation. Most women (87%, 86,301 of 98,961 evaluable) received same-day services (including 5% undergoing same-visit cryotherapy and 82% screening VIA-negative). The proportion of women with cervical intraepithelial neoplasia grade 2 and worse (CIN2+) among those referred for histopathologic evaluation was 44.1% (1,735/3,938 with histopathology results). Detection rates for CIN2+ and invasive cervical cancer were 17 and 7 per 1,000 women screened, respectively. Women with HIV were more likely to screen positive, to be referred for histopathologic evaluation, and to have cervical precancer and cancer than HIV-negative women. We creatively disrupted the 'no screening' status quo prevailing in Zambia and addressed the heavy burden of cervical disease among previously unscreened women by establishing and scaling-up public-sector screening and treatment services at a population level. Key determinants

Beyond a Learning Society? It Is All to Be Done Again: Zambia and Zimbabwe

ERIC Educational Resources Information Center

Alexander, David

2006-01-01

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…

Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries

PubMed Central

Palafox, Benjamin; Patouillard, Edith; Tougher, Sarah; Goodman, Catherine; Hanson, Kara; Kleinschmidt, Immo; Rueda, Sergio Torres; Kiefer, Sabine; O’Connell, Kathryn A.; Zinsou, Cyprien; Phok, Sochea; Akulayi, Louis; Arogundade, Ekundayo; Buyungo, Peter; Mpasela, Felton; Chavasse, Desmond

2014-01-01

Background Private for-profit outlets are important treatment sources for malaria in most endemic countries. However, these outlets constitute only the last link in a chain of businesses that includes manufacturers, importers and wholesalers, all of which influence the availability, price and quality of antimalarials patients can access. We present evidence on the composition, characteristics and operation of these distribution chains and of the businesses that comprise them in six endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia). Methods and Findings We conducted nationally representative surveys of antimalarial wholesalers during 2009–2010 using an innovative sampling approach that captured registered and unregistered distribution channels, complemented by in-depth interviews with a range of stakeholders. Antimalarial distribution chains were pyramidal in shape, with antimalarials passing through a maximum of 4–6 steps between manufacturer and retailer; however, most likely pass through 2–3 steps. Less efficacious non-artemisinin therapies (e.g. chloroquine) dominated weekly sales volumes among African wholesalers, while volumes for more efficacious artemisinin-based combination therapies (ACTs) were many times smaller. ACT sales predominated only in Cambodia. In all countries, consumer demand was the principal consideration when selecting products to stock. Selling prices and reputation were key considerations regarding supplier choice. Business practices varied across countries, with large differences in the proportions of wholesalers offering credit and delivery services to customers, and the types of distribution models adopted by businesses. Regulatory compliance also varied across countries, particularly with respect to licensing. The proportion of wholesalers possessing any up-to-date licence from national regulators was lowest in Benin and Nigeria, where vendors in traditional markets are important

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

PubMed

Jacobs, Choolwe; Moshabela, Mosa; Maswenyeho, Sitali; Lambo, Nildah; Michelo, Charles

2017-01-01

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to

eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Pfaendler, Krista S; Sahasrabuddhe, Vikrant V; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L; Stringer, Jeffrey S A

2010-07-01

Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries. Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

Addressing the Human Resources for Health crisis in countries: How far have we gone? What can we expect to achieve by 2015?

PubMed

Dayrit, Manuel M; Dolea, Carmen; Dreesch, Norbert

2011-06-01

The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa. This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved.

Assessment of coalbed gas resources of the Kalahari Basin Province of Botswana, Zimbabwe, and Zambia, Africa, 2016

USGS Publications Warehouse

Brownfield, Michael E.; Schenk, Christopher J.; Klett, Timothy R.; Tennyson, Marilyn E.; Mercier, Tracey J.; Gaswirth, Stephanie B.; Marra, Kristen R.; Hawkins, Sarah J.; Finn, Thomas M.; Le, Phuong A.; Leathers-Miller, Heidi M.

2017-02-24

Using a geology-based assessment methodology, the U.S. Geological Survey estimated undiscovered, technically recoverable mean resources of 4.5 trillion cubic feet of coalbed gas in the Kalahari Basin Province of Botswana, Zambia, and Zimbabwe, Africa.

Financial accessibility and user fee reforms for maternal healthcare in five sub-Saharan countries: a quasi-experimental analysis.

PubMed

Leone, Tiziana; Cetorelli, Valeria; Neal, Sarah; Matthews, Zoë

2016-01-28

Evidence on whether removing fees benefits the poorest is patchy and weak. The aim of this paper is to measure the impact of user fee reforms on the probability of giving birth in an institution or undergoing a caesarean section (CS) in Ghana, Burkina Faso, Zambia, Cameroon and Nigeria for the poorest strata of the population. Women's experience of user fees in 5 African countries. Using quasi-experimental regression analysis we tested the impact of user fee reforms on facilities' births and CS differentiated by wealth, education and residence in Burkina Faso and Ghana. Mapping of the literature followed by key informant interviews are used to verify details of reform implementation and to confirm and support our countries' choice. We analysed data from consecutive surveys in 5 countries: 2 case countries that experienced reforms (Ghana and Burkina Faso) by contrast with 3 that did not experience reforms (Zambia, Cameroon, Nigeria). User fee reforms are associated with a significant percentage of the increase in access to facility births (27 percentage points) and to a much lesser extent to CS (0.7 percentage points). Poor (but not the poorest), and non-educated women, and those in rural areas benefitted the most from the reforms. User fees reforms have had a higher impact in Burkina Faso compared with Ghana. Findings show a clear positive impact on access when user fees are removed, but limited evidence for improved availability of CS for those most in need. More women from rural areas and from lower socioeconomic backgrounds give birth in health facilities after fee reform. Speed and quality of implementation might be the key reason behind the differences between the 2 case countries. This calls for more research into the impact of reforms on quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries

PubMed Central

Jenkins, Rachel; Kydd, Robert; Mullen, Paul; Thomson, Kenneth; Sculley, James; Kuper, Susan; Carroll, Joanna; Gureje, Oye; Hatcher, Simon; Brownie, Sharon; Carroll, Christopher; Hollins, Sheila; Wong, Mai Luen

2010-01-01

Background Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. Methods In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. Findings We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149) , Nigeria (384) , Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100, 000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Conclusions Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health

Sustainability of health information systems: a three-country qualitative study in southern Africa.

PubMed

Moucheraud, Corrina; Schwitters, Amee; Boudreaux, Chantelle; Giles, Denise; Kilmarx, Peter H; Ntolo, Ntolo; Bangani, Zwashe; St Louis, Michael E; Bossert, Thomas J

2017-01-10

Health information systems are central to strong health systems. They assist with patient and program management, quality improvement, disease surveillance, and strategic use of information. Many donors have worked to improve health information systems, particularly by supporting the introduction of electronic health information systems (EHIS), which are considered more responsive and more efficient than older, paper-based systems. As many donor-driven programs are increasing their focus on country ownership, sustainability of these investments is a key concern. This analysis explores the potential sustainability of EHIS investments in Malawi, Zambia and Zimbabwe, originally supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR). Using a framework based on sustainability theories from the health systems literature, this analysis employs a qualitative case study methodology to highlight factors that may increase the likelihood that donor-supported initiatives will continue after the original support is modified or ends. Findings highlight commonalities around possible determinants of sustainability. The study found that there is great optimism about the potential for EHIS, but the perceived risks may result in hesitancy to transition completely and parallel use of paper-based systems. Full stakeholder engagement is likely to be crucial for sustainability, as well as integration with other activities within the health system and those funded by development partners. The literature suggests that a sustainable system has clearly-defined goals around which stakeholders can rally, but this has not been achieved in the systems studied. The study also found that technical resource constraints - affecting system usage, maintenance, upgrades and repairs - may limit EHIS sustainability even if these other pillars were addressed. The sustainability of EHIS faces many challenges, which could be addressed through systems' technical design, stakeholder

Prevention of Congenital Syphilis Through Antenatal Screenings in Lusaka, Zambia: A Systematic Review.

PubMed

Akhtar, Faisal; Rehman, Sabah

2018-01-16

Congenital syphilis is one of the preventable diseases caused by the gram-negative bacteria Treponema pallidum; yet, it imposes a serious global health and economic burden, with more than half of the cases resulting in serious adverse outcomes, including infant mortality. Mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million adjusted life years (DALYs) and around $309 million in medical costs. In 2006, an estimated 9.7 million children of age less than five years died in developing countries; almost four million were neonatal deaths. There were 3.2 million stillbirths globally, among whom 95% were in the developing countries. In sub-Saharan Africa, there is an estimated 2.7% (0.1%-10.3%) of pregnant women infected with syphilis, representing more than 900,000 pregnancies at risk each year. There were many non-specific and specific diagnostic tests used in the past, which required laboratory equipment and electricity, but there are many newer tests available now that provide rapid results with high sensitivity and specificity, e.g., the immunochromatographic strip (ICS) and rapid syphilis tests (RST). Early syphilis can be completely eliminated with a single injection of penicillin, which is readily available, cheap, and highly effective, and treating pregnant women with penicillin is 98% effective at preventing congenital syphilis. Targeting women at a high risk of having syphilis makes universal screening in antenatal programs the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a program to prevent congenital syphilis in the perinatal, neonatal, and postnatal periods is evident. While considering resource allocation to child survival programs in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system. In countries like Zambia and other resource

Prevention of Congenital Syphilis Through Antenatal Screenings in Lusaka, Zambia: A Systematic Review

PubMed Central

Rehman, Sabah

2018-01-01

Congenital syphilis is one of the preventable diseases caused by the gram-negative bacteria Treponema pallidum; yet, it imposes a serious global health and economic burden, with more than half of the cases resulting in serious adverse outcomes, including infant mortality. Mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million adjusted life years (DALYs) and around $309 million in medical costs. In 2006, an estimated 9.7 million children of age less than five years died in developing countries; almost four million were neonatal deaths. There were 3.2 million stillbirths globally, among whom 95% were in the developing countries. In sub-Saharan Africa, there is an estimated 2.7% (0.1%-10.3%) of pregnant women infected with syphilis, representing more than 900,000 pregnancies at risk each year. There were many non-specific and specific diagnostic tests used in the past, which required laboratory equipment and electricity, but there are many newer tests available now that provide rapid results with high sensitivity and specificity, e.g., the immunochromatographic strip (ICS) and rapid syphilis tests (RST). Early syphilis can be completely eliminated with a single injection of penicillin, which is readily available, cheap, and highly effective, and treating pregnant women with penicillin is 98% effective at preventing congenital syphilis. Targeting women at a high risk of having syphilis makes universal screening in antenatal programs the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a program to prevent congenital syphilis in the perinatal, neonatal, and postnatal periods is evident. While considering resource allocation to child survival programs in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system. In countries like Zambia and other resource

Long-term studies on the economic impact of ticks on Sanga cattle in Zambia.

PubMed

de Castro, J J; James, A D; Minjauw, B; Di Giulio, G U; Permin, A; Pegram, R G; Chizyuka, H G; Sinyangwe, P

1997-01-01

Three different tick control policies were tested in groups of traditionally managed Sanga cattle in the Central Province of Zambia over a period of 3 years. One group was given strategic tick control using 12 pyrethroid acaricide spray applications between the onset and the end of the wet season (October to March). The productivity of this herd was compared with that of a group with no tick control and a group under an intensive tick control regimen of spraying every week in the wet season and every 2 weeks in the dry season (36 applications per year). The highest output was associated with intensive tick control, followed by strategic control and then no tick control policies. However, when the costs of tick control were taken into account, the strategic tick control policy produced the best economic result, followed by the intensive and then the no tick control policies. Neither the strategic nor the intensive tick control policy was sufficient to prevent the transmission of East Coast fever (ECF) infection when this disease was introduced to the area.

Unexpected anthropophily in the potential secondary malaria vectors Anopheles coustani s.l. and Anopheles squamosus in Macha, Zambia.

PubMed

Fornadel, Christen M; Norris, Laura C; Franco, Veronica; Norris, Douglas E

2011-08-01

Anopheles coustani s.l. and Anopheles squamosus are sub-Saharan mosquito species that have been implicated in malaria transmission. Although generally believed to be of negligible importance due to their overwhelmingly zoophilic behavior, An. coustani s.l. and An. squamosus made up a large proportion of the anophelines collected by human landing catches during the 2007-2008 and 2008-2009 rainy seasons in Macha, Zambia. Further, polymerase chain reaction-based blood meal identification showed that the majority of blood meals from these mosquito species caught in human-baited Centers for Disease Control light traps were from human hosts. Although no An. coustani s.l. or An. squamosus were found to be positive for Plasmodium, the demonstrated anthropophilic tendencies of these mosquitoes in southern Zambia suggest their potential as secondary malaria vectors.

Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies.

PubMed

Kipsaina, Chebiwot; Ozanne-Smith, Joan; Bartolomeos, Kidist; Routley, Virginia

2015-08-01

Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances

Prevalence and diversity of Babesia, Hepatozoon, Ehrlichia, and Bartonella in wild and domestic carnivores from Zambia, Africa.

PubMed

Williams, Brianna M; Berentsen, Are; Shock, Barbara C; Teixiera, Maria; Dunbar, Michael R; Becker, Matthew S; Yabsley, Michael J

2014-03-01

A molecular survey was conducted for several hemoparasites of domestic dogs and three species of wild carnivores from two sites in Zambia. Three Babesia spp. were detected including Babesia felis and Babesia leo in lions (Panthera leo) and a Babesia sp. (similar to Babesia lengau) in spotted hyenas (Crocuta crocuta) and a single lion. All wild dogs (Lycaon pictus) and domestic dogs were negative for Babesia. High prevalences for Hepatozoon were noted in all three wild carnivores (38-61%) and in domestic dogs (13%). Significantly higher prevalences were noted in hyenas and wild dogs compared with domestic dogs and lions. All carnivores were PCR negative for Ehrlichia canis, Ehrlichia ewingii, and Bartonella spp. Overall, high prevalences and diversity of Babesia and Hepatozoon were noted in wild carnivores from Zambia. This study is the first molecular characterization of Babesia from any hyena species and is the first report of a Babesia sp. closely related to B. lengau, a parasite previously only reported from cheetahs (Acinonyx jubatus), in lions and hyenas. Although usually benign in wild carnivores, these hemoparasites can be pathogenic under certain circumstances. Importantly, data on vectors for these parasites are lacking, so studies are needed to identify vectors as well as determine transmission routes, infection dynamics, and host specificity of these hemoparasites in wildlife in Africa and also the risk of transmission between domestic animals and wildlife.

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia.

PubMed

Tjoa, Aaron; Kapihya, Margaret; Libetwa, Miriam; Schroder, Kate; Scott, Callie; Lee, Joanne; McCarthy, Elizabeth

2010-06-30

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. We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting

Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

PubMed Central

2010-01-01

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. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment

Strengthening and expanding the capacity of health worker education in Zambia.

PubMed

Michelo, Charles; Zulu, Joseph Mumba; Simuyemba, Moses; Andrews, Benjamin; Katubulushi, Max; Chi, Benjamin; Njelesani, Evariste; Vwalika, Bellington; Bowa, Kasonde; Maimbolwa, Margaret; Chipeta, James; Goma, Fastone; Nzala, Selestine; Banda, Sekelani; Mudenda, John; Ahmed, Yusuf; Hachambwa, Lotti; Wilson, Craig; Vermund, Sten; Mulla, Yakub

2017-01-01

Zambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia. Data generated through documentary review, key informant interviews and observations were analyzed using a thematic approach. The MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turn around of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle. Expansion and improvement in training processes for health care workers requires targeted investment within medical institutions and strengthening local and international partnerships.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia.

PubMed

Hjelm, Lisa; Handa, Sudhanshu; de Hoop, Jacobus; Palermo, Tia

2017-03-01

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia. Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline. Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels. In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population. Copyright © 2017 UNICEF. Published by Elsevier Ltd.. All rights reserved.

Multi-disciplinary assessments of climate change impacts on agriculture to support adaptation decision making in developing countries

NASA Astrophysics Data System (ADS)

Fujisawa, Mariko; Kanamaru, Hideki

2016-04-01

Many existing climate change impact studies, carried out by academic researchers, are disconnected from decision making processes of stakeholders. On the other hand many climate change adaptation projects in developing countries lack a solid evidence base of current and future climate impacts as well as vulnerabilities assessment at different scales. In order to fill this information gap, FAO has developed and implemented a tool "MOSAICC (Modelling System for Agricultural Impacts of Climate Change)" in several developing countries such as Morocco, the Philippines and Peru, and recently in Malawi and Zambia. MOSAICC employs a multi-disciplinary assessment approach to addressing climate change impacts and adaptation planning in the agriculture and food security sectors, and integrates five components from different academic disciplines: 1. Statistical downscaling of climate change projections, 2. Yield simulation of major crops at regional scale under climate change, 3. Surface hydrology simulation model, 4. Macroeconomic model, and 5. Forestry model. Furthermore MOSAICC has been developed as a capacity development tool for the national scientists so that they can conduct the country assessment themselves, using their own data, and reflect the outcome into the national adaptation policies. The outputs are nation-wide coverage, disaggregated at sub-national level to support strategic planning, investments and decisions by national policy makers. MOSAICC is designed in such a way to promote stakeholders' participation and strengthen technical capacities in developing countries. The paper presents MOSAICC and projects that used MOSAICC as a tool with case studies from countries.

Identifying Factors for Worker Motivation in Zambia's Rural Health Facilities.

PubMed

Cross, Samuel S; Baernholdt, Dr Marianne

2017-01-01

Within Zambia there is a shortage of health workers in rural areas. This study aims to identify motivating factors for retaining rural health workers. Sixty rural health workers completed surveys and 46 were interviewed. They rated the importance of six motivating factors and discussed these and other factors in interviews. An interview was conducted with a Government Human Resources Manager (HR Manager) to elicit contextual information. All six factors were identified as being very important motivators, as were two additional factors. Additional career training was identified by many as the most important factor. Comparison of results and the HR Manager interview revealed that workers lacked knowledge about opportunities and that the HR manager was aware of barriers to career development. The Zambian government might better motivate and retain rural health workers by offering them any combination of identified factors, and by addressing the barriers to career development.

Prevalence of canine gastrointestinal helminths in urban Lusaka and rural Katete Districts of Zambia.

PubMed

Bwalya, Eugene C; Nalubamba, King S; Hankanga, C; Namangala, B

2011-07-01

Faecal samples were collected from January 2010 through September 2010 to determine the prevalence of gastrointestinal (GI) helminths infestation in dogs in urban Lusaka and rural Katete Districts of Zambia. A total of 452 faecal samples (n=160 Katete, n=292 Lusaka) were examined by faecal flotation for the presence of helminth eggs and 82.5% of dogs were positive for GI helminths in Katete compared to 76% for Lusaka. Positive results with the presence of at least one parasite corresponded to 72.9% Ancylostoma caninum, 11% Toxocara canis, 4.8% Toxascaris leonina, 2.4% Dipylidium caninum, 0.7% Taeniidae and 0.3% T. vulpis, species for Lusaka while Katete recorded 70.6% A. caninum, 18.1% T. vulpis, 11.1% T. canis, 13.1% D. caninum, 3.8% T. leonina, and 0.6% Taeniidae. Except for T. vulpis and D. caninum (p<0.05) the results indicated no significant difference in the prevalence of the identified GI helminth between Lusaka and Katete. There was no significant difference in the prevalence between genders of GI helminth infestation demonstrated in this study and only A. caninum showed significant difference in prevalence by age category. The study also showed the presence of zoonotic intestinal helminths A. caninum, T. canis and D. caninum. The study highlights that there was no significant difference in spectrum and prevalence of GI helminths between urban and rural areas in Zambia. It further brings to light the importance of educating owners of dogs on the importance of regular deworming of dogs and control of ectoparasites in order to minimise the risk that these dogs pose to them and the public. © 2011 Elsevier B.V. All rights reserved.

Tobacco--its role in the economy and the health of African countries.

PubMed

1985-01-01

In Africa the issue of smoking and health is complicated by the fact that in many countries tobacco is grown commercially and is relied upon to bring in foreign exchange through export, of revenue for the government if sold on the home market. Consequently, in some nations the ministries of health and of agriculture are working at cross purposes. This contradiction is recognized in the report issued recently of a World Health Organization (WHO) seminar on smoking and health organized for English-speaking Member States of the WHO African Region, and held in Zambia. In opening the seminar, the prime minister of Zambia, Mr. N. Mundia, stated that governments had an obligation to educate people on the risks involved in the use of tobacco but that this could pose a moral dilemma where tobacco production made an apparently significant contribution to the economy. Additionally, he warned that developing countries are considered valuable markets by tobacco companies and stressed that if the promotion of tobacco products by such companies represented a threat "to the health of our people, we cannot let it happen." This point was endorsed by Mr. W.C. Mwambazi, the National WHO Program Coordinator who stated that smoking was on the increase in many developing countries as a result of unscrupulous marketing practices by cigarette manufacturers and that smoking was a major threat to the realization of health for all by the year 2000. Aspects of smoking and health that have special relevance for Africa are emphasized in the report. The few studies carried out in Africa tend to confirm findings from the developed world that smoking increases the risk of cancer and coronary heart disease. Not only is tobacco smoked in Africa, but it is chewed and taken as snuff, and these uses also entail a risk to health. Case studies included in the report show that transnational tobacco companies take full advantage of the present lack of legislation in most African countries on the promotion

Health Outcomes and Cost Impact of the New WHO 2013 Guidelines on Prevention of Mother-to-Child Transmission of HIV in Zambia

PubMed Central

Ishikawa, Naoko; Shimbo, Takuro; Miyano, Shinsuke; Sikazwe, Izukanji; Mwango, Albert; Ghidinelli, Massimo N.; Syakantu, Gardner

2014-01-01

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

Medication Side Effects among People with Epilepsy Taking Phenobarbital in Zambia

PubMed Central

Elafros, Melissa A.; Bui, Esther; Birbeck, Gretchen L.

2014-01-01

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 2.1 mg/kg/day (SD: 2.78 mg/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 WHO 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

Medication side effects among people with epilepsy taking phenobarbital in Zambia.

PubMed

Elafros, Melissa A; Bui, Esther; Birbeck, Gretchen L

2014-11-01

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: 2.78 mg/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

Antimicrobial resistance in human and animal pathogens in Zambia, Democratic Republic of Congo, Mozambique and Tanzania: an urgent need of a sustainable surveillance system.

PubMed

Mshana, Stephen E; Matee, Mecky; Rweyemamu, Mark

2013-10-12

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.

Urban and Rural Ozone Collect over Lusaka (Zambia, 15.5 S, 28 E) during SAFARI-2000 (September 2000)

NASA Technical Reports Server (NTRS)

Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tai; Phalane, N. Agnes; Coetzee, Gert J. R.

2002-01-01

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.

A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia

PubMed Central

Biemba, Godfrey; Chiluba, Boniface; Yeboah-Antwi, Kojo; Silavwe, Vichaels; Lunze, Karsten; Mwale, Rodgers K; Russpatrick, Scott; Hamer, Davidson H

2017-01-01

ABSTRACT Introduction: Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system. Program Description: We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs' reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions. Observations: CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to

A Mobile-Based Community Health Management Information System for Community Health Workers and Their Supervisors in 2 Districts of Zambia.

PubMed

Biemba, Godfrey; Chiluba, Boniface; Yeboah-Antwi, Kojo; Silavwe, Vichaels; Lunze, Karsten; Mwale, Rodgers K; Russpatrick, Scott; Hamer, Davidson H

2017-09-27

Effective community health management information systems (C-HMIS) are important in low-resource countries that rely heavily on community-based health care providers. Zambia currently lacks a functioning C-HMIS to provide real-time, community-based health information from community health workers (CHWs) to health center staff and higher levels of the health system. We developed a C-HMIS mobile platform for use by CHWs providing integrated community case management (iCCM) services and their supervisors to address challenges of frequent stock-outs and inadequate supportive supervision of iCCM-trained CHWs. The platform used simple feature mobile phones on which were loaded the District Health Information System version 2 (DHIS2) software and Java 2 platform micro edition (J2ME) aggregation and tracker applications. This project was implemented in Chipata and Chadiza districts, which supported previous mHealth programs and had cellular coverage from all 3 major network carriers in Zambia. A total of 40 CHWs and 20 CHW supervisors received mobile phones with data bundles and training in the mobile application, after which they implemented the program over a period of 5.5 months, from February to mid-July 2016. CHWs used the mobile phones to submit data on iCCM cases seen, managed, and referred, as well as iCCM medical and diagnostic supplies received and dispensed. Using their mobile phones, the supervisors tracked CHWs' reported cases with medicine consumption, sent CHWs feedback on their referrals, and received SMS reminders to set up mentorship sessions. CHWs were able to use the mobile application to send weekly reports to health center supervisors on disease caseloads and medical commodities consumed, to make drug and supply requisitions, and to send pre-referral notices to health centers. Health center staff used the mobile system to provide feedback to CHWs on the case outcomes of referred patients and to receive automated monthly SMS reminders to invite CHWs to

Assessment of Integrated Environmental Management in Public and Private Schools in the Copperbelt Province of Zambia

ERIC Educational Resources Information Center

Makisa, Kaponda

2016-01-01

Copperbelt Province is one of the ten provinces of Zambia. It has public and private schools which have been faced with escalating levels of environmental problems due to growth in human population and economic growth. The environmental problems which are matters of concern in the schools include, unsound waste management, loss of vegetation…

Grassroot Soccer Resiliency Pilot Program: Building Resiliency through Sport-Based Education in Zambia and South Africa

ERIC Educational Resources Information Center

Peacock-Villada, Paola; DeCelles, Jeff; Banda, Peter S.

2007-01-01

Grassroot Soccer (GRS), a U.S.-based nonprofit organization, designed a curriculum and sport-based teaching model to build resiliency, targeting boys and girls in Lusaka, Zambia, and Johannesburg, South Africa, where most children are reminded daily of the devastation caused by AIDS and where many face chronic and acute hardship. Collaborating…

Factors associated with neonatal mortality in the general population: evidence from the 2007 Zambia Demographic and Health Survey (ZDHS); a cross sectional study

PubMed Central

Lukonga, Etambuyu; Michelo, Charles

2015-01-01

Introduction Neonatal mortality accounts for almost 40 percent of under-five child mortality globally and this could be associated with a complex chain of factors including but not limited to socio-economic, biological and healthcare-related factors. We examined factors that may be associated with neonatal mortality in Zambia. Methods Using across-sectional design, data were extracted from the 2007 Zambia Demographic and Health Survey for women using a “Women's Questionnaire” for respondents aged 15-49 years in the selected households. Records of women who reported having given birth to live infants within the five years preceding the survey defined the study population. However only records on those infants who could have lived through the first month (28 days) were assessed (de facto population). Results Overall (n=6 435), there were 3204(49.8%) males and 3231(50.2%)females. There were 219 (3.4%) neonatal deaths recorded. Low birth weight and overweight were reported as the prominent factors. The odds of dying were significantly higher for infants with low birth weight compared to infants born with normal weight, (aOR=2.58, 95%CI 1.02-6.49). The pattern was the same in both rural though insignificant. Over weight born babies showed increased odds of dying (aOR 3.21, 95%CI 1.36-7.59). Compared to infants born from Mothers with no education, infants born from mothers with higher education were associated with increased odds of dying (aOR 3.55, CI 95%, 1.26-9.94). Conclusion Neonatal survival is still a challenge in this population and determinants show varying socio-demographic contrasts. This may suggest limitations in past efforts to improve neonatal health. Future strategies need to continue but should account for varying setting specific epidemiological contrasts. PMID:26090022

A randomized controlled trial to promote long-term contraceptive use among HIV-serodiscordant and concordant positive couples in Zambia.

PubMed

Stephenson, Rob; Vwalika, Bellington; Greenberg, Lauren; Ahmed, Yusuf; Vwalika, Cheswa; Chomba, Elwyn; Kilembe, William; Tichacek, Amanda; Allen, Susan

2011-04-01

Countries facing high HIV prevalence often also experience high levels of fertility and low contraceptive use, suggesting high levels of unmet need for contraceptive services. In particular, the unique needs of couples with one or both partners HIV positive are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in the absence of reduction of the risk of HIV and other sexually transmitted infections (STIs). This article presents an examination of contraceptive method uptake among a cohort of HIV serodiscordant and concordant positive study participants in Zambia. Baseline contraceptive use was low; however, exposure to a video-based intervention that provided information on contraceptive methods and modeled desirable future planning behaviors dramatically increased the uptake of modern contraceptive methods. Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet the needs and concerns of HIV-positive women or those with HIV-positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on dual method use, combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy.

"The way the country has been carved up by researchers": ethics and power in north-south public health research.

PubMed

Walsh, Aisling; Brugha, Ruairi; Byrne, Elaine

2016-12-12

Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north-south public health research, using Zambia as a case study. Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers (n = 20), Zambian national stakeholders (n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north (n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10. Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu's theory of Power and Practice highlight new aspects of research ethics: Northern and southern researchers perceive that different habituses exist, north and south - habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships. Bourdieu's hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them. Bourdieu's concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital. Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north-south public health research.

Strengthening and expanding the capacity of health worker education in Zambia

PubMed Central

Michelo, Charles; Zulu, Joseph Mumba; Simuyemba, Moses; Andrews, Benjamin; Katubulushi, Max; Chi, Benjamin; Njelesani, Evariste; Vwalika, Bellington; Bowa, Kasonde; Maimbolwa, Margaret; Chipeta, James; Goma, Fastone; Nzala, Selestine; Banda, Sekelani; Mudenda, John; Ahmed, Yusuf; Hachambwa, Lotti; Wilson, Craig; Vermund, Sten; Mulla, Yakub

2017-01-01

Introduction Zambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia. Methods Data generated through documentary review, key informant interviews and observations were analyzed using a thematic approach. Results The MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turn around of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle. Conclusion Expansion and improvement in training processes for health care workers requires targeted investment within medical institutions and strengthening local and international partnerships. PMID:28819513

Movement Behaviour of Traditionally Managed Cattle in the Eastern Province of Zambia Captured Using Two-Dimensional Motion Sensors.

PubMed

Lubaba, Caesar H; Hidano, Arata; Welburn, Susan C; Revie, Crawford W; Eisler, Mark C

2015-01-01

Two-dimensional motion sensors use electronic accelerometers to record the lying, standing and walking activity of cattle. Movement behaviour data collected automatically using these sensors over prolonged periods of time could be of use to stakeholders making management and disease control decisions in rural sub-Saharan Africa leading to potential improvements in animal health and production. Motion sensors were used in this study with the aim of monitoring and quantifying the movement behaviour of traditionally managed Angoni cattle in Petauke District in the Eastern Province of Zambia. This study was designed to assess whether motion sensors were suitable for use on traditionally managed cattle in two veterinary camps in Petauke District in the Eastern Province of Zambia. In each veterinary camp, twenty cattle were selected for study. Each animal had a motion sensor placed on its hind leg to continuously measure and record its movement behaviour over a two week period. Analysing the sensor data using principal components analysis (PCA) revealed that the majority of variability in behaviour among studied cattle could be attributed to their behaviour at night and in the morning. The behaviour at night was markedly different between veterinary camps; while differences in the morning appeared to reflect varying behaviour across all animals. The study results validate the use of such motion sensors in the chosen setting and highlight the importance of appropriate data summarisation techniques to adequately describe and compare animal movement behaviours if association to other factors, such as location, breed or health status are to be assessed.

A PCR-based survey of animal African trypanosomosis and selected piroplasm parasites of cattle and goats in Zambia.

PubMed

Musinguzi, Simon Peter; Suganuma, Keisuke; Asada, Masahito; Laohasinnarong, Dusit; Sivakumar, Thillaiampalam; Yokoyama, Naoaki; Namangala, Boniface; Sugimoto, Chihiro; Suzuki, Yasuhiko; Xuan, Xuenan; Inoue, Noboru

2017-01-10

We screened cattle and goats from the districts of Chama, Monze and Mumbwa in Zambia for animal African trypanosomes, Babesia bigemina and Theileria parva using PCRs; 38.1% of the samples tested positive for at least one of the parasite species. The most common parasite was Trypanosoma vivax (19.8%). Its incidence was significantly higher in goats than in cattle, (P<0.05). B. bigemina was found in samples from all the three areas, making it the most widespread of the parasites in Zambia. Among the tested samples, 12.0% of the positive samples were mixed infections. There were significant differences in the infection rates of T. vivax (Mumbwa had a significantly higher infection rate [39.6%, P<0.0001]), Th. parva (Monze had the only cases [P<0.0004]) and B. bigemina (Monze had a significantly higher infection rate [40.5%, P<0.0001]). According to the hematocrit values, the packed cell volume (%) among the cattle with mixed infections was significantly lower than that of the other cattle. The presence of multiple parasite species and mixed infections among the Zambian cattle and goat populations is of both clinical and economic importance to livestock farming. The absence of trypanosomosis among the samples from Monze can be attributed to tsetse eradication efforts that took place around Lake Kariba. This shows that the prevention and control of these parasitic diseases can have a significant impact on the disease status, which can translate directly into the improvement of the livestock sector in Zambia.

A PCR-based survey of animal African trypanosomosis and selected piroplasm parasites of cattle and goats in Zambia

PubMed Central

MUSINGUZI, Simon Peter; SUGANUMA, Keisuke; ASADA, Masahito; LAOHASINNARONG, Dusit; SIVAKUMAR, Thillaiampalam; YOKOYAMA, Naoaki; NAMANGALA, Boniface; SUGIMOTO, Chihiro; SUZUKI, Yasuhiko; XUAN, Xuenan; INOUE, Noboru

2016-01-01

We screened cattle and goats from the districts of Chama, Monze and Mumbwa in Zambia for animal African trypanosomes, Babesia bigemina and Theileria parva using PCRs; 38.1% of the samples tested positive for at least one of the parasite species. The most common parasite was Trypanosoma vivax (19.8%). Its incidence was significantly higher in goats than in cattle, (P<0.05). B. bigemina was found in samples from all the three areas, making it the most widespread of the parasites in Zambia. Among the tested samples, 12.0% of the positive samples were mixed infections. There were significant differences in the infection rates of T. vivax (Mumbwa had a significantly higher infection rate [39.6%, P<0.0001]), Th. parva (Monze had the only cases [P<0.0004]) and B. bigemina (Monze had a significantly higher infection rate [40.5%, P<0.0001]). According to the hematocrit values, the packed cell volume (%) among the cattle with mixed infections was significantly lower than that of the other cattle. The presence of multiple parasite species and mixed infections among the Zambian cattle and goat populations is of both clinical and economic importance to livestock farming. The absence of trypanosomosis among the samples from Monze can be attributed to tsetse eradication efforts that took place around Lake Kariba. This shows that the prevention and control of these parasitic diseases can have a significant impact on the disease status, which can translate directly into the improvement of the livestock sector in Zambia. PMID:27616437

The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia.

PubMed

Kapiriri, Lydia; Chanda-Kapata, Pascalina

2018-02-17

Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select

HOW MANY WILL DROPOUT--A STUDY OF EVENING STUDENTS OF THE EVELYN HONE COLLEGE OF FURTHER EDUCATION, LUSAKA, ZAMBIA (IN AFRICAN ADULT EDUCATION, JUN 1967, PAGES 28-38).

ERIC Educational Resources Information Center

NOAK, HANS

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…

Cost and financial sustainability of a household-based water treatment and storage intervention in Zambia.

PubMed

Banerjee, Anyana; McFarland, Deborah A; Singh, Ritu; Quick, Robert

2007-09-01

Providing safe water to >1 billion people in need is a major challenge. To address this need, the Safe Water System (SWS) - household water treatment with dilute bleach, safe water storage, and behavior change - has been implemented in >20 countries. To assess the potential sustainability of the SWS, we analyzed costs in Zambia of "Clorin" brand product sold in bottles sufficient for a month of water treatment at a price of $0.09. We analyzed production, marketing, distribution, and overhead costs of Clorin before and after sales reached nationwide scale, and analyzed Clorin sales revenue. The average cost per bottle of Clorin production, marketing and distribution at start-up in 1999 was $1.88 but decreased by 82% to $0.33 in 2003, when >1.7 million bottles were sold. The financial loss per bottle decreased from $1.72 in 1999 to $0.24 in 2003. Net program costs in 2003 were $428,984, or only $0.04 per person-month of protection. A sensitivity analysis showed that if the bottle price increased to $0.18, the project would be self-sustaining at maximum capacity. This analysis demonstrated that efficiencies in the SWS supply chain can be achieved through social marketing. Even with a subsidy, overall program costs per beneficiary are low.

The ACTwatch project: methods to describe anti-malarial markets in seven countries.

PubMed

Shewchuk, Tanya; O'Connell, Kathryn A; Goodman, Catherine; Hanson, Kara; Chapman, Steven; Chavasse, Desmond

2011-10-31

Policy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs). To help address some of these gaps, a five-year multi-country research project called ACTwatch was launched. The project is designed to provide a comprehensive picture of the anti-malarial market to inform national and international anti-malarial drug policy decision-making. The project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia from 2008 to 2012.ACTwatch measures which anti-malarials are available, where they are available and at what price and who they are used by. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different anti-malarials passing through public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving drug outlets, and measures mark-ups at each supply chain level. On the demand side, nationally representative household surveys capture treatment seeking patterns and use of anti-malarial drugs, as well as respondent knowledge of anti-malarials. The research project provides findings on both the demand and supply side determinants of anti-malarial access. There are four key features of ACTwatch. First is the overlap of the three study components where nationally representative data are collected over similar periods, using a common sampling approach. A second feature is the number and diversity of countries that are studied which allows for cross-country comparisons. Another distinguishing feature is its ability to measure trends over time. Finally, the project aims to disseminate findings widely for decision

The ACTwatch project: methods to describe anti-malarial markets in seven countries

PubMed Central

2011-01-01

Background Policy makers, governments and donors are faced with an information gap when considering ways to improve access to artemisinin-based combination therapy (ACT) and malaria diagnostics including rapid diagnostic tests (RDTs). To help address some of these gaps, a five-year multi-country research project called ACTwatch was launched. The project is designed to provide a comprehensive picture of the anti-malarial market to inform national and international anti-malarial drug policy decision-making. Methods The project is being conducted in seven malaria-endemic countries: Benin, Cambodia, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia from 2008 to 2012. ACTwatch measures which anti-malarials are available, where they are available and at what price and who they are used by. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different anti-malarials passing through public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving drug outlets, and measures mark-ups at each supply chain level. On the demand side, nationally representative household surveys capture treatment seeking patterns and use of anti-malarial drugs, as well as respondent knowledge of anti-malarials. Discussion The research project provides findings on both the demand and supply side determinants of anti-malarial access. There are four key features of ACTwatch. First is the overlap of the three study components where nationally representative data are collected over similar periods, using a common sampling approach. A second feature is the number and diversity of countries that are studied which allows for cross-country comparisons. Another distinguishing feature is its ability to measure trends over time. Finally, the project aims to disseminate

Implementing antiretroviral therapy programs in resource-constrained settings: lessons from Monze, Zambia.

PubMed

Adedimeji, Adebola; Malokota, Oliver; Manafa, Ogenna

2011-05-01

We describe the impact of an antiretroviral therapy program on human resource utilization and service delivery in a rural hospital in Monze, Zambia, using qualitative data. We assess project impact on staff capacity utilization, service delivery, and community perception of care. Increased workload resulted in fatigue, low staff morale, and exacerbated critical manpower shortages, but also an increase in users of antiretroviral therapy, improvement in hospital infrastructure and funding, and an overall community satisfaction with service delivery. Integrating HAART programs within existing hospital units and services may be a good alternative to increase overall efficiency.

Preliminary assessment of the computer-based Taenia solium educational program 'The Vicious Worm' on knowledge uptake in primary school students in rural areas in eastern Zambia.

PubMed

Hobbs, Emma C; Mwape, Kabemba Evans; Van Damme, Inge; Berkvens, Dirk; Zulu, Gideon; Mambwe, Moses; Chembensofu, Mwelwa; Phiri, Isaac Khozozo; Masuku, Maxwell; Bottieau, Emmanuel; Devleesschauwer, Brecht; Speybroeck, Niko; Colston, Angela; Dorny, Pierre; Willingham, Arve Lee; Gabriël, Sarah

2018-03-01

The zoonotic helminth Taenia solium is endemic in Zambia, causing human (taeniasis and (neuro)cysticercosis) and pig (porcine cysticercosis) diseases with high health, social and economic burdens. We aimed to evaluate the impact of a health educational program intended to lead to powerful and cumulative improvements in knowledge, attitudes and practices that decrease parasite transmission and disease occurrence. Half-day health education workshops were conducted in three primary schools in the highly endemic Eastern Province of Zambia, using the computer-based T. solium educational program 'The Vicious Worm'. Questionnaires were administered before and after the educational component to determine the program's impact on knowledge uptake in primary school students. In total, 99 students participated: 38 males and 61 females, with a median age of 14 years (range 10-18 years). Baseline general knowledge of T. solium, including awareness of the different human and pig disease states, and disease diagnosis, treatment and prevention, was quite high (average score 62%) and consistent across all three study areas. Participants' knowledge had significantly increased after the educational component, particularly regarding parasite transmission and disease prevention. Preliminary assessment of 'The Vicious Worm' indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia. Follow-up studies are planned to assess the longer term impact of the program on knowledge uptake in the study neighbourhoods. Inclusion of tailored 'The Vicious Worm' educational workshops should be considered in integrated cysticercosis control programs in endemic areas of sub-Saharan Africa. © 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

A Library Response to the Massification of Higher Education: The Case of the University of Zambia Library

ERIC Educational Resources Information Center

Kanyengo, Christine Wamunyima

2009-01-01

This paper looks at the challenges that libraries in Africa face in responding to massification of higher education by discussing the University of Zambia library's response in library and information resources provision. As a result of massification of higher education, libraries have been forced not only to employ new and different strategies to…

To What did They Consent? Understanding Consent Among Low Literacy Participants in a Microbicide Feasibility Study in Mazabuka, Zambia.

PubMed

Munalula-Nkandu, Esther; Ndebele, Paul; Siziya, Seter; Munthali, J C

2015-12-01

We conducted a study to review the consenting process in a vaginal microbicide feasibility study conducted in Mazabuka, Zambia. Participants were drawn from those participating in the microbicide study. A questionnaire and focus group discussion were used to collect information on participants' understanding of study aims, risks and benefits. Altogether, 200 participants took part in this study. The results of the study showed that while all participants signed or endorsed their thumbprints to the consent forms, full informed consent was not attained from most of the participants since 77% (n = 154) of the participants had numerous questions about the study and 34% (n = 68) did not know who to get in touch with concerning the study. Study objectives were not fully understood by over 61% of the participants. Sixty four percent of the participants were not sure of the risks of taking part in the microbicide study. A significant number thought the study was all about determining their HIV status. Some participants were concerned that their partners were not on the trial as they were convinced that being on the study meant that that they had a lifetime protection from HIV infection. The process of obtaining consent was inadequate as various phases of the study were not fully understood. We recommend the need for researchers to reinforce the consenting process in all studies and more so when studies are conducted in low literacy populations. © 2014 John Wiley & Sons Ltd.

Issues in the design of a clinical trial with a behavioral intervention--the Zambia exclusive breast-feeding study.

PubMed

Thea, Donald M; Vwalika, Cheswa; Kasonde, Prisca; Kankasa, Chipepo; Sinkala, Moses; Semrau, Katherine; Shutes, Erin; Ayash, Christine; Tsai, Wei-Yann; Aldrovandi, Grace; Kuhn, Louise

2004-08-01

We present the rationale and design of the Zambian Exclusive Breast-feeding Study (ZEBS), a randomized trial evaluating the efficacy of short-duration exclusive breast-feeding (EBF) as a strategy to reduce postnatal human immunodeficiency virus (HIV) transmission while preserving the other health benefits of this important mode of infant feeding. One thousand two hundred HIV-positive pregnant women were recruited in Lusaka, Zambia, and followed with their infants for 24 months. In addition to Nevirapine (NVP), all women received intensive and frequent clinic- and home-based counseling to support exclusive breast-feeding. When the infant was 1 week of age, half of the women were randomly assigned to a group encouraged to abruptly (<24 h) cease all breast-feeding at 4 months. The primary outcome of the experimental (randomized) comparison is HIV-free survival at 24 months. The design is also observational and will compare HIV transmission rates between those who do and do not adhere to the counseling intervention promoting exclusive breast-feeding. Our study aims to quantify the benefit-risk ratio of early cessation of exclusive breast-feeding to interrupt mother-to-child transmission of HIV with an intensive behavioral intervention and has both observational and experimental analytic approaches. Our study design assesses efficacy and also has a prominent applied component that if the intervention is effective, it will permit rapid and sustainable adoption within low-resource communities.

Improved diagnostic testing and malaria treatment practices in Zambia.

PubMed

Hamer, Davidson H; Ndhlovu, Micky; Zurovac, Dejan; Fox, Matthew; Yeboah-Antwi, Kojo; Chanda, Pascalina; Sipilinyambe, Naawa; Simon, Jonathon L; Snow, Robert W

2007-05-23

Improving the accuracy of malaria diagnosis with rapid antigen-detection diagnostic tests (RDTs) has been proposed as an approach for reducing overtreatment of malaria in the current era of widespread implementation of artemisinin-based combination therapy in sub-Saharan Africa. To assess the association between use of microscopy and RDT and the prescription of antimalarials. Cross-sectional, cluster sample survey, carried out between March and May 2006, of all outpatients treated during 1 working day at government and mission health facilities in 4 sentinel districts in Zambia. Proportions of patients undergoing malaria diagnostic procedures and receiving antimalarial treatment. Seventeen percent of the 104 health facilities surveyed had functional microscopy, 63% had RDTs available, and 73% had 1 or more diagnostics available. Of patients with fever (suspected malaria), 27.8% (95% confidence interval [CI], 13.1%-42.5%) treated in health facilities with malaria diagnostics were tested and 44.6% had positive test results. Of patients with negative blood smear results, 58.4% (95% CI, 36.7%-80.2%) were prescribed an antimalaria drug, as were 35.5% (95% CI, 16.0%-55.0%) of those with a negative RDT result. Of patients with fever who did not have diagnostic tests done, 65.9% were also prescribed antimalarials. In facilities with artemether-lumefantrine in stock, this antimalarial was prescribed to a large proportion of febrile patients with a positive diagnostic test result (blood smear, 75.0% [95% CI, 51.7%-98.3%]; RDT, 70.4% [95% CI, 39.3%-100.0%]), but also to some of those with a negative diagnostic test result (blood smear, 30.4% [95% CI, 8.0%-52. 9%]; RDT, 26.7% [95% CI, 5.7%-47.7%]). Despite efforts to expand the provision of malaria diagnostics in Zambia, they continue to be underused and patients with negative test results frequently receive antimalarials. Provision of new tools to reduce inappropriate use of new expensive antimalarial treatments must be

Behavior Change Pathways to Voluntary Medical Male Circumcision: Narrative Interviews with Circumcision Clients in Zambia

PubMed Central

Price, Jessica E.; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C.; Topp, Stephanie M.; Shiliya, Nicholas; Hatzold, Karin

2014-01-01

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

eC3—A Modern Telecommunications Matrix for Cervical Cancer Prevention in Zambia

PubMed Central

Parham, Groesbeck P.; Mwanahamuntu, Mulindi H.; Pfaendler, Krista S.; Sahasrabuddhe, Vikrant V.; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L.; Stringer, Jeffrey S.A.

2013-01-01

Objectives Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. Materials and Methods We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world’s poorest countries. Results Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of “electronic cervical cancer control” bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. Conclusions The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of “screen-and-treat” programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus–based screening approaches and wireless telemedicine communications. PMID:20592550

Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review

PubMed Central

Brown, Elizabeth; Devereux, Sara; Fairhead, Cassandra; Holeman, Isaac

2017-01-01

Background The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites—Communication Initiative Network, TechNet-21, and PATH—were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. PMID:28978495

Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study.

PubMed

Bowman, Kendra G; Jovic, Goran; Rangel, Shawn; Berry, William R; Gawande, Atul A

2013-06-01

Pediatric surgical care in developing countries is not well studied. We sought to identify the range of pediatric surgery available, the barriers to provision, and level of safety of surgery performed for the entire pediatric population in Zambia. In cooperation with the Ministry of Health, we validated and adapted a World Health Organization instrument. During onsite visits, the availability of 32 emergency and essential surgical procedures relevant to children was surveyed. The availability of basic World Health Organization surgical safety criteria was determined. A single interviewer visited 103 (95%) of 108 surgical hospitals in Zambia and carried out 495 interviews. An average of 68% of the 32 emergency and essential surgical procedures was available (range 32%-100%). Lack of surgical skill was the primary reason for referral in 72% of procedure types, compared with 24%, 2% and 3% due to lack of equipment, supplies and anesthesia skills, respectively (p<0.001). Minimum pediatric surgical safety criteria were met by 14% of hospitals. The primary limitation to providing pediatric surgical care in Zambia is lack of surgical skills. Minimum safety standards were met by 14% of hospitals. Efforts to improve pediatric surgery should prioritize teaching surgical skills to expand access and providing safety training, equipment and supplies to increase safety. Copyright © 2013 Elsevier Inc. All rights reserved.

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia.

PubMed

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

Knowledge about experiences in accessing HIV services among persons with disabilities who are living with HIV in sub-Saharan Africa is limited. Although HIV transmission among persons with disabilities in Africa is increasingly acknowledged, there is a need to bring to life the experiences and voices from persons with disabilities living with HIV to raise awareness of programme implementers and policy makers about their barriers in accessing HIV services. This paper explores how the barriers faced by persons with disabilities living with HIV impede their ability to access HIV-related services and manage their disease. We conducted focus group discussions with 76 persons (41 females; 35 males) with physical, visual and/or hearing impairments who were living with HIV in Ghana, Uganda and Zambia (2012-2013). We explored challenges and facilitators at different levels (individual, psychosocial and structural) of access to HIV services. Transcripts were analyzed using a framework analysis approach. Persons with disabilities living with HIV encountered a wide variety of challenges in accessing HIV services. Delays in testing for HIV were common, with most waiting until they were sick to be tested. Reasons for delayed testing included challenges in getting to the health facilities, lack of information about HIV and testing, and HIV- and disability-related stigma. Barriers to HIV-related services, including care and treatment, at health facilities included lack of disability-friendly educational materials and sign interpreters, stigmatizing treatment by providers and other patients, lack of skills to provide tailored services to persons with disabilities living with HIV and physically inaccessible infrastructure, all of which make it extremely difficult for persons with disabilities to initiate and adhere to HIV treatment. Accessibility challenges were greater for women than men due to gender-related roles. Challenges were similar across the three countries. Favourable

Limited accessibility to HIV services for persons with disabilities living with HIV in Ghana, Uganda and Zambia

PubMed Central

Tun, Waimar; Okal, Jerry; Schenk, Katie; Esantsi, Selina; Mutale, Felix; Kyeremaa, Rita Kusi; Ngirabakunzi, Edson; Asiah, Hilary; McClain-Nhlapo, Charlotte; Moono, Grimond

2016-01-01

three countries. Favourable experiences in accessing HIV services were reported in Uganda and Zambia, where disability-tailored services were offered by non-governmental organizations and government facilities (Uganda only). Conclusions Persons with disabilities living with HIV encounter many challenges in accessing HIV testing and continued care and treatment services. Changes are needed at every level to ensure accessibility of HIV services for persons with disabilities. PMID:27443266

The cost structure of routine infant immunization services: a systematic analysis of six countries

PubMed Central

Geng, Fangli; Suharlim, Christian; Brenzel, Logan; Resch, Stephen C; Menzies, Nicolas A

2017-01-01

Abstract Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77–93% of national routine infant immunization costs. Labour and vaccine costs comprised 14–69% and 13–69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48–78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches

Impact of Pregnancy-Related Deaths on Female Life Expectancy in Zambia: Application of Life Table Techniques to Census Data

PubMed Central

Banda, Richard; Sandøy, Ingvild Fossgard; Fylkesnes, Knut; Janssen, Fanny

2015-01-01

Introduction Since 2000, the world has been coalesced around efforts to reduce maternal mortality. However, few studies have estimated the significance of eliminating maternal deaths on female life expectancy. We estimated, based on census data, the potential gains in female life expectancy assuming complete elimination of pregnancy-related mortality in Zambia. Methods We used data on all-cause and pregnancy-related deaths of females aged 15–49 reported in the Zambia 2010 census, and evaluated, adjusted and smoothed them using existing and verified techniques. We used associated single decrement life tables, assuming complete elimination of pregnancy-related deaths to estimate the potential gains in female life expectancy at birth, at age 15, and over the ages 15–49. We compared these gains with the gains from eliminating deaths from accidents, injury, violence and suicide. Results Complete elimination of pregnancy-related deaths would extend life expectancy at birth among Zambian women by 1.35 years and life expectancy at age 15 by 1.65 years. In rural areas, this would be 1.69 years and 2.19 years, respectively, and in urban areas, 0.78 years and 0.85 years. An additional 0.72 years would be spent in the reproductive age group 15–49; 1.00 years in rural areas and 0.35 years in urban areas. Eliminating deaths from accidents, injury, suicide and violence among women aged 15–49 would cumulatively contribute 0.55 years to female life expectancy at birth. Conclusion Eliminating pregnancy-related mortality would extend female life expectancy in Zambia substantially, with more gains among adolescents and females in rural areas. The application of life table techniques to census data proved very valuable, although rigorous evaluation and adjustment of reported deaths and age was necessary to attain plausible estimates. The collection of detailed high quality cause-specific mortality data in future censuses is indispensable. PMID:26513160

Knowledge and perceptions of asthma in Zambia: a cross-sectional survey.

PubMed

Jumbe Marsden, Emilia; Wa Somwe, Somwe; Chabala, Chishala; Soriano, Joan B; Vallès, Cesar Picado; Anchochea, Julio

2016-02-12

Zambia is currently experiencing an epidemiological transition, from communicable to non-communicable diseases. The annual rate of physician-diagnosed asthma is estimated at 3 %. However, the general public's knowledge of asthma symptoms and signs, and their perception of asthma remain unknown. A survey was conducted aiming to determine knowledge and perceptions of asthma among Zambians. Adults and adolescents attending four clinics in the capital, Lusaka, were surveyed using a standardized questionnaire from July 2011 to March 2012. Data from 1,540 participants (mean age 30.7 years, 65% female) were collected. Most patients (74%) were living in low-cost housing. One hundred and sixteen (7.6%) participants reported either a medical diagnosis of asthma or currently taking asthma medications. The most frequent asthma symptoms reported were wheezing (88%), and waking up at night with either shortness of breath (85%), chest tightness (85%), or cough (67%). Medications used to treat asthma were mostly oral short-acting beta-agonists (SABA) (59%), inhaled SABA (30.2%) and antibiotics (29.8%). Inhaled steroids were only used by 16.4% while less than 1% were on long-acting beta-agonists (LABA). Many misconceptions were identified among the entire surveyed population with only 54.7% believing hospitalisations are not preventable, 54.7% believing asthma symptoms can be prevented with the right medications and 37% believing inhalers are addictive. Nearly 60% thought that people with asthma cannot exercise or play hard. Significantly more individuals with asthma compared to those without thought tablets are better than inhalers for the treatment of asthma (46% vs 30%). We conclude that knowledge on asthma is poor in Zambia, where there remains many misconceptions on asthma and its management.

Taenia spp. infections in wildlife in the Bangweulu and Kafue flood plains ecosystems of Zambia.

PubMed

Muma, J B; Gabriël, S; Munyeme, M; Munang'andu, H M; Victor, B; Dorny, P; Nalubamba, K S; Siamudaala, V; Mwape, K E

2014-09-15

Taenia spp. have an indirect life cycle, cycling between a definitive and an intermediate host with zoonotic species causing public health problems in many developing countries. During the course of 2 separate surveys in Zambia (2004 and 2009), the presence of Taenia larval stages (cysticerci) was examined in Kafue lechwe (Kobus leche kafuensis), Black lechwe (Kobus leche smithermani) and other wildlife species from the Kafue and Bangweulu flood plains. Examinations involved post-mortem inspection and serum specific antigen detection. The recovered cysts from seven carcasses were characterised using PCR and DNA sequence analysis. The overall proportion of infection in wildlife on post-mortem examination was 19.0% (95% CI: 9.1-29.0%). The proportion of infected wildlife based on post-mortem examinations in the Kafue flood plains was estimated at 28.6% (95% CI: 13.3-43.9%), while the seroprevalence was estimated at 25.0% (95% CI: 2.9-47.1%). The seroprevalence for cattle in the Kafue flood plains was estimated at 61.5% (95% CI: 42.0-81.0%) while that of Kafue lechwe in the same ecosystem was estimated at 66.6% (95% CI: 45.6-85.7%). Infection rates were higher in Kafue lechwe than in Black lechwe suggesting differences in the exposure patterns. The sequencing results indicated that none of the recovered cysts were either Taenia solium or Taenia saginata. We therefore conclude they most likely belong to a less studied (wildlife) Taenia species that requires further characterisation. Copyright © 2014 Elsevier B.V. All rights reserved.

Prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients attending a secondary care hospital in Zambia.

PubMed

Nagelkerke, Marjolijn M B; Sikwewa, Kapembwa; Makowa, Dennis; de Vries, Irene; Chisi, Simon; Dorigo-Zetsma, J Wendelien

2017-08-10

Antimicrobial resistance is an increasing global health problem. Very little data on resistance patterns of pathogenic bacteria in low-income countries exist. The aim of this study was to measure the prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients in the resource constraint setting of a secondary care hospital in Zambia. Nasal and rectal samples from 50 in- and 50 outpatients were collected. Patients were randomly selected and informed consent was obtained. Nasal samples were tested for the presence of methicillin-resistant Staphylococcus aureus (MRSA), and rectal samples for Gram-negative rods (family of Enterobacteriaceae) non-susceptible to gentamicin, ciprofloxacin and ceftriaxone. Additionally, E-tests were performed on ceftriaxone-resistant Enterobacteriaceae to detect extended-spectrum β-lactamases (ESBLs). 14% of inpatients carried S. aureus, and 18% of outpatients. No MRSA was found. 90% of inpatients and 48% of outpatients carried one or more Enterobacteriaceae strains (75% Escherichia coli and Klebsiella pneumonia) resistant to gentamicin, ciprofloxacin and/or ceftriaxone (p < 0.001). Among inpatients gentamicin resistance was most prevalent (in 78%), whereas among outpatients ciprofloxacin resistance prevailed (in 38%). All ceftriaxone-resistant Enterobacteriaceae were ESBL-positive; these were present in 52% of inpatients versus 12% of outpatients (p < 0.001). We conclude it is feasible to perform basic microbiological procedures in the hospital laboratory in a low-income country and generate data on antimicrobial susceptibility. The high prevalence of antimicrobial drug resistant Enterobacteriaceae carried by in- and outpatients is worrisome. In order to slow down antimicrobial resistance, surveillance data on local susceptibility patterns of bacteria are a prerequisite to generate guidelines for antimicrobial therapy, to guide in individual patient treatment and to support implementation of infection control

Property grabbing and will writing in Lusaka, Zambia: an examination of wills of HIV-infected cohabiting couples.

PubMed

Mendenhall, E; Muzizi, L; Stephenson, R; Chomba, E; Ahmed, Y; Haworth, A; Allen, S

2007-03-01

High rates of HIV and poverty place women in a precarious economic situation in Lusaka, Zambia. Mortality from HIV infection is high, leaving many households single headed and creating almost a half a million orphans. One of the most prevalent forms of gender violence that creates poverty in women is when the male's family claims the property of the deceased from the widow and the children. The Zambia-Emory HIV Research Project collected 184 wills from individuals in monogamous unions where one or both of the individuals were HIV-positive. Despite the fact that many wills specifically stated that their extended family was not allowed to tamper with their possessions in the event of death, property grabbing proved to be a prevalent and difficult issue in Lusaka. In order to improve the lives of widowed women in Lusaka, the government and other civic and non-governmental organisations must inform women of their rights to own and protect their land and other assets in the event of their husbands' death, an issue of increasing importance in the area of HIV/AIDS.

Orphan/vulnerable child caregiving moderates the association between women’s autonomy and their BMI in three African countries

PubMed Central

Carter-Pokras, Olivia; Madhavan, Sangeetha; Feldman, Robert; He, Xin; Lee, Sunmin

2014-01-01

Enhancement of women’s autonomy is a key factor for improving women’s health and nutrition. With nearly 12 million orphan and vulnerable children (OVC) in Africa due to HIV/AIDS, the study of OVC primary caregivers’ nutrition is fundamental. We investigated the association between married women’s autonomy and their nutritional status; explored whether this relationship was modified by OVC primary caregiving; and, analyzed whether decision-making autonomy mediated the association between household wealth and body mass index (BMI). This cross-sectional study used data from Demographic Health Surveys collected during 2006–2007 from 20–49 year old women in Namibia (n=2,633), Swaziland (n=1,395), and Zambia (n=2,920). Analyses included logistic regression, Sobel and Goodman tests. Our results indicated that women’s educational attainment increased the odds for being overweight (Swaziland and Zambia) and decreased the odds for being underweight (Namibia). In Zambia, having at least primary education increased the odds for being overweight only among child primary caregivers regardless of the OVC status of the child, and having autonomy for buying everyday household items increased the odds for being overweight only among OVC primary caregivers. Decision-making autonomy mediated the association between household wealth and OVC primary caregivers’ BMI in Zambia (Z=2.13, p-value0.03). We concluded that depending on each country’s contextual characteristics, having education can decrease the odds for being an underweight woman or increase the odds for being an overweight woman. Further studies should explore why in Namibia, education has an effect on women’s overweight status only among women who are caring for a child. PMID:24888977

Counselor and Participant Perspectives of Trauma-Focused Cognitive Behavioral Therapy for Children in Zambia: A Qualitative Study

PubMed Central

Murray, Laura K.; Skavenski, Stephanie; Michalopoulos, Lynn M.; Bolton, Paul A.; Bass, Judith K.; Familiar, Itziar; Imasiku, Mwiya; Cohen, Judy

2014-01-01

Objective 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. Method Semi-structured 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. Results 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. Conclusion 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

Women's empowerment and choice of contraceptive methods in selected African countries.

PubMed

Do, Mai; Kurimoto, Nami

2012-03-01

It is generally believed that women's lack of decision-making power may restrict their use of modern contraceptives. However, few studies have examined the different dimensions of women's empowerment and contraceptive use in African countries. Data came from the latest round of Demographic and Health Surveys conducted between 2006 and 2008 in Namibia, Zambia, Ghana and Uganda. Responses from married or cohabiting women aged 15-49 were analyzed for six dimensions of empowerment and the current use of female-only methods or couple methods. Bivariate and multivariate multinomial regressions were used to identify associations between the empowerment dimensions and method use. Positive associations were found between the overall empowerment score and method use in all countries (relative risk ratios, 1.1-1.3). In multivariate analysis, household economic decision making was associated with the use of either female-only or couple methods (1.1 for all), as was agreement on fertility preferences (1.3-1.6) and the ability to negotiate sexual activity (1.1-1.2). In Namibia, women's negative attitudes toward domestic violence were correlated with the use of couple methods (1.1). Intervention programs aimed at increasing contraceptive use may need to involve different approaches, including promoting couples' discussion of fertility preferences and family planning, improving women's self-efficacy in negotiating sexual activity and increasing their economic independence.

Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study

PubMed Central

2013-01-01

Background The primary bottleneck to achieving the MDGs in low-income countries is health systems that are too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is one of the countries that are lagging behind in achieving millennium development targets. Several barriers have been identified as hindering the progress towards health related millennium development goals. Designing an intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship (BHOMA) project was designed to address the challenges in the Zambia’s MOH using a system wide approach. We applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system strengthening. Methods A qualitative study was conducted looking at the status of the Six WHO building blocks for health systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9. Results The study showed that building block specific weaknesses had cross cutting effect in other health system building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. Several barriers were identified as hindering access to health services by the local communities. These included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side barriers: Long distance to health facility, cost of transport and cultural practices. Participating

Situational analysis of communication of HIV and AIDS information to persons with visual impairment: a case of Kang'onga Production Centre in Ndola, Zambia.

PubMed

Chintende, Grace Nsangwe; Sitali, Doreen; Michelo, Charles; Mweemba, Oliver

2017-04-04

Despite the increases in health promotion and educational programs on HIV and AIDS, lack of information and communication on HIV and AIDS for the visually impaired persons continues. The underlying factors that create the information and communication gaps have not been fully explored in Zambia. It is therefore important that, this situational analysis on HIV and AIDS information dissemination to persons with visual impairments at Kang'onga Production Centre in Ndola was conducted. The study commenced in December 2014 to May 2015. A qualitative case study design was employed. The study used two focus group discussions with males and females. Each group comprised twelve participants. Eight in-depth interviews involving the visually impaired persons and five key informants working with visually impaired persons were conducted. Data was analysed thematically using NVIVO 8 software. Ethical clearance was sought from Excellency in Research Ethics and Science. Reference Number 2014-May-030. It was established that most visually impaired people lacked knowledge on the cause, transmission and treatment of HIV and AIDS resulting in misconceptions. It was revealed that health promoters and people working with the visually impaired did not have specific HIV and AIDS information programs in Zambia. Further, it was discovered that the media, information education communication and health education were channels through which the visually impaired accessed HIV and AIDS information. Discrimination, stigma, lack of employment opportunities, funding and poverty were among the many challenges identified which the visually impaired persons faced in accessing HIV and AIDS information. Integration of the visually impaired in HIV and AIDS programs would increase funding for economic empowerment and health promotions in order to improve communication on HIV and AIDS information. The study showed that, the visually impaired persons in Zambia are not catered for in the dissemination of HIV

Gastroenterology training in a resource-limited setting: Zambia, Southern Africa

PubMed Central

Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

2013-01-01

AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention

Gastroenterology training in a resource-limited setting: Zambia, Southern Africa.

PubMed

Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

2013-07-07

To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease

Scaling-Up Access to Antiretroviral Therapy for Children: A Cohort Study Evaluating Care and Treatment at Mobile and Hospital-Affiliated HIV Clinics in Rural Zambia

PubMed Central

van Dijk, Janneke H.; Moss, William J.; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine G.

2014-01-01

Background Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia. Methods Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility. Results Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ) and CD4+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4+ T-cell percentages. Conclusions HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas. PMID:25122213

A Randomized Controlled Trial to Promote Long-Term Contraceptive Use Among HIV-Serodiscordant and Concordant Positive Couples in Zambia

PubMed Central

Vwalika, Bellington; Greenberg, Lauren; Ahmed, Yusuf; Vwalika, Cheswa; Chomba, Elwyn; Kilembe, William; Tichacek, Amanda; Allen, Susan

2011-01-01

Abstract Background Countries facing high HIV prevalence often also experience high levels of fertility and low contraceptive use, suggesting high levels of unmet need for contraceptive services. In particular, the unique needs of couples with one or both partners HIV positive are largely missing from many current family planning efforts, which focus on the prevention of pregnancies in the absence of reduction of the risk of HIV and other sexually transmitted infections (STIs). Methods This article presents an examination of contraceptive method uptake among a cohort of HIV serodiscordant and concordant positive study participants in Zambia. Results Baseline contraceptive use was low; however, exposure to a video-based intervention that provided information on contraceptive methods and modeled desirable future planning behaviors dramatically increased the uptake of modern contraceptive methods. Conclusions Including information on family planning in voluntary counseling and testing (VCT) services in addition to tailoring the delivery of family planning information to meet the needs and concerns of HIV-positive women or those with HIV-positive partners is an essential step in the delivery of services and prevention efforts to reduce the transmission of HIV. Family planning and HIV prevention programs should integrate counseling on dual method use, combining condoms for HIV/STI prevention with a long-acting contraceptive for added protection against unplanned pregnancy. PMID:21410332

Survival of people on antiretroviral treatment in Zambia: a retrospective cohort analysis of HIV clients on ART.

PubMed

Amanzi, Patrick; Michelo, Charles; Simoonga, Christopher; Dambe, Rosalia; Chongwe, Gershom

2016-01-01

Provision of free anti-retroviral therapy in Zambia started in June 2004. There were only 15,000 people on treatment as at December that year, mainly due to lack of access. This number rose to 580,000 people as at December 2013. The general objective of this study was to determine survival of people on ART and to examine associated predictors for survival. The study included ART patients enrolled between the year 2002 and 2013 (n=10,395) in 285 health facilities in Zambia. Patient files were analyzed retrospectively. The study used Kaplan Meier and Cox-proportional hazard models to describe the relationship between lost to follow up and age, sex, baseline CD4 cell count and weight. Results showed that lost to follow up accounted for 90% of the clients that had dropped out, while 10% was to deaths. Low baseline CD4 count (p-value 0.001, HR 0.9994, (95% CI 0.9993, 0.9996) at initiation was associated with lost to follow up together with weight at initiation (p-value 0.031, HR 0.9987 at 95% CI (0.9975, 0.9998)) of ART. This study has demonstrated that lost to follow up is a substantial contributing factor to drop outs among HIV patients on treatment. Strengthening of community treatment supporters especially immediate family members in emphasizing to the client the need to continue treatment is necessary. The health facility could do more in emphasizing the importance of treatment especially in the initial stages. Further, in order to reduce opportunistic infections and probable deaths during treatment, cotrimoxazole prophylaxis should be maintained so as to raise the CD4 levels. Improved nutritional assessment and counseling to boost the nutritional status of the clients throughout should be encouraged.

Resuscitating voter interest in Zambia: the Adult Education Association of Zambia's role in national elections.

PubMed

Chakanika, W W; Chuma, P C

1999-08-01

This paper examines the role of the Adult Education Association of Zambia (AEAZ) in the Zambian national elections. Outlined in this paper are workshop topics, challenges encountered, and outcomes of the education campaign by the AEAZ in its crusade to inform voters of their rights and obligations. The six interrelated topics presented at various civic awareness campaigns were leadership qualities; community participation in national development; responsible citizenship; electoral process and the management of elections; the role of a member parliament; and human rights. The primary problem of the AEAZ campaign was language. Although English is preferred in urban areas, most of the residents in the rural areas are illiterate, and the campaign had to be conducted in several local languages, where most of the people were unfamiliar to campaigners. Other challenges affecting the AEAZ outreach efforts were lack of reliable transportation and lack of funds. Despite these challenges, the campaign was successful in encouraging citizens to vote, lobbying, advocacy, and holding political representatives accountable for their actions. This was evident in the 1996 presidential and general elections, in which there was a significant increase in the number of voters who took part in the electoral process. This paper concludes that nongovernmental organizations involved in the sensitization campaigns should coordinate and collaborate in order to enhance their capacity.

Health labour market policies in support of universal health coverage: a comprehensive analysis in four African countries.

PubMed

Sousa, Angelica; Scheffler, Richard M; Koyi, Grayson; Ngah, Symplice Ngah; Abu-Agla, Ayat; M'kiambati, Harrison M; Nyoni, Jennifer

2014-09-26

Progress toward universal health coverage in many low- and middle-income countries is hindered by the lack of an adequate health workforce that can deliver quality services accessible to the entire population. We used a health labour market framework to investigate the key indicators of the dynamics of the health labour market in Cameroon, Kenya, Sudan, and Zambia, and identified the main policies implemented in these countries in the past ten years to address shortages and maldistribution of health workers. Despite increased availability of health workers in the four countries, major shortages and maldistribution persist. Several factors aggravate these problems, including migration, an aging workforce, and imbalances in skill mix composition. In this paper, we provide new evidence to inform decision-making for health workforce planning and analysis in low- and middle-income countries. Partial health workforce policies are not sufficient to address these issues. It is crucial to perform a comprehensive analysis in order to understand the dynamics of the health labour market and develop effective polices to address health workforce shortages and maldistribution as part of efforts to attain universal health coverage.

Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia

PubMed Central

Masiye, Felix; Kaonga, Oliver; Kirigia, Joses M

2016-01-01

Background Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities. Methods Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households’ out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE) experienced by households. Results Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence. Conclusion Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the

Does User Fee Removal Policy Provide Financial Protection from Catastrophic Health Care Payments? Evidence from Zambia.

PubMed

Masiye, Felix; Kaonga, Oliver; Kirigia, Joses M

2016-01-01

Out-of-pocket payments in health care have been shown to impose significant burden on households in Sub-Saharan Africa, leading to constrained access to health care and impoverishment. In an effort to reduce the financial burden imposed on households by user fees, some countries in Sub-Saharan Africa have abolished user fees in the health sector. Zambia is one of few countries in Sub-Saharan Africa to abolish user fees in primary health care facilities with a view to alleviating financial burden of out-of-pocket payments among the poor. The main aim of this paper was to examine the extent and patterns of financial protection from fees following the decision to abolish user fees in public primary health facilities. Our analysis is based on a nationally representative health expenditure and utilization survey conducted in 2014. We calculated the incidence and intensity of catastrophic health expenditure based on households' out-of-pocket payments during a visit as a percentage of total household consumption expenditure. We further show the intensity of the problem of catastrophic health expenditure (CHE) experienced by households. Our analysis show that following the removal of user fees, a majority of patients who visited public health facilities benefitted from free care at the point of use. Further, seeking care at public primary health facilities is associated with a reduced likelihood of incurring CHE after controlling for economic wellbeing and other covariates. However, 10% of households are shown to suffer financial catastrophe as a result of out-of-pocket payments. Further, there is considerable inequality in the incidence of CHE whereby the poorest expenditure quintile experienced a much higher incidence. Despite the removal of user fees at primary health care level, CHE is high among the poorest sections of the population. This study also shows that cost of transportation is mainly responsible for limiting the protective effectiveness of user fee removal

The Effect of Cryotherapy on Human Papillomavirus Clearance among HIV-positive Women in Lusaka, Zambia

PubMed Central

Katundu, Katundu; Bateman, Allen C.; Pfaendler, Krista S.; Mwanahamuntu, Mulindi H.; Kapambwe, Sharon; Vermund, Sten H.; Sahasrabuddhe, Vikrant V.; Msadabwe, Susan C.; Stringer, Jeffrey S.A.; Parham, Groesbeck P.; Chibwesha, Carla J.

2015-01-01

Objective We sought to investigate the progression of human papillomaviruses (HPV) infection in HIV-positive women after cryotherapy. Methods We examined changes in detection of high-risk HPV (hrHPV) cervical infections among HIV-infected women over a 12-week period following cryotherapy using stored specimens from a cohort study conducted between June 2009 and March 2011 in Lusaka, Zambia. Samples from visits at baseline and weeks 4, 8, and 12 were tested using the Roche Linear Array assay. Results A total of 89 women were included in the analysis. The median age was 32 years (interquartile range [IQR]: 28–36 years). The median CD4+ cell count was 350 cells/μL (IQR: 214–470 cells/μL) and 66% of women were receiving antiretroviral therapy. At baseline, the prevalence of hrHPV was 91% (95% confidence interval [CI]: 83–95%). HPV45 was the most common HPV type, present in (30%) women, followed by HPV16 (27%), HPV18 (27%), HPV51 (20%), and HPV58 (22%). Among women with valid results both at baseline and 12 weeks, 17/67 (25%) cleared their initial hrHPV infection within 12 weeks of treatment, though 65% (11/17) had new hrHPV types detected. Conclusions Cryotherapy led to clearance of 25% of hrHPV infections within 12 weeks of treatment. However, hrHPV infection remained persistent in most women and new hrHPV types were detected often, explaining the high rate of persistence and recurrence of cervical disease in this population. Continued efforts to scale-up HPV vaccination and cervical screening should remain a priority in high HIV burden settings such as Zambia. PMID:26125097

The impact of oral health on daily performances and its association with clinical variables in a population in Zambia.

PubMed

Andersson, P; Kavakure, J; Lingström, P

2017-05-01

The aim of this study was to investigate oral impacts on daily performance and to relate these data to oral clinical variables. The study was performed at a dental clinic in Livingstone, Zambia, and included 78 subjects (mean age 28, range 15-48 years) consecutively recruited in connection with a dental care visit. Data were collected through a structured interview using the Oral Impacts on Daily Performances (OIDP) index measuring oral health-related quality of life followed by a clinical examination. Oral health affected one or more daily performances during the last 6 months for 61.5% of the subjects. 'Difficulty of eating and enjoying food' was the performance reported most frequently (42.3%), and 'speaking and pronouncing clearly' was least often reported (10.3%). DMFT was 3.8, ±3.6 (mean ± SD; range 0-15). A majority of the individuals had periodontal pockets ≥4 mm (mean 4.3, ±2.6) (94.9%) and gingival bleeding on probing >20% (88.5%). Two or more decayed teeth were shown to be significantly associated (OR 4.6, CI 1.2-17.1) with one or more oral impacts on daily performances in a multivariate logistic regression analysis. This study shown that there is a significant association between decayed teeth and oral impacts on daily performances. More research is needed, however, for deeper understanding of oral health problems and their impacts on daily life in Zambia. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Contribution of market value chain to the control of African swine fever in Zambia.

PubMed

Siamupa, C; Saasa, N; Phiri, A M

2018-01-01

African swine fever (ASF) is a worldwide disease of pigs endemic in most sub-Saharan African countries. Zambia has been experiencing outbreaks of ASF for many years because the disease is endemic in the eastern part of the country, with incursion into the central part of Lusaka Province. The latest outbreaks of ASF in Lusaka occurred in 2013 with substantial pig mortalities, loss in trade, and cost of control measures and compensation of affected farmers. The aims of the study were to identify market value chain-related factors that were associated with ASF outbreaks and assess why these outbreaks are becoming frequent despite control measures being put in place. Using a mixed-method design, participants involved in the value chain were purposively sampled. Some pig farmers were included using a respondent-driven technique. Farmers came from Lusaka, Chilanga, Kafue, and Chongwe districts. Other participants included district veterinary officers, veterinary assistants, police officers, and veterinary staff manning veterinary checkpoints, abattoir and processing plant managers, meat inspectors, market chairpersons, and traders. Semi-structured questionnaires, in-depth interviews, and direct observations were used to collect data to come up with narrations, tables, and flow charts. In assessing the contribution of the value chain in ASF, aspects of ASF screening, market availability and procedures, knowledge on ASF transmission, occurrence of ASF outbreak, and regulation of pig movement were investigated. Despite government ASF control measures being applied, the following were noted: (1) low awareness levels of ASF transmission among pig farmers and traders; (2) only 50% of farmers had their animals screened for ASF before sale; (3) all the markets did not have the pork inspected; (4) laxity in enforcing livestock movement control because of inadequate police and veterinary staff manning checkpoints; (5) lack of enforcement of meat inspection and food safety

Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status.

PubMed

Masa, Rainier; Chowa, Gina; Nyirenda, Victor

2017-07-01

In Zambia, more people living with HIV now have access to lifesaving antiretroviral therapy than ever before. However, progress in HIV treatment and care has not always resulted in lower mortality. Adherence remains a critical barrier to treatment success. The objective of this study was to examine the barriers and facilitators of antiretroviral therapy adherence, particularly the role of household economic status. The study included a cross-sectional sample of 101 people living with HIV (PLHIV) in two rural communities in eastern Zambia. Adherence was measured using patient self-assessment and pharmacy information. Household economic status included components such as occupation, income, assets, food security, and debt. Multivariable logistic regression was conducted to examine the associations between household economic factors and adherence. Our findings suggest that the role of economic status on adherence appears to be a function of the economic component. Debt and non-farming-related occupation were consistently associated with non-adherence. The association between assets and adherence depends on the type of asset. Owning more transportation-related assets was consistently associated with non-adherence, whereas owning more livestock was associated with self-reported adherence. Additionally, living in a community with fewer economic opportunities was associated with non-adherence. The associations between place of residence and pharmacy refill adherence and between transportation assets and self-reported adherence were statistically significant. Improving adherence requires a multifaceted strategy that addresses the role of economic status as a potential barrier and facilitator. Programmes that provide economic opportunities and life-skills training may help PLHIV to overcome economic, social, and psychological barriers.

Theory-Driven Process Evaluation of a Complementary Feeding Trial in Four Countries

ERIC Educational Resources Information Center

Newman, Jamie E.; Garces, Ana; Mazariegos, Manolo; Hambidge, K. Michael; Manasyan, Albert; Tshefu, Antoinette; Lokangaka, Adrien; Sami, Neelofar; Carlo, Waldemar A.; Bose, Carl L.; Pasha, Omrana; Goco, Norman; Chomba, Elwyn; Goldenberg, Robert L.; Wright, Linda L.; Koso-Thomas, Marion; Krebs, Nancy F.

2014-01-01

We conducted a theory-driven process evaluation of a cluster randomized controlled trial comparing two types of complementary feeding (meat versus fortified cereal) on infant growth in Guatemala, Pakistan, Zambia and the Democratic Republic of Congo. We examined process evaluation indicators for the entire study cohort (N = 1236) using chi-square…

Evaluating Opportunities for Achieving Cost Efficiencies Through the Introduction of PrePex Device Male Circumcision in Adult VMMC Programs in Zambia and Zimbabwe.

PubMed

Vandament, Lyndsey; Chintu, Naminga; Yano, Nanako; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Gertrude; Xaba, Sinokuthemba; Mpasela, Felton; Muguza, Edward; Mangono, Tichakunda; Madidi, Ngonidzashe; Samona, Alick; Tagar, Elva; Hatzold, Karin

2016-06-01

Results from recent costing studies have put into question potential Voluntary Medical Male Circumcision (VMMC) cost savings with the introduction of the PrePex device. We evaluated the cost drivers and the overall unit cost of VMMC for a variety of service delivery models providing either surgical VMMC or both PrePex and surgery using current program data in Zimbabwe and Zambia. In Zimbabwe, 3 hypothetical PrePex only models were also included. For all models, clients aged 18 years and older were assumed to be medically eligible for PrePex and uptake was based on current program data from sites providing both methods. Direct costs included costs for consumables, including surgical VMMC kits for the forceps-guided method, device (US $12), human resources, demand creation, supply chain, waste management, training, and transport. Results for both countries suggest limited potential for PrePex to generate cost savings when adding the device to current surgical service delivery models. However, results for the hypothetical rural Integrated PrePex model in Zimbabwe suggest the potential for material unit cost savings (US $35 per VMMC vs. US $65-69 for existing surgical models). This analysis illustrates that models designed to leverage PrePex's advantages, namely the potential for integrating services in rural clinics and less stringent infrastructure requirements, may present opportunities for improved cost efficiency and service integration. Countries seeking to scale up VMMC in rural settings might consider integrating PrePex only MC services at the primary health care level to reduce costs while also increasing VMMC access and coverage.

Theileria parva seroprevalence in traditionally kept cattle in southern Zambia and El Nino.

PubMed

Fandamu, P; Duchateau, L; Speybroeck, N; Marcotty, T; Mbao, V; Mtambo, J; Mulumba, M; Berkvens, D

2005-04-01

Sero-epidemiological surveys involving 27,526 cattle over a period of 8 years show that Theileria parva, the parasite causing East Coast fever (ECF) is found throughout southern Zambia. Higher values of T. parva sero-prevalence were observed in the plateau districts of Monze, Choma and Mazabuka than in the valley districts of Siavonga and Sinazongwe. Our results reveal a strong association between high T. parva sero-prevalence and the presence of the periodic climatic phenomenon known as the El Nino Southern Oscillation. More T. parva sero-positive samples were recorded during El Nino years (1997/98) (P<0.001) than other years in the study period. From this association, we conclude that Multiple El Nino Southern Oscillation Indices can be used to predict years with high or low ECF infection prevalence thereby contributing to the improved control of ECF in the area.

Strategies for promoting equity: experience with community financing in three African countries.

PubMed

Gilson, L; Kalyalya, D; Kuchler, F; Lake, S; Oranga, H; Ouendo, M

2001-10-01

Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy.

Effect of currency exchange rate fluctuations on Aid Effectiveness in the Health Sector in Zambia.

PubMed

Chansa, Collins; Sundewall, Jesper; Östlund, Numi

2018-06-22

Development assistance for health (DAH) remains a significant and important source of health financing in many low and lower middle-income countries. However, this assistance has not been fully effective. This study explores the effect of currency exchange rate fluctuations on volatility of DAH in Zambia using a mixed methods approach. Data covering the period 1997-2008 were collected from various financial and programmatic reports, while six key informant interviews were conducted to validate and translate findings from the quantitative analysis. Results show fluctuations in the volume of funds disbursed to the Ministry of Health by donors due to changes in the exchange rates between non-US$ currencies and the US$, ranging from -11.1% to +13.4% during the period 1997-2008. The overall effect was a loss of US$ 13.4 million over the period 1997-2008 which is equivalent to an annual average loss of US$ 1.1 million per annum. There were also fluctuations in the US$ amount that was converted to the Zambian Kwacha to fund districts ranging from -22% to +22% over the same period. The monthly average loss that was incurred was US$ 302 214 per month, but large gains and losses were observed when individual months were analysed. Information from key informants suggest that currency exchange rate losses contribute to reductions in the health workforce, quantity and quality of health services, while currency exchange rate gains can contribute to reduced absorption capacity and/or low utilization of financial resources. The study concludes that fluctuations in currency exchange rates contribute to volatility in DAH, reduces financial stability and leads to unpredictability of DAH which ultimately affects health service delivery. For DAH to be effective, governments and donors should increase awareness and work systematically to mitigate currency exchange risks.

Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia.

PubMed

Kayeyi, Nkomba; Sandøy, Ingvild F; Fylkesnes, Knut

2009-08-25

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. 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). 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. The findings suggested structural

Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review.

PubMed

Oliver-Williams, Clare; Brown, Elizabeth; Devereux, Sara; Fairhead, Cassandra; Holeman, Isaac

2017-10-04

The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites-Communication Initiative Network, TechNet-21, and PATH-were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. ©Clare Oliver-Williams, Elizabeth Brown, Sara Devereux, Cassandra Fairhead, Isaac Holeman. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.10.2017.

The Participatory Research Approach in Non-Western Countries: Practical Experiences from Central Asia and Zambia

ERIC Educational Resources Information Center

Katsui, Hisayo; Koistinen, Mari

2008-01-01

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…

Intention to use the female condom following a mass-marketing campaign in Lusaka, Zambia.

PubMed Central

Agha, S

2001-01-01

OBJECTIVES: This report examines intention to use the female condom among men and women in Lusaka, Zambia, who were exposed to mass-marketing of the female condom. METHODS: The study used data from a representative sample of consumers at outlets that sell or distribute the female condom and the male condom. RESULTS: In spite of a high level of awareness of the female condom, use of this method in the last year was considerably lower than use of the male condom. Intention to use the female condom in the future was highest among respondents who had used only the female condom in the last year. CONCLUSIONS: The female condom is likely to be most important for persons who are unable or unwilling to use the male condom. PMID:11211646

HIV self-testing among female sex workers in Zambia: A cluster randomized controlled trial.

PubMed

Chanda, Michael M; Ortblad, Katrina F; Mwale, Magdalene; Chongo, Steven; Kanchele, Catherine; Kamungoma, Nyambe; Fullem, Andrew; Dunn, Caitlin; Barresi, Leah G; Harling, Guy; Bärnighausen, Till; Oldenburg, Catherine E

2017-11-01

was higher in the delivery arm compared to the coupon arm (RR = 1.14, 95% CI 1.05-1.23, P = 0.001) at 1 month, but there was no difference at 4 months. Among participants reporting a positive HIV test at 1 (N = 144) and 4 months (N = 235), linkage to care was non-significantly lower in the 2 HIVST arms compared to the standard-of-care arm. There were 4 instances of intimate partner violence related to study participation, 3 of which were related to HIV self-test use. Limitations include the self-reported nature of study outcomes and overall high uptake of HIV testing. In this study among FSWs in Zambia, we found that HIVST was acceptable and accessible. However, HIVST may not substantially increase HIV cascade progression in contexts where overall testing and linkage are already high. ClinicalTrials.gov NCT02827240.

Reprint of "Modelling the influence of temperature and rainfall on malaria incidence in four endemic provinces of Zambia using semiparametric Poisson regression".

PubMed

Shimaponda-Mataa, Nzooma M; Tembo-Mwase, Enala; Gebreslasie, Michael; Achia, Thomas N O; Mukaratirwa, Samson

2017-11-01

Although malaria morbidity and mortality are greatly reduced globally owing to great control efforts, the disease remains the main contributor. In Zambia, all provinces are malaria endemic. However, the transmission intensities vary mainly depending on environmental factors as they interact with the vectors. Generally in Africa, possibly due to the varying perspectives and methods used, there is variation on the relative importance of malaria risk determinants. In Zambia, the role climatic factors play on malaria case rates has not been determined in combination of space and time using robust methods in modelling. This is critical considering the reversal in malaria reduction after the year 2010 and the variation by transmission zones. Using a geoadditive or structured additive semiparametric Poisson regression model, we determined the influence of climatic factors on malaria incidence in four endemic provinces of Zambia. We demonstrate a strong positive association between malaria incidence and precipitation as well as minimum temperature. The risk of malaria was 95% lower in Lusaka (ARR=0.05, 95% CI=0.04-0.06) and 68% lower in the Western Province (ARR=0.31, 95% CI=0.25-0.41) compared to Luapula Province. North-western Province did not vary from Luapula Province. The effects of geographical region are clearly demonstrated by the unique behaviour and effects of minimum and maximum temperatures in the four provinces. Environmental factors such as landscape in urbanised places may also be playing a role. Copyright © 2017 Elsevier B.V. All rights reserved.

Beyond Time: Temporal and Extra-Temporal Functions of Tense and Aspect Marking in Totela, a Bantu Language of Zambia

ERIC Educational Resources Information Center

Crane, Thera Marie

2011-01-01

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…

Changes in tuberculosis notifications and treatment delay in Zambia when introducing a digital X-ray service

PubMed Central

Schaap, A.; Muyoyeta, M.; Mulenga, D.; Brown, J.; Ayles, H.

2012-01-01

Setting: In August 2009, a digital chest X-ray (CXR) machine was installed at a busy urban health centre in Lusaka, Zambia. Objective: To describe the changes in tuberculosis (TB) notifications and treatment delay ≥7 days in Zambia after introducing a digital X-ray service. Design: Operational retrospective research of TB notification, laboratory and CXR data for Q4 2008 (prior to digital CXR) compared to Q4 2009. Results: Notifications for sputum smear-negative TB increased by 8.1%, from 370/527 (70.2%) in Q4 2008 to 425/544 (78.1%) in Q4 2009, despite a 6.7% decrease in sputum smear positivity in Q4 2009. TB treatment delay decreased from 75/412 (18.2%) in Q4 2008 to 52/394 (13.2%) in Q4 2009 (P = 0.05). Conclusion: In Q4 2009, sputum smear-negative TB notifications increased and treatment delay decreased. However, accurate diagnosis of TB is challenging in this setting, and misdiagnosis and overtreatment may occur. Moreover, other factors in addition to the introduction of the digital X-ray service could have contributed to these findings. Nonetheless, we found that the digital X-ray service had many advantages and that it may aid in more efficient TB diagnosis. PMID:26392952

Let us fight and support one another: adolescent girls and young women on contributors and solutions to HIV risk in Zambia

PubMed Central

Butts, Stefani A; Parmley, Lauren E; Alcaide, Maria L; Rodriguez, Violeta J; Kayukwa, Annette; Chitalu, Ndashi; Weiss, Stephen M; Jones, Deborah L

2017-01-01

In Zambia, adolescent girls and young women (AGYW) are disproportionately affected by human immunodeficiency virus (HIV), social, cultural and economic factors making them particularly vulnerable. This study was designed to understand the context in which AGYW are at risk and to identify perceived drivers of the epidemic and potential strategies to reduce HIV risk. Focus group discussions were conducted with AGYW in Zambian districts with the highest HIV prevalence from February through August 2016. The focus group guide addressed HIV risk factors and strategies for HIV prevention in AGYW. Focus group discussions were recorded, translated and transcribed, themes identified and responses coded. Results suggest that gender inequality undermined potentially protective factors against HIV among AGYW. Poverty and stigmatization were major barriers to accessing available HIV prevention services as well as primary risk factors for HIV infection. Sponsorship to support AGYW school attendance, programs for boys and girls to foster gender equality and financial assistance from the government of Zambia to support AGYW most in need were proposed as strategies to reduce HIV risk. Results highlight the utility of using community-based research to guide potential interventions for the affected population. Future research should explore the use of multilevel interventions to combat HIV among AGYW. PMID:29033613

Let us fight and support one another: adolescent girls and young women on contributors and solutions to HIV risk in Zambia.

PubMed

Butts, Stefani A; Parmley, Lauren E; Alcaide, Maria L; Rodriguez, Violeta J; Kayukwa, Annette; Chitalu, Ndashi; Weiss, Stephen M; Jones, Deborah L

2017-01-01

In Zambia, adolescent girls and young women (AGYW) are disproportionately affected by human immunodeficiency virus (HIV), social, cultural and economic factors making them particularly vulnerable. This study was designed to understand the context in which AGYW are at risk and to identify perceived drivers of the epidemic and potential strategies to reduce HIV risk. Focus group discussions were conducted with AGYW in Zambian districts with the highest HIV prevalence from February through August 2016. The focus group guide addressed HIV risk factors and strategies for HIV prevention in AGYW. Focus group discussions were recorded, translated and transcribed, themes identified and responses coded. Results suggest that gender inequality undermined potentially protective factors against HIV among AGYW. Poverty and stigmatization were major barriers to accessing available HIV prevention services as well as primary risk factors for HIV infection. Sponsorship to support AGYW school attendance, programs for boys and girls to foster gender equality and financial assistance from the government of Zambia to support AGYW most in need were proposed as strategies to reduce HIV risk. Results highlight the utility of using community-based research to guide potential interventions for the affected population. Future research should explore the use of multilevel interventions to combat HIV among AGYW.

Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial.

PubMed

Thomas, Ranjeeta; Burger, Ronelle; Harper, Abigail; Kanema, Sarah; Mwenge, Lawrence; Vanqa, Nosivuyile; Bell-Mandla, Nomtha; Smith, Peter C; Floyd, Sian; Bock, Peter; Ayles, Helen; Beyers, Nulda; Donnell, Deborah; Fidler, Sarah; Hayes, Richard; Hauck, Katharina

2017-11-01

The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. As part of the HPTN 071 (PopART) study, data from adults aged 18-44 years were gathered between Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use. We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratory-confirmed HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa; 4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and 18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score -0·002, 95% CI -0·01 to 0·001; p=0·219) nor in South Africa (0·000, -0·002 to 0·003; p=0·939). However, scores did differ between HIV-positive individuals who had initiated ART less than 5 years previously and HIV

A case study for a psychographic-behavioral segmentation approach for targeted demand generation in voluntary medical male circumcision.

PubMed

Sgaier, Sema K; Eletskaya, Maria; Engl, Elisabeth; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Gertrude; Xaba, Sinokuthemba; Nanga, Alice; Gogolina, Svetlana; Odawo, Patrick; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-09-13

Public health programs are starting to recognize the need to move beyond a one-size-fits-all approach in demand generation, and instead tailor interventions to the heterogeneity underlying human decision making. Currently, however, there is a lack of methods to enable such targeting. We describe a novel hybrid behavioral-psychographic segmentation approach to segment stakeholders on potential barriers to a target behavior. We then apply the method in a case study of demand generation for voluntary medical male circumcision (VMMC) among 15-29 year-old males in Zambia and Zimbabwe. Canonical correlations and hierarchical clustering techniques were applied on representative samples of men in each country who were differentiated by their underlying reasons for their propensity to get circumcised. We characterized six distinct segments of men in Zimbabwe, and seven segments in Zambia, according to their needs, perceptions, attitudes and behaviors towards VMMC, thus highlighting distinct reasons for a failure to engage in the desired behavior.

A case study for a psychographic-behavioral segmentation approach for targeted demand generation in voluntary medical male circumcision

PubMed Central

Eletskaya, Maria; Engl, Elisabeth; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Gertrude; Xaba, Sinokuthemba; Nanga, Alice; Gogolina, Svetlana; Odawo, Patrick; Gumede-Moyo, Sehlulekile; Kretschmer, Steve

2017-01-01

Public health programs are starting to recognize the need to move beyond a one-size-fits-all approach in demand generation, and instead tailor interventions to the heterogeneity underlying human decision making. Currently, however, there is a lack of methods to enable such targeting. We describe a novel hybrid behavioral-psychographic segmentation approach to segment stakeholders on potential barriers to a target behavior. We then apply the method in a case study of demand generation for voluntary medical male circumcision (VMMC) among 15–29 year-old males in Zambia and Zimbabwe. Canonical correlations and hierarchical clustering techniques were applied on representative samples of men in each country who were differentiated by their underlying reasons for their propensity to get circumcised. We characterized six distinct segments of men in Zimbabwe, and seven segments in Zambia, according to their needs, perceptions, attitudes and behaviors towards VMMC, thus highlighting distinct reasons for a failure to engage in the desired behavior. PMID:28901285

Effects of the Gama Cuulu radio serial drama on HIV-related behavior change in Zambia.

PubMed

Kraft, Joan Marie; Hill, Zelee; Membe, Ian; Zhang, Yujia; Meassick, Elizabeth Onjoro; Monsour, Michael; Maumbi, Mwendalubi; Ndubani, Phillimon; Manengu, Joy Masheke; Mwinga, Alwyn

2012-01-01

The Gama Cuulu radio serial drama is written and produced in Zambia's Southern Province. It promotes behavior change and service use to prevent HIV transmission. The authors evaluated the effects of Gama Cuulu on intermediate outcomes (e.g., perceived norms), as well as number of sexual partners, condom use, and HIV testing in the past year among adults between 18 and 49 years of age. The authors used a pretest/posttest assessment with a comparison group design, with Southern Province as the intervention area and Western Province as the comparison area. Approximately 1,500 in-person interviews were conducted in both provinces in 2006 (pretest), 2007, and 2008. Regression models included terms for province, time, and the interaction of the two. Outcomes improved in both provinces (e.g., by 2008, 37.6% of participants in Southern Province and 28.3% participants in Western Province tested for HIV in the past year). Pretest-to-posttest changes in condom use (from 20.2% to 29.4% in Southern Province) and 5 intermediate outcomes were significantly different in the 2 provinces. However, changes in condom use were not associated with listening to Gama Cuulu and changes in other outcomes were similar in both provinces. Weak intervention effects might be attributable to implementation challenges or the saturation of HIV programs in Zambia.

Marketing of breast-milk substitutes in Zambia: evaluation of compliance to the international regulatory code.

PubMed

Funduluka, P; Bosomprah, S; Chilengi, R; Mugode, R H; Bwembya, P A; Mudenda, B

2018-03-01

We sought to assess the level of non-compliance with the International Code of Marketing breast-milk substitutes (BMS) and/or Statutory Instrument (SI) Number 48 of 2006 of the Laws of Zambia in two suburbs, Kalingalinga and Chelstone, in Zambia. This was a cross sectional survey. Shop owners (80), health workers (8) and mothers (214) were interviewed. BMS labels and advertisements (62) were observed. The primary outcome was mean non-compliance defined as the number of article violations divided by the total 'obtainable' violations. The score ranges from 0 to 1 with 0 representing no violations in all the articles and one representing violations in all the articles. A total of 62 BMS were assessed. The mean non-compliance score by manufacturers in terms of violations in labelling of BMS was 0.33 (SD = 0.28; 95% CI: 0.26, 0.40). These violations were mainly due to labels containing pictures or graphics representing an infant. 80 shops were also assessed with mean non-compliance score in respect of violations in tie-in-sales, special display, and contact with mothers at the shop estimated as 0.14 (SD = 0.14; 95% CI: 0.11, 0.18). Non-compliance with the Code and/or the local SI is high after 10 years of domesticating the Code.

The political economy of maize production and poverty reduction in Zambia: analysis of the last 50 years.

PubMed

Hanjra, Munir A; Culas, Richard J

2011-01-01

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�

Healthcare provision for HIV co-infected tuberculosis patients in rural Zambia: an observational cohort study at primary care centers

PubMed Central

2013-01-01

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

Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need.

PubMed

Fiedler, John L; Mubanga, Freddie; Siamusantu, Ward; Musonda, Mofu; Kabwe, Kabaso F; Zulu, Charles

2014-01-01