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Attention in this discussion of Zambia is directed to the following: geography; the people; history; government; the economy; foreign relations; defense; and relations between Zambia and the US. In 1986, the population totaled 7 million with an annual growth rate of 3.7%. The infant mortality rate is 87/1000 with a life expectancy of 51 years. Zambia, located in south-central Africa, is bordered by Zaire, Tanzania, Malawi, Mozambique, Zimbabwe, Botswana, Angola, and Namibia. The population is made up of over 70 Bantu-speaking tribes. Expatriates, mostly British (15,000 in 1986) or South African, live primarily in Lusaka where they are employed in mines and related activities. Some ancestors of present-day Zambians most likely arrived about 2000 years ago and eventually displaced or absorbed indigenous stone age hunters and gatherers. The major waves of Bantu-speaking immigrants began in the 15th century; the greatest influx occurred in the late 17th to the early 19th centuries. After the mid-19th century, the area was penetrated by Western explorers. In 1888, Northern and Southern Rhodesia (now Zambia and Zimbabwe) were proclaimed a British sphere of influence. Southern Rhodesia was annexed formally and granted self-government in 1923. Independence was realized on October 24, 1964. Zambia was the 1st British territory to become a republic immediately upon realizing independence. The constitution promulgated on August 25, 1973, abrogated the original 1964 constitution, and this new constitution and the national elections that followed in December 1973 were the final steps in achieving what is termed a "1-party participatory democracy." President Kenneth Kaunda is the major figure in the country's politics. He has wide popular support and traditionally has bridged the rivalries among the country's various regions and ethnic groups. The economy of Zambia is based primarily on its majority state-owned copper industry, which is the only significant source of foreign exchange. Copper production has dropped to less than 500,000 metric tons/year from a high of 720,000 in 1976. Beginning in late 1982, Zambian government leaders took several important steps to deal with the country's economic plight, including restricting public spending, reducing government subsidies, raising farm producer incentives, and devaluing the currency. The US maintains a substantial foreign assistance program in Zambia. PMID:12178072
Adult Education Research in Zambia.
ERIC Educational Resources Information Center
Analyzes adult education research in Zambia and looks at how it has been undertaken and what else needs to be done. Highlights the paucity of research and the weaknesses in what has been completed. (JOW)
Mtonga, Harry L.
Implementing Educational Policies in Zambia.
National Technical Information Service (NTIS)
At the time of independence from Britain in 1964, the educational system in Zambia was, as elsewhere in Africa, racially segregated and heavily biased against Africans. The paper briefly reviews the situation at independence before enumerating post-indepe...
P. P. W. Achola
Primary health care reforms in Zambia have focused on the themes of effective leadership, community involvement, and improved service quality. To achieve these goals, the Ministry of Health's structure has been decentralized and a Health Reforms Implementation Team (including a Quality Assurance Unit) has been established. This unit collaborates with government and private sector organizations and professional groups in areas such as strategic planning, problem solving, facility assessment, standards setting, and indicator development. Each province has two linkage facilitators who provide district-level training and support to quality assurance coaches. As part of this process, staff at Nanga Rural Health Center in Mazabuka District selected patient privacy as a priority quality assurance issue and established an enclosed area for patient interviews. This measure facilitated increased patient disclosure about and comfort with discussing sensitive medical issues such as family planning and sexually transmitted diseases. Next, the health center staff examined the problem of pharmaceutical shortages, and user fees were identified as a means of purchasing commonly unavailable drugs. At the Magoye Rural Health Center, quality assurance assessment led to the consolidation of services such as infant weighing and immunization at the same location, thereby significantly increasing service utilization. PMID:12347471
Reinke, J; Tembo, J; Limbambala, M F; Chikuta, S; Zaenger, D
Zambia's Catholic Schools and Secularization.
ERIC Educational Resources Information Center
Explores the origins and development of the Catholic Church's involvement in secular schooling in Zambia. Illustrates that at the primary level, government's secularization led to the hand over of these schools; but at the secondary level a more universal type of Catholic school developed. (CMK)
Carmody, Brendan
In Mansa District, Zambia, people are unaware of the risk factors of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). To remedy this, the District HIV Prevention and Care Team invited a member of the Positive and Living Squad (PALS), John Luonde, to speak at educational sessions for various target audiences. Goals included providing information, dissipating misinformation, alleviating community fears, and mobilizing people through specific activities that addressed identified needs. The sessions began with the testimony of John Luonde and a simple question and answer period, which were followed by focus groups, often with a video, for more difficult or sensitive topics. Information materials were distributed and a condom demonstration was conducted. Although some institutions initially refused permission because of the holiday season or the possible impact on staff, Luonde returned to cover the missed groups. More than 105 people from 9 sectors of the community participated. Groups that were represented included the Mansa Sports Club, the Mutende Deaf Branch, a factory, the local army and police, and physicians from the Mansa Hospital Board. Questions from the different groups were similar. Participants saw that, although anyone could contract AIDS (the central theme of the project), they could still hope for productive years with proper treatment, self-care, and diet. Most participants wanted to change their sexual behavior and Luonde was asked to return. Women and people with physical disabilities need to be targeted. Although condoms were previously seen as promoting promiscuity, institutions are now requesting their distribution. The team is collaborating with a social marketing organization on condom use promotion. Distribution sites include bars, restaurants, filling stations, supermarkets, and hair dressers. At the request of the community, a meeting was held with the director of the Mansa Hospital Board to develop policy guidelines and to plan sessions on hospital care of persons with HIV and staff attitude toward them. PMID:12288110
Kapyepye, E
Low enthalpy geothermal project in Zambia
A project financed by the Italian Ministry of Foreign Affairs (MAE), implements the installation of two organic Rankine cycle (ORC) turbogenerators in remote, rural areas of Zambia. The Italian Government grant amounts to 2,000,000 US dollars. The Government of Zambia will bear all costs of the Zambian counterpart and will provide the low voltage transmission line and distribution grid.
Dominco, E.; Liguori, P.E.
Spontaneously settled refugees in Northwestern Province, Zambia.
The UN High Commissioner for Refugees (UNHCR) commissioned researchers from the University of Zambia to conduct a socioeconomic survey and census of "spontaneously settled" Zairean and Angolan refugees in the Northwestern Province of Zambia in 1982. The sample consisted of 188 Angolans, 201 Zaireans, and 2 South Africans. The difficulties experienced by refugees in Northwestern Province in achieving integration were related to a combination of factors including the lack of a clear national policy on refugees and refugee status, a national concern for maintaining security, the popular belief that aliens are responsible for an increasing crime rate, the desire by immigration officials for stricter laws to control alien infiltration, conflict between traditional and modern leaders, and Zambia's deteriorating economic situation. In spite of the problems described, the integration of refugees into existing communities is a desirable goal and should be encouraged. One should not assume that self-settling refugees are able to live with ethnic kin, receive assistance and hospitality, and thus are better off than those in camps. The Zambian case provides ample evidence that integration is not easy even with kin support, shared ethnicity, language, and historical connections. Moreover, given the fact that Zambia will continue to receive refugees it is vital that there is a well defined refugee policy and an administrative mechanism for implementing that policy at all levels. This will be particularly important in Zambia as it will undoubtedly continue to receive large influxes of refugees, from countries such as Namibia, Uganda, Angola, Mozambique, and South Africa. PMID:12267853
Freund, P J; Kalumba, K
77 FR 66797 - Executive-Led Trade Mission to South Africa and Zambia
Federal Register 2010, 2011, 2012, 2013
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Federal Register 2010, 2011, 2012, 2013
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Floodwaters Renew Zambia's Kafue Wetland
NASA Technical Reports Server (NTRS)
Not all floods are unwanted. Heavy rainfall in southern Africa between December 2003 and April 2004 provided central Zambia with floodwaters needed to support the diverse uses of water within the Kafue Flats area. The Kafue Flats are home to about one million people and provide a rich inland fishery, habitat for an array of unique wildlife, and the means for hydroelectricity production. The Flats falls between two dams: Upstream to the west (not visible here) is the Izhi-tezhi, and downstream (middle right of the images) is the Kafue Gorge dam. Since the construction of these dams, the flooded area has been reduced and the timing and intensity of the inundation has changed. During June 2004 an agreement was made with the hydroelectricity company to restore water releases from the dams according to a more natural flooding regime. These images from NASA's Multi-angle Imaging SpectroRadiometer (MISR) illustrate surface changes to the wetlands and other surfaces in central Zambia resulting from an unusually lengthy wet season. The Kafue Flats appear relatively dry on July 19, 2003 (upper images), with the Kafue River visible as a slender dark line that snakes from east to west on its way to join the Zambezi (visible in the lower right-hand corner). On July 21, 2004 (lower images), well into the dry season, much of the 6,500-square kilometer area of the Kafue Flats remains inundated. To the east of the Kafue Flats is Lusaka, the Zambian capital, visible as a pale area in the middle right of the picture, north of the river. In the upper portions of these images is the prominent roundish shape of the Lukanga Swamp, another important wetland.The images along the left are natural-color views from MISR's nadir camera, and the images along the right are angular composites in which red band data from MISR's 46o forward, nadir, and 46o backward viewing cameras is displayed as red, green and blue, respectively. In order to preserve brightness variations among the various cameras, the data from each camera were processed identically. Here, color changes indicate surface texture, and are influenced by terrain, vegetation structure, soil type and soil moisture content. Wet surfaces or areas with standing water appear blue in this display because sun glitter makes smooth, wet surfaces look brighter at the backward camera's view angle. Mostly the landscape appears somewhat purple, indicating that most of the surfaces scatter sunlight in both backward and forward directions. Areas that appear with a slight greenish hue can indicate sparce vegetation, since the nadir camera is more likely to sight the gaps between the trees or shrubs, and since vegetation is darker (in the red band) than the underlying soil surface. Areas which preferentially exhibit a red or pink hue correspond with wetland vegetation. The plateau of the Kafue National Park, to the west of Lukanga Swamp, appears brighter in 2004 compared with 2003, which indicates weaker absorption at the red band. Overall, the 2004 image exhibits a subtle blue hue (preference for forward-scattering) compared with 2003, which indicates overall surface changes that may be a result of enhanced surface wetness. The Multiangle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire globe between 82o north and 82o south latitude. These data products were generated from a portion of the imagery acquired during Terra orbits 19072 and 24421. The panels cover an area of 235 kilometers x 239 kilometers, and utilize data from blocks 100 to 103 within World Reference System-2 path 172. MISR was built and is managed by NASA's Jet Propulsion Laboratory, Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.
Fires in Angola, Zambia, and Namibia
NASA Technical Reports Server (NTRS)
This series of MODIS images shows biomass burning in southern Africa in April, May, and June of 2002. The images span a number of different viewpoints of the region, but the country of Angola, with its highly dendritic (carved by rivers) geological formations are common to them all. Many of the images show part of four countries: Angola (usually at left), Zambia (right), Botswana (bottom right), and Namibia (bottom left). In many images, at lower center, the Okavango River creates a green broomstick-shaped delta in Boptwsana.
Costs of Anti-Retroviral Treatment in Zambia.
National Technical Information Service (NTIS)
This report analyzes the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy (HAART), volunta...
G. Kombe O. Smith
77 FR 48498 - Executive-Led Trade Mission to South Africa and Zambia
Federal Register 2010, 2011, 2012, 2013
...Executive-Led Trade Mission to South Africa and Zambia AGENCY: International...Executive- Led Trade Mission to South Africa and Zambia scheduled for November...S. Consulate, Johannesburg, South Africa, Tel: +55-11...
Improving Aid Effectiveness in Aid-Dependent Countries : Lessons from Zambia
Zambia was a middle-income country when it achieved independence from Great Britain in 1964. After decades of international aid Zambia has become a low-income country, and its per capita GDP is only now returning to the levels it had reached over forty years ago. While aid is far from the only variable at work in Zambia's development, its impact has
Monica Beuran; Ga�l Raballand; Julio Revilla
Improving aid effectiveness in aid-dependent countries : lessons from Zambia
Zambia was a middle-income country when it achieved independence from Great Britain in 1964. After decades of international aid Zambia has become a low-income country, and its per capita GDP is only now returning to the levels it had reached over forty years ago. While aid is far from the only variable at work in Zambia's development, its impact has
Monica Beuran; Ga�l Raballand; Julio Revilla
Country experience in organizing for quality: Zambia.
This article describes the activities of the Quality Assurance Program (QAP) within the Central Board of Health (CBH) in Zambia. QAP provides training and technical support to quality assurance (QA) to District Health Management Teams (DHMTs) and health centers. DHMT members were trained as QA facilitators. Training in target districts first addressed the setting and monitoring of standards. Training later focused on development of problem solving capacity. Health providers were trained by central staff to self-assess, to measure performance to agreed standards, and to respond to client-user needs. The Directorate of Monitoring and Evaluation provides training and oversight in QA to the DHMTs and their health centers. Training generally consists of a sensitization workshop, week-long training in dynamic standard setting, 5-day training in development of monitoring indicators at the district and facility level, and 2-week skills training in use of QA tools. CBH monitors quality by quarterly performance audits, supervision visits by DHMTs, and the health management information system (HMIS). The new HMIS was piloted in 15 districts and is being established nationwide. CBH developed a manual of standards for 6 priority health areas: reproductive health and family planning, HIV/AIDS and sexually transmitted diseases, child health and nutrition, tuberculosis, and water and sanitation. 85 QA teams operate in 90% of the districts. Problem solving methods have led to team building among professionals, increased competence of staff to address problems, and capacity building for management. PMID:12322022
Marquez, L; Madubuike, C
Acceptability of neonatal male circumcision in Lusaka, Zambia
Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of
Emily Waters; Elizabeth Stringer; Bridget Mugisa; Salome Temba; Kasonde Bowa; David Linyama
Acceptability of neonatal male circumcision in Lusaka, Zambia
Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of
Emily Waters; Elizabeth Stringer; Bridget Mugisa; Salome Temba; Kasonde Bowa; David Linyama
Modeling flooding patterns in the Kafue Flats, Zambia
The Kafue Flats is one of the most important wetlands in Zambia. In the early 70's the Kafue Gorge reservoir was built mainly for hydropower production not far downstream the outlet of the Kafue Flats. Only a few years later a dam was constructed upstream the Flats to extend the limited storage of Kafue Gorge. Besides its ecological value the
Philipp Meier; Wolfgang Kinzelbach
Social Isolation and Aging in Zambia: Examining the Possible Predictors
This research paper examined social isolation and aging in Zambia by examining possible predictors. The paper produces evidence on risk factors likely to engender social isolation among the elderly population of Zambia. Snowball sampling was undertaken to select 690 adults aged 60 and over in communities as well as those living in homes for the aged. A structured questionnaire was used to solicit information from respondents. Results show that old people in Zambia experience forms of social isolation which exhibit themselves (but not limited to) through such factors as loss of appetite, stress, moody, hopeless, useless, unhappy, and lonely. On balance, however, the direction of association and the number of statistically significant findings suggest that associations between variables examined and risk factors associated with social isolation amongst older people in this analysis could explain the overall situation occuring currently in Zambia and probably other developing countries. In view of this, this study recommends that further work is needed to identify and explain details of factors of social isolation using techniques such as focus group discussions as well as in-depth interviews with key informants. Such approaches may even help to explain why, for example, sex seems not to be significant in determining indicators of social isolation.
Mapoma, Christopher Chabila; Masaiti, Gift
Trypanocidal drug resistance in eastern province of Zambia
A survey to investigate resistance to drugs used in the treatment of bovine trypanosomosis was conducted in the eastern province of Zambia between 1996 and 1998. A cross-sectional study was conducted in three districts (Petauke, Katete, Lundazi) at 34 village sampling sites selected at random from villages that had shown greater than 6% prevalence of bovine trypanosomosis during an earlier
L. Sinyangwe; V. Delespaux; J. Brandt; S. Geerts; J. Mubanga; N. Machila; P. H. Holmes; M. C. Eisler
Use of Traditional Medicine among Pregnant Women in Lusaka, Zambia
Objective: We studied the prevalence of and predictors for traditional medicine use among pregnant women seeking care in the Lusaka, Zambia public health system. Subjects: We surveyed 1128 pregnant women enrolled in a clinical trial of perinatal human immunodefi- ciency virus (HIV) prevention strategies at two district delivery centers. Outcome measures: Postpartum questionnaires were administered to determine demographic characteris- tics,
Yolan Banda; Victoria Chapman; Robert L. Goldenberg; Jeffrey S. A. Stringer; Jennifer F. Culhane; Moses Sinkala; Sten H. Vermund; Benjamin H. Chi
Adolescents' Conceptions of "Moral": Haiti, the United States, and Zambia.
ERIC Educational Resources Information Center
Describes a study which applies a cultural-relativist approach to the study of the meaning of "moral" among adolescents in Haiti, Zambia, and the United States. Compares the conceptions of moral expressed by youths in these societies. Speculates about what cultural conditions might account for the similarities and differences among groups. (Author)
Michel, Claudine; And Others
Country Reports on Human Rights Practices, 2001: Zambia.
National Technical Information Service (NTIS)
Zambia is a republic governed by a president and a unicameral national assembly. After 2 decades of one-party rule, free and fair multiparty elections in November 1991 resulted in the victory of the Movement for Multi-Party Democracy (MMD) and the electio...
Country Reports on Human Rights Practices, 1999: Zambia.
National Technical Information Service (NTIS)
Zambia is a republic governed by a president and a unicameral national assembly. After two decades of one-party rule, free and fair multiparty elections in November 1991 resulted in the victory of the Movement for Multi-Party Democracy (MMD) and the elect...
Distance Education in Zambia. A Report on a Consultancy.
ERIC Educational Resources Information Center
Education is a key element in Zambia's national development; distance education is particularly suitable as a means of human resource development. The main purposes of distance education are to provide education for the unserved, predominantly rural indigenous population; provide second-chance education for dropouts; raise the educational level of�
Tate, Ormond
Nutrient and carbon cycling in the Kafue River (Zambia)
The lower Kafue River in central Zambia flows through the Kafue Flats (830 sq. km), a sensitive floodplain ecosystem (Ramsar site), and serves as an important subsistence fishery. The lower Kafue River (Qavg ~ 300 m3\\/s) is heavily impacted by two dams that regulate flow and flooding, and in so doing have substantially degraded the habitats. While the hydrology and
R. Zurbruegg; D. Senn; M. Lehmann; J. Wamulume; I. Nyambe; B. Wehrli
Mapping the Geographical Distribution of Lymphatic Filariasis in Zambia
Background Past case reports have indicated that lymphatic filariasis (LF) occurs in Zambia, but knowledge about its geographical distribution and prevalence pattern, and the underlying potential environmental drivers, has been limited. As a background for planning and implementation of control, a country-wide mapping survey was undertaken between 2003 and 2011. Here the mapping activities are outlined, the findings across the numerous survey sites are presented, and the ecological requirements of the LF distribution are explored. Methodology/Principal findings Approximately 10,000 adult volunteers from 108 geo-referenced survey sites across Zambia were examined for circulating filarial antigens (CFA) with rapid format ICT cards, and a map indicating the distribution of CFA prevalences in Zambia was prepared. 78% of survey sites had CFA positive cases, with prevalences ranging between 1% and 54%. Most positive survey sites had low prevalence, but six foci with more than 15% prevalence were identified. The observed geographical variation in prevalence pattern was examined in more detail using a species distribution modeling approach to explore environmental requirements for parasite presence, and to predict potential suitable habitats over unsurveyed areas. Of note, areas associated with human modification of the landscape appeared to play an important role for the general presence of LF, whereas temperature (measured as averaged seasonal land surface temperature) seemed to be an important determinant of medium-high prevalence levels. Conclusions/significance LF was found to be surprisingly widespread in Zambia, although in most places with low prevalence. The produced maps and the identified environmental correlates of LF infection will provide useful guidance for planning and start-up of geographically targeted and cost-effective LF control in Zambia.
Mwase, Enala T.; Stensgaard, Anna-Sofie; Nsakashalo-Senkwe, Mutale; Mubila, Likezo; Mwansa, James; Songolo, Peter; Shawa, Sheila T.; Simonsen, Paul E.
Patterns of Rift Valley fever activity in Zambia.
An hypothesis that there was an annual emergence of Rift Valley fever virus in Zambia, during or after the seasonal rains, was examined with the aid of sentinel cattle. Serum samples taken during 1974 and 1978 showed evidence of epizootic Rift Valley fever in Zambia, with more than 80% positive. A sentinel herd exposed from 1982 to 1986 showed that some Rift Valley fever occurred each year. This was usually at a low level, with 3-8% of the susceptible cattle seroconverting. In 1985-6 more than 20% of the animals seroconverted, and this greater activity was associated with vegetational changes--which could be detected by remote-sensing satellite imagery--which have also been associated with greater virus activity in Kenya. PMID:1547835
Davies, F G; Kilelu, E; Linthicum, K J; Pegram, R G
Patterns of Rift Valley fever activity in Zambia.
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.
Davies, F. G.; Kilelu, E.; Linthicum, K. J.; Pegram, R. G.
Prevalence and correlates of concurrent sexual partnerships in Zambia.
Concurrent partnerships may cause more rapid spread of HIV in a population. We examined how the prevalence of parallel relationships changed among men and women aged 15-49 in Zambia from 1998 to 2003 using data collected during the Sexual Behavior Surveys 1998, 2000, and 2003. Predictors of concurrent partnerships among men were studied by univariate and multivariate regression analyses. Thirteen percent of rural and 8% of urban men reported more than one ongoing relationship in 1998, and these proportions declined to 8% and 6%, respectively in 2003. The proportion of women reporting concurrent relationships was 0-2%. The most important predictors of concurrency were early sexual debut, being married, early marriage and absence from home. The reduction in concurrent sexual partnerships is consistent with reductions in other sexual risk behaviors found in other studies and may have contributed to the recently observed decline in HIV prevalence in Zambia. PMID:18841461
Sand�y, Ingvild F; Dzekedzeke, Kumbutso; Fylkesnes, Knut
Reforming pensions in Zambia : an analysis of existing schemes and options for reform
All of Zambia's pension schemes are deficient in design, financing, and administration. This report urges that Zambia restructure its social protection system to complement its new economic strategy. That restructuring must address such basic problems as macroeconomic fluctuations and an unstable financial sector; high inflation rates and politically-motivated low-yield investments and loans; income ceilings irregularly adjusted for inflation; overgenerous public
Monika Queisser; Clive Bailey; John Woodall
Penry, E. H. 1985. Notes on breeding of Cisticola brunnescens and C. juncidis in Zambia. Ostrich 56: 229�235.Details are given of breeding data from Cisticola juncidis and C. brunnescens in Kitwe. Zambia in December 1979 and January 1980. Composition, structure and dimensions of nests, incubation periods, nestling periods, chick development and breeding success are presented and comparisons are made between
E. H. Penry
Anthelmintic efficacy in captive wild impala antelope ( Aepyceros melampus) in Lusaka, Zambia
There has been an increase in the number of wild ungulates kept in captivity for ecotourism and conservation in Zambia and these animals are susceptible to a number of diseases including gastrointestinal helminth infections. Surveys to determine anthelmintic efficacy to gastrointestinal nematodes in captive-wildlife are not common and there have been no reports of anthelmintic resistance in captive-wildlife in Zambia.
King S. Nalubamba; B. Mudenda Ntombi
Inequalities in public health care delivery in Zambia
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 to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia.
Prevalence of trypanosomiasis in cattle in south-west Zambia.
A trypanosomiasis survey was conducted in South-West Zambia. From a total of 3,346 cattle sampled 342 cattle showed a positive trypanosomiasis parasitaemia. During the survey trypanosome species and PCV values were also recorded. With simple statistical analysis populations with higher and lower prevalence rates were differentiated. The results indicated that the Kwando River Basin Tsetse Fly Belt and the Kafue River Basin Tsetse Fly Belt infested a larger area than originally assumed and that a link-up between both belts occurred or will occur in the near future. PMID:3400114
Corten, J J; ter Huurne, A A; Moorhouse, P D; de Rooij, R C
Will savannas survive outside the parks? A lesson from Zambia
NASA Astrophysics Data System (ADS)
Miombo woodlands cover the transition zone between dry open savannas and moist forests in Southern Africa. They cover about 2.7 million km2 in southern Africa and provide many ecosystem services that support rural life, including medical products, wild foods, construction timber and fuel. In Zambia, as in many of its neighbouring countries, miombo woodlands are currently experiencing accelerating degradation and clearing, mostly with charcoal production as the initial driver. Domestic energy needs in the growing urban areas are largely satisfied by charcoal, which is less energy-efficient fuel on a tree-to-table basis than the firewood that is used in rural areas, but has a higher energy density and is thus cheaper to transport. This study uses data from inventories and from eddy covariance measurements of carbon exchange to characterize the impact of charcoal production on miombo woodlands. We address the following questions: (i) how much carbon is lost at local as well as at national scale and (ii) does forest degradation result in the loss of a carbon sink? On the basis of our data we (iii) estimate the per capita emissions through deforestation and forest degradation in Zambia and relate it to fossil fuel emissions. Furthermore, (iv) a rough estimate of the energy that is provided by charcoal production to private households at a national level is calculated and (v) options for alternative energy supply to private households are discussed.
Kutsch, W.; Merbold, L.; Scholes, B.; Mukelabai, M.
Telemedicine in Primary Health: The Virtual Doctor Project Zambia
This paper is a commentary on a project application of telemedicine to alleviate primary health care problems in Lundazi district in the Eastern province of Zambia. The project dubbed 'The Virtual Doctor Project' will use hard body vehicles fitted with satellite communication devices and modern medical equipment to deliver primary health care services to some of the neediest areas of the country. The relevance and importance of the project lies in the fact that these areas are hard-to-reach due to rugged natural terrain and have very limited telecommunications infrastructure. The lack of these and other basic services makes it difficult for medical personnel to settle in these areas, which leads to an acute shortage of medical personnel. We comment on this problem and how it is addressed by 'The Virtual Doctor Project', emphasizing that while the telemedicine concept is not new in sub-Saharan Africa, the combination of mobility and connectivity to service a number of villages 'on the go' is an important variation in the shift back to the 1978 Alma Ata principles of the United Nations World Health Organization [WHO]. This overview of the Virtual Doctor Project in Zambia provides insight into both the potential for ICT, and the problems and limitations that any "real-world" articulation of this technology must confront.
Efficiency and emission characteristics of two Zambia cookstoves using charcoal and coal briquettes.
National Technical Information Service (NTIS)
The emission characteristics of charcoal and coal briquettes in two Zambia household cookstoves were evaluated using an improved chamber method. The two domestic appliances were the traditional mbaula and the newly developed ceramic stove, referred to as ...
J. Kaoma G. Kasali A. Ellegaard
Decentralization of the Health System in Zambia. Major Applied Research 6, Technical Report 2.
National Technical Information Service (NTIS)
Zambia's ambitious process of decentralization after 1995 is examined in this study using the decision-space analytical approach in national level data analysis and in field case studies of nine districts. The study found that the deconcentrated system al...
T. Bossert M. B. Chitah M. Simonet L. Mwansa M. Daura
Mutumwa Nchimi healers and wizardry beliefs in Zambia.
Mutumwa Nchimi practitioners in Zambia today are neotraditional healers who specialize in the diagnosis and curing of illnesses and misfortunes allegedly caused by wizardry (buloshi). Nchimi means 'witch-diviner' and Mutumwa means 'sent (by God)'. Their witch-divining practices are thus placed within the new biblical religious framework. Mutumwa Nchimi healers are contemporary African psychiatrists and psychotherapists who fully accept and work within the framework of the wizardry paradigm as the explanatory mechanism for a whole range of problems and illnesses experienced by a large number of Zambia's urban dwellers. Their success in attracting patients bears witness to the extent to which wizardry still persists as a paradigm for evil. The research data used is comprised of 143 complete tape-recorded cases of Mutumwa Nchimi diagnoses in addition to 1233 summaries of book-recorded cases. Buloshi is mentioned as the cause of illness and misfortune in 58% of the tape-recorded cases and in 55.9% of the book-recorded cases. Wizardry is perceived by Mutumwa Nchimi healers to relate to two dimensions which refer to the activity of witchcraft and of sorcery respectively. The former relates to witch spirits and fibanda ghosts; the latter relates to the use of bwanga magical charms. In addition to the need for prayer and reconciliation, psychotherapy requires the cleansing of one's body and of one's house from buloshi attack. The two dimensions of witchcraft and of sorcery, though distinct, are seen to be essentially related to one another. The dreams of patients, in which unconscious pressures come to the surface, are perceived to confirm the existence and reality of wizardry assault. Wizardry beliefs are placed firmly within the context of social relationships and social change in Zambia and psychosocial analysis is at the centre of the diagnostic process. Wizardry beliefs are seen by Mutumwa Nchimi healers to reflect the problems faced by urban dwellers in particular who, on the one hand, find themselves afflicted by feelings of shame or guilt with respect to failure to observe traditional morality and, on the other hand, by an awareness of suspected rival forces in the competitive urban environment. PMID:3393933
Dillon-Malone, C
HIV stress in primary school teachers in Zambia.
A study was made of stress factors experienced by primary school teachers in Zambia after they had attended a course on stress management and counselling skills. Their pupils were significantly affected by poverty, death and illness of parents, fellow-pupils and teachers, teenage sex and pregnancy, violence in the home and, among girls, low self-esteem. The HIV epidemic had a major bearing on these factors, and there were wide-ranging effects on the teachers' own lives. Despite the training they had been given, many teachers felt that they could not adequately counsel their pupils on these matters. The teachers were in need of continuing support and training to enable them to cope with this aspect of their work.
Baggaley, R.; Sulwe, J.; Chilala, M.; Mashambe, C.
Lymphatic filariasis in Luangwa District, South-East Zambia
Background Past case reports and recent data from LF mapping surveys indicate that LF occurs in Zambia, but no studies have been carried out to document its epidemiology and health implications. The present study assessed infection, disease, transmission and human perception aspects of LF in an endemic area of Luangwa District, South-East Zambia, as a background for planning and implementation of control. Methods Two neighbouring rural communities were registered and a questionnaire survey undertaken. Clinical examination, and sampling of blood for circulating filarial antigens (CFA; marker of adult worm infection) and antibodies to Bm14 antigen (marker of exposure to transmission), were carried out during the daytime. Blood from CFA positive individuals was examined for microfilariae (mf) at night. Vector surveys were carried out in selected households, using light traps. Results 985 individuals aged ? 1�year were registered. The CFA prevalence increased with age from 1.2% in age group 1�14�years to 20.6% in age group 50+ years (overall 8.6%). Wuchereria bancrofti mf were identified in 10.9% of CFA positive individuals (corresponding to a community prevalence of 0.9%). Prevalence and intensity of Bm14 antibodies were much higher in individuals ? 30�years than in younger individuals (57.2 vs. 19.3%; 0.594 vs. 0.241 OD-values). Elephantiasis and hydrocele were well known clinical manifestations in the area, but only one case of hydrocele was detected in the study population. Identified potential vectors were Anopheles funestus and An. gambiae. Conclusion The study confirmed that LF was endemic in the study communities, but infection and disease prevalence was low. Several indications, including a marked recent decline in CFA prevalence, suggest that transmission in the area is on the decrease, perhaps because of intensive application of malaria control measures targeting the Anopheles vectors. It is recommended that mass drug administration is initiated to accelerate this positive trend of decline in LF transmission in the area.
Sex differentials in the uptake of antiretroviral treatment in Zambia.
This study explores socio-structural factors that influence uptake of antiretroviral treatment (ART) in Zambia and assess differences between men and women. We conducted a case-control study nested in a community- and health facility-based survey, between September 2010 and February 2011. Cases were defined as HIV-positive individuals who, while eligible, never started ART and controls were HIV-positive individuals who were on ART. Cases and controls were matched by place of residence. We performed a conditional logistic regression analysis using a discrete logistic model stratified by sex. Overall, a significantly larger proportion of men (32.7%) than women (25.6%) did not uptake ART (Pearson ?(2) = 5.9135; p = 0.015). In the crude analysis, poor health status and low self-efficacy were common factors associated with non-uptake in both sexes. After adjusting for covariates, men were more likely than women to refuse ART even though men's self-rated health was lower than women's. In general, the adjusted analysis suggests that HIV status disclosure affects uptake in both sexes but women's uptake of ART is largely hampered by poverty-related factors while for men, side effects and social pressure, probably associated with masculinity, are more important barriers. Alarmingly men's health seems to deteriorate until they start treatment, in contrast to women. Understanding gender differences in uptake and attitudes to ART is a crucial component to providing effective and appropriate health care to both men and women living with HIV/AIDS in Zambia. PMID:24666201
Gari, S; Martin-Hilber, A; Malungo, J R S; Musheke, M; Merten, S
Analyzing the Process of Health Financing Reform in South Africa and Zambia: Zambia Country Report. Major Applied Research 1, Technical Paper No. 2.
National Technical Information Service (NTIS)
This report presents the findings of the Zambian country study undertaken as part of a two country project called Analyzing the process of health sector reform in South Africa and Zambia (also known as the SAZA project). The report presents an analysis of...
S. Lake M. Daura M. Mabandhla F. Masiye S. Mulenga I. Antezana C. Mwikisa S. Bennett
Provision of Learning and Teaching Materials for Pupils with Visual Impairment: Results from a National Survey in Zambia
ERIC Educational Resources Information Center
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�
Akakandelwa, Akakandelwa; Munsanje, Joseph
Anthelmintic efficacy in captive wild impala antelope (Aepyceros melampus) in Lusaka, Zambia.
There has been an increase in the number of wild ungulates kept in captivity for ecotourism and conservation in Zambia and these animals are susceptible to a number of diseases including gastrointestinal helminth infections. Surveys to determine anthelmintic efficacy to gastrointestinal nematodes in captive-wildlife are not common and there have been no reports of anthelmintic resistance in captive-wildlife in Zambia. This study was carried out to determine the efficacy of the benzimidazole anthelmintic fenbendazole in captive wild impala (Aepyceros melampus) in Zambia. During the month of April 2011, at the end of the rainy season, the faecal egg count reduction test was performed at a private game facility for assessing anthelmintic efficacy of oral fenbendazole and the anthelmintic treatment showed an efficacy of 90%. Haemonchus spp. and Trichostrongylus spp. were the predominant genera present before treatment, but Haemonchus spp. larvae were the only genus recovered from the faecal cultures after anthelmintic treatment. This represents the first documentation of anthelmintic treatment failure in captive wild-antelopes in Zambia. It also demonstrated the ineffectiveness of the common traditional practice of deworming captive-wild antelopes at the end of the rainy season due to the rapid re-infection of impala that occurs due to high pasture infectivity. Suggestions on changes to current anthelmintic use/practices that will make them more efficacious and reduce the possibility of development of anthelmintic resistance in captive wild game in Zambia are also made. PMID:22115945
Nalubamba, King S; Mudenda, Ntombi B
The Zambia Children's KS-HHV8 Study: Rationale, Study Design, and Study Methods
The epidemic of human immunodeficiency virus in Zambia has led to a dramatic rise in the incidence of human herpesvirus-8 (HHV-8)�associated Kaposi's sarcoma in both adults and children. However, there is a paucity of knowledge about the routes of HHV-8 transmission to young children. The Zambia Children's KS-HHV8 Study, a large, prospective cohort study in Lusaka, Zambia, was launched in 2004 to investigate the role of household members as a source of HHV-8 infection in young children and social behaviors that may modify the risk of HHV-8 acquisition. This cohort is distinct from other epidemiologic studies designed to investigate HHV-8 incidence and transmission because it recruited and followed complete households in the urban central African context. Between July 2004 and March 2007, 1,600 households were screened; 368 households comprising 464 children and 1,335 caregivers and household members were enrolled. Follow-up of this population continued for 48 months postrecruitment, affording a unique opportunity to study horizontal transmission of HHV-8 and understand the routes and sources of transmission to young children in Zambia. The authors describe the study rationale, design, execution, and characteristics of this cohort, which provides critical data on the epidemiology and transmission of HHV-8 to young children in Zambia.
Minhas, Veenu; Crabtree, Kay L.; Chao, Ann; Wojcicki, Janet M.; Sifuniso, Adrian M.; Nkonde, Catherine; Kankasa, Chipepo; Mitchell, Charles D.; Wood, Charles
The Zambia Children's KS-HHV8 Study: rationale, study design, and study methods.
The epidemic of human immunodeficiency virus in Zambia has led to a dramatic rise in the incidence of human herpesvirus-8 (HHV-8)-associated Kaposi's sarcoma in both adults and children. However, there is a paucity of knowledge about the routes of HHV-8 transmission to young children. The Zambia Children's KS-HHV8 Study, a large, prospective cohort study in Lusaka, Zambia, was launched in 2004 to investigate the role of household members as a source of HHV-8 infection in young children and social behaviors that may modify the risk of HHV-8 acquisition. This cohort is distinct from other epidemiologic studies designed to investigate HHV-8 incidence and transmission because it recruited and followed complete households in the urban central African context. Between July 2004 and March 2007, 1,600 households were screened; 368 households comprising 464 children and 1,335 caregivers and household members were enrolled. Follow-up of this population continued for 48 months postrecruitment, affording a unique opportunity to study horizontal transmission of HHV-8 and understand the routes and sources of transmission to young children in Zambia. The authors describe the study rationale, design, execution, and characteristics of this cohort, which provides critical data on the epidemiology and transmission of HHV-8 to young children in Zambia. PMID:21447476
Minhas, Veenu; Crabtree, Kay L; Chao, Ann; Wojcicki, Janet M; Sifuniso, Adrian M; Nkonde, Catherine; Kankasa, Chipepo; Mitchell, Charles D; Wood, Charles
�All for some�: water inequity in Zambia and Zimbabwe
NASA Astrophysics Data System (ADS)
In southern Africa, gross disparities in access to water are symptomatic of the overall uneven pattern of development. Despite post-independence egalitarian rhetoric, in countries such as Zambia and Zimbabwe inappropriate models (piped house connections in the urban areas, high technology irrigation schemes in the agricultural sector), combined with weak macro-economies and poorly formulated sectoral policies have actually exacerbated the disparities. Zero or very low tariffs have played a major role in this. Although justified as being consistent with water�s special status, inadequate tariffs in fact serve to undermine any programme of making water accessible to all. This has led to a narrowing of development options, resulting in exclusivist rather than inclusivist development, and stagnation rather than dynamism. A major part of the explanation for perpetuation of such unsatisfactory outcomes is the existence of political interest groups who benefit from the status quo. The first case study in the paper involves urban water consumers in Zambia, where those with piped water connections seek to continue the culture of low tariffs which is by now deeply embedded. The result is that the water supply authorities (in this case the newly formed, but still politically constrained �commercialised utilities�) are unable even to maintain adequate supplies to the piped customers, let alone extend service to the peri-urban dwellers, 56% of whom do not have access to safe water. The paper outlines some modest, workable principles to achieve universal, affordable access to water in the urban areas, albeit through a mix of service delivery mechanisms. In a second case study of rural productive water in Zimbabwe, the reasons for only 2% of the rural subsistence farming households being involved in formal small-scale irrigation schemes 20 years after independence are explored. Again, a major part of the explanation lies in government pursuing a water delivery model which is not affordable or sustainable on a wide scale. Its provision, via substantial capital and recurrent subsidies, for a small group has a large opportunity cost for society as a whole. The small-scale irrigators have a vested interest in ensuring that the subsidies are maintained, but in the process continue to absorb a disproportionate amount of resources which could be used for development elsewhere. By choosing simpler, cheaper water technologies, and assisting farmers with growing and marketing high value crops, the resources could instead be used to benefit a much larger proportion of households. With well designed programmes aimed at achieving equity, large numbers of subsistence farmers could improve their incomes and start working their way out of poverty.
Robinson, Peter B.
Can family planning outreach bridge the urban-rural divide in Zambia?
Background 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. Methods 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. Results 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. Conclusion Outreach in the form of health worker visits can improve access to family planning services, but it does not eliminate barriers to access or address continued high-fertility desires in Zambia. Until policymakers consider strategies that address both family planning demand creation and supply of services, progress in Zambia and the rest of sub-Saharan Africa will continue to lag behind the rest of the world.
White, Justin S; Speizer, Ilene S
Piecework (ganyu) as an indicator of household vulnerability in rural Zambia.
Piecework (ganyu) is short-term, casual labor common in rural Zambia and neighboring countries. Reliance on piecework as a strategy to cope during food shortages in the rainy/cultivation season can restrict own-farm production, and thus, is regarded as an indicator of a household's vulnerability to food insecurity. Based on a household's level of participation in piecework, we explore this claim in rural Zambia using survey data collected during the rainy and dry seasons in 2009. We argue that seasonal assessments are essential if such dependence on piecework is used as a robust measure of a household's vulnerability to food insecurity. PMID:23927046
Cole, Steven M; Hoon, Parakh N
Priorities for Antiretroviral Therapy Research in Sub-Saharan Africa: A 2002 Consensus Conference in Zambia
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 operational research to assess clinical and field-based strategies to maximize adherence for better outcomes of ART in Zambia To assess ART approaches most valuable for pediatric and adolescent patients in Zambia Conference participants recommended that HIV-related clinical care and research be integrated within home-based care services and operated within the existing health delivery structures to ensure sustainability, reduce costs, and strengthen the structures. Conclusion Our consensus was that antiretroviral clinical trials and operational research are essential for Zambia to address the new challenges arising from increasing ART availability. There is global consensus that antiretroviral clinical trials in resource-constrained countries are possible, and the capacity for such trials should be developed further in Africa.
Zulu, Isaac; Schuman, Paula; Musonda, Rosemary; Chomba, Elwyn; Mwinga, Kasonde; Sinkala, Moses; Chisembele, Maureen; Mwaba, Peter; Kasonde, Dorothy; Vermund, Sten H.
Preventing HIV with young people: a case study from Zambia.
The US President's Emergency Plan for AIDS Relief (PEPFAR) is funding thousands of community-based organisations, international NGOs and government services in high HIV prevalence countries to persuade young people to abstain from sex until marriage (Abstinence, Behaviour Change, Youth--ABY). This paper describes how this strategy is being implemented in Zambia, and community responses to it. It is derived from published information and observations and discussions in the Eastern Province in 2005-2006. A few NGOs have challenged the strategy, but many took the funds and are paying large numbers of peer educators to promote abstinence only. Messages are rife that condoms have holes or don't work sufficiently well to make them worth using. Condom promotion materials have been replaced. Service providers refuse to give condoms to young people. Young people who had attended sexuality and life skills programmes that gave them accurate information are rejecting inaccurate messages and demanding condoms. Without this education, however, inaccurate messages will spread quickly. It is not possible to promote condoms only for high risk people without stigmatising both the people and condoms, and it also jeopardises promoting condom use for contraception. Everything possible must be done to reduce negative messages about condoms. Everyone involved in HIV/AIDS needs to reflect on their own work in relation to this new climate and ensure that all prevention options are widely available, correct information is given and condoms are available for everyone who needs them. PMID:17101424
Gordon, Gill; Mwale, Vincent
Thelazia rhodesii in the African Buffalo, Syncerus caffer, in Zambia
We report 2 cases of Thelazia rhodesii infection in the African buffaloes, Syncerus caffer, in Zambia. African buffalo calves were captured from the livestock and wildlife interface area of the Kafue basin in the dry season of August 2005 for the purpose to translocate to game ranches. At capture, calves (n=48) were examined for the presence of eye infections by gently manipulating the orbital membranes to check for eye-worms in the conjunctival sacs and corneal surfaces. Two (4.3%) were infected and the mean infection burden per infected eye was 5.3 worms (n=3). The mean length of the worms was 16.4 mm (95% CI; 14.7-18.2 mm) and the diameter 0.41 mm (95% CI; 0.38-0.45 mm). The surface cuticle was made of transverse striations which gave the worms a characteristic serrated appearance. Although the calves showed signs of kerato-conjunctivitis, the major pathological change observed was corneal opacity. The calves were kept in quarantine and were examined thrice at 30 days interval. At each interval, they were treated with 200 �g/kg ivermectin, and then translocated to game ranches. Given that the disease has been reported in cattle and Kafue lechwe (Kobus lechwe kafuensis) in the area, there is a need for a comprehensive study which aims at determining the disease dynamics and transmission patterns of thelaziasis between wildlife and livestock in the Kafue basin.
Chembensofu, Mweelwa; Siamudaala, Victor M.; Munyeme, Musso; Matandiko, Wigganson
Conceptualization of appropriate technology in Lundazi district of rural Zambia
A sample of 144 people from the Lundazi District of the Eastern Province of rural Zambia in Central Africa responded to a questionnaire. The first objective of the study was to determine how men and women conceptualize and evaluated appropriate technology for food production, processing, preservation, and storage; second, to investigate if participation in modern institutions (COSISOCHINS) was related to conceptualization of appropriate technology. There were no significant gender differences in how men and women viewed appropriate technology. Participation in modern institutions was not significantly related to how people conceptualized and evaluated appropriate technology. There were significant gender differences in participation in modern institutions; men participated more than women. The findings remained the same when age, education, income and marital status held constant. Sex-role task overlap and exclusiveness in gender division of labor account for lack of significant gender differences. Modern institutions can be useful if they are effectively integrated with the social structure, gender division of labor, and social organization of the production process of the rural communities of the Third World.
Tembo, M.S.
Acceptability and uptake of neonatal male circumcision in Lusaka, Zambia.
Neonatal male circumcision (NMC) is an uncommon procedure in Southern Africa, but is being scaled up in Zambia for long-term HIV prevention. We conducted a cross-sectional survey on NMC with a convenience sample of mothers of newborn boys at two public clinics in Lusaka. Following the survey, mothers received information on availability of NMC, and uptake of the service was tracked. Predictors of uptake were assessed using bivariate and multivariate logistic regression. Of the 1,249 eligible mothers approached, 1000 (80%) agreed to participate. Although 97% of surveyed mothers said they definitely or probably planned to have their newborn son circumcised, only 11% of participants brought their newborn sons for NMC. Significant predictors of uptake in adjusted models included: Older maternal age (AOR 3.77, 95% CI 1.48-9.63 for age 36 and above compared to mothers age 25 and below), having attended antenatal care at an NMC site (AOR 2.13, 95% CI 1.32-3.44), older paternal age (AOR 4.36, 95% CI 1.28-14.91 for age 26-35 compared to fathers age 25 and below), and the infant's father being circumcised (AOR 2.21, 95% CI 1.35-3.62). While acceptability studies in Southern Africa have suggested strong support for MC among parents for having their sons circumcised, this may not translate to high uptake of newly-introduced NMC services. PMID:22968397
Waters, Emily; Li, Michelle; Mugisa, Bridget; Bowa, Kasonde; Linyama, David; Stringer, Elizabeth; Stringer, Jeffrey
Urban women's informal savings and credit systems in Zambia.
This article is based on findings from semi-structured interviews and discussions among "chilimba" groups in Zambia. Chilimba groups are primarily women's groups that engage in credit and savings programs. Group membership ranges from 4 to 20 members. The women agree on a fixed, regular cash contribution that is given in turn to each member in a specified order. Market groups tend to be larger and contributions of about a dollar are made daily. Smaller groups tend to make larger, but less frequent contributions. Default is rare, as the commitment is taken very seriously. New members are added at the end of the rotation. Loans can be used for domestic or business use. Chilimba groups are evidence that very poor people desire savings. Chilimba brings together people with similar financial needs and resources. Chilimba does not require formal, written procedures or formal institutional frameworks. Chilimba is not a remedy for reducing overall poverty. It is appropriate only for people with some regular source of income. It does not serve as a safety net in emergencies. Long-term loans are not possible. A limitation is its openness and lack of structure that permit potential abuse. It is a livelihood strategy for women, but benefits could be gained from including men. It is urged that groups consider whether the position of the poor is being enhanced or undermined. Different models need to be tested. Members themselves must decide on the type and phasing of activities. PMID:12347267
O'reilly, C
Information Provision in Emergency Settings: The Experience of Refugee Communities in Zambia
ERIC Educational Resources Information Center
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�
Kanyengo, Brendah Kakulwa; Kanyengo, Christine Wamunyima
Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia
BACKGROUND: Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. METHODS: Health facility record reviews were conducted in 52 facilities in Malawi and 39 facilities in Zambia in 2006\\/07 and 2008; quarterly totals from
Ruair� Brugha; John Kadzandira; Joseph Simbaya; Patrick Dicker; Victor Mwapasa; Aisling Walsh
Evolving a Model Learning Resource Center for a Developing Country (Zambia).
ERIC Educational Resources Information Center
For a developing nation such as Zambia, quality education, utilization of manpower, and proper training are priority problems. Therefore a study was conducted to establish and document the need for a well-planned, staffed and executed learning resource center to solve some of that country's learning problems. Basic facts about the country of�
Patel, Jasubhai J.
Report from the Field: Education under Structural Adjustment in Nigeria and Zambia.
ERIC Educational Resources Information Center
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)
Babalola, Joel B.; Lungwangwa, Geoffrey; Adeyinka, Augustus A.
A water quality intervention that consists of water treatment, safe storage, and community education was field tested in Kitwe, Zambia. A total of 166 intervention households were randomly selected from one community and 94 control households from another. Baseline surveys were conducted and the intervention was distributed. Weekly active diarrhea surveillance, biweekly water testing, and a follow-up survey were conducted.
The prevalence of porcine cysticercosis in Eastern and Southern provinces of Zambia
The objective of this study was to determine the prevalence and importance of porcine cysticercosis in rural areas of Zambia. The study involved an abattoir survey of 1316 pigs at a slaughter slab in Lusaka and two field surveys in villages in Southern and Eastern provinces. Lingual examination of live pigs and visual inspection of their carcass as well as
I. K. Phiri; P. Dorny; S. Gabriel; A. L. Willingham; N. Speybroeck; J. Vercruysse
Un/Doing Gender? A Case Study of School Policy and Practice in Zambia
ERIC Educational Resources Information Center
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�
Bajaj, Monisha
Distribution of copper, lead, cadmium and zinc concentrations in soils around Kabwe town in Zambia
The extent of pollution of the environment as a result of mining activities in Kabwe, the provincial capital of Central province in Zambia has not yet been evaluated. Mining of lead and zinc were the core activities of Kabwe mine while cadmium and silver were produced as by-products. The smelting processes produced a significant amount of copper. The spatial distribution
Backsion D. Tembo; Kwenga Sichilongo; Joseph Cernak
Due to the high cost of inorganic fertilizer, small-scale resource poor farmers of Northern Zambia are unable to afford it. Cheaper alternatives are being sought. Addition of P alone tends to be ineffective as some of the P is fixed. Thus, use of Tithonia alone or in combination with sources of P was employed as this approach has been shown
C. N. Malama
Post-impoundment changes in the fish fauna of Lake Itezhi-tezhi, Zambia
The fish fauna of the newly inundated Lake Itezhi-tezhi, Zambia was observed between 1980 and 1985. Marked changes in the community structure were identified. The most obvious were a decline in species diversity and a shift in species composition from acommunity with a preponder- ance of Alesles lateralis (Boulenger) (Characidae), to one dominated by cichlids. These changes were primarily due
C. K. Kapasa; I. G. Cowx
Survival strategies of the elderly in Gwembe Valley, Zambia: Gender, residence and kin networks
Fundamental social and material reproductive activities take place in the domestic setting, especially in subsistence societies. For the elderly in these societies, residential arrangements significantly influence their well being because of the redistribution of resources that occurs within the domestic unit. This article examines the critical issue of how the elderly of Zambia's Gwembe Valley organize their residential arrangements. The
Lisa Cliggett
Aspects of productivity of traditionally managed Barotse cattle in the Western Province of Zambia
In sub-Saharan Africa, traditionally managed livestock is important because of the provision of draught power and manure, the provision of security and investment possibilities, for the provision of meat and milk, and for social purposes (eg. brideprice, gifts). In the Western Province of Zambia, cattle are the only livestock of significance. The soils of the province virtually entirely consist of
Klink van E. G. M
Analyzing Geographical Access to HIV Sentinel Clinics in Relation to Other Health Clinics in Zambia
This paper illustrates that in countries such as Zambia where available sentinel clinic data lack patient use information while including location and clinic type, advanced geospatial modeling can be a good proxy for measuring access to health care facilities including HIV sentinel clinics. The analysis shows mapped patterns of potential accessibility to HIV sentinel clinics versus all other clinics, while
Imelda K. Moise; Ezekiel Kalipeni; Leo C. Zulu
Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation
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.
Disease constraints for utilization of the African buffalo (Syncerus caffer) on game ranches in Zambia.
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. PMID:16786973
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
Stigma, HIV\\/AIDS and prevention of mother-to-child transmission in Zambia
This report evaluates the extent of perceived and enacted HIV\\/AIDS-related stigma in a rural setting in Zambia. Stigmatisation is abundant, ranging from subtle actions to the most extreme degradation, rejection and abandonment. Women with HIV and pregnant women assumed to be HIV positive are repeatedly subjected to extensive forms of stigma, particularly once they become sick or if their child
Virginia Bond; Elaine Chase; Peter Aggleton
Barriers and facilitators to patients' adherence to antiretroviral treatment in Zambia: a qualitative study
Patients' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV\\/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients' and health care professionals' perceived barriers and facilitators to patients' adherence to ART. Based on data from individual interviews and focus group interviews
Nawa Sanjobo; Jan C Frich; Atle Fretheim
This paper is a product of a larger study conducted between 2002 and 2004 on the state of libraries and use of Information Communication Technology (ICT) in research and academic libraries in Zambia. It examines the role of information professionals in enhancing access to animal health information under prevailing conditions. Animal health is an integral aspect of the agricultural sector,
Muyoyeta Simui
WP 80 - An overview of women�s work and employment in Zambia
*Management Summary* This report provides information on Zambia on behalf of the implementation of the DECISIONS FOR LIFE project in that country. The DECISIONS FOR LIFE project aims to raise awareness amongst young female workers about their employment opportunities and career possibilities, family building and the work-family balance. This report is part of the Inventories, to be made by the
Maarten Klaveren; Kea Tijdens; Melanie Hughie Williams; Nuria Ramos Martin
An analysis of trypanocidal drug use in the Eastern Province of Zambia
As part of the development of a strategy for the control of bovine trypanosomosis in Zambia, a survey was conducted to quantify and qualify the current use of trypanocidal drugs (diminazene aceturate and isometamidium chloride) in a tsetse-controlled and a tsetse-infested area of the Eastern Province. A total of 207 trypanocide users were interviewed. Questions were posed on herd structure,
P Van den Bossche; M Doran; R. J Connor
Stratigraphy and palynostratigraphy, Karoo Supergroup (Permian and Triassic), mid-Zambezi Valley, southern Zambia
The Karoo Supergroup outcropst in the mid-Zambezi Valley, southern Zambia. It is underlain by the Sinakumbe Group of Ordovician to Devonian age. The Lower Karoo Group (Late Carboniferous to Permian age) consists of the basal Siankondobo Sandstone Formation, which comprises three facies, overlain by the Gwembe Coal Formation with its economically important coal deposits, in turn overlain by the Madumabisa
Imasiku A. Nyambe; John Utting
Access, Quality, and Opportunity: A Case Study of Zambia Open Community Schools (ZOCS)
ERIC Educational Resources Information Center
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�
Mwalimu, Michelle
Comparative Policy Brief: Status of Intellectual Disabilities in the Republic of Zambia
ERIC Educational Resources Information Center
In the Republic of Zambia, an estimated 256,000 persons have some form of disability, and of these, 5.4% have intellectual disabilities. Even now, traditional beliefs about the etiology of intellectual disabilities persist and considerable stigma is attached to the presence of persons with intellectual disabilities who are often excluded from�
Mung'omba, James
HIV Testing among Adolescents in Ndola, Zambia: How Individual, Relational, and Environmental Factors Relate to Demand
ERIC Educational Resources Information Center
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�
Denison, Julie A.; McCauley, Ann P.; Dunnett-Dagg, Wendy A.; Lungu, Nalakwanji; Sweat, Michael D.
Fertilizer market development: a comparative analysis of Ethiopia, Kenya, and Zambia
This article synthesizes case studies from Kenya, Zambia, and Ethiopia to assess how differences in the implementation of fertilizer marketing policies have affected the costs and risks borne by marketing actors, the investment response by private traders, and fertilizer consumption.Financial cost accounting techniques indicate that domestic marketing costs account for 50% or more of farm-gate prices. The sum of importer,
T. S. Jayne; J. Govereh; M. Wanzala; M. Demeke
Integrating mental health into primary health care in Zambia: a care provider's perspective
BACKGROUND: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative
Lonia Mwape; Alice Sikwese; Augustus Kapungwe; Jason Mwanza; Alan Flisher; Crick Lund; Sara Cooper
Traditional healers and the treatment of sexually transmitted illnesses in rural Zambia
Lately there has been increasing interest regarding the practice of traditional healers and their use of indigenous plants to treat illnesses. Twenty-three local healers (n�ganga) in Chiawa, rural Zambia, were interviewed about knowledge, practices, and their use of indigenous plants in the diagnosis and treatment of sexually transmitted illnesses (STIs) among male clients. They were also asked about their perceptions
Phillimon Ndubani; Bengt H�jer
Zambia: a church where Brothers are not brothers.
George grew up with no family and attended a Catholic Mission High School in Zaire. He joined an order of Brothers in Kabwe in the Copperbelt of Zambia. In December, 1992, the order required him to undergo an HIV test. In February, 1993, when on holiday, he received a letter' from a superior informing him that he was HIV positive. The superior wrote that George was no longer an acceptable and worthy person to spread God's word, and that he was expelled from the order. Yet, he had behaved well at the order and at the school. The expulsion left George with no food, shelter, money, or job. He was all alone. He had had his first and only sexual encounter at age 22, which was with an older female friend. He had had no more sexual relationships. This brief sexual encounter led to his contracting HIV. The Church's rejection of George is a loss for the Church because this good man could have educated people about HIV and helped reduce the stigma of HIV/AIDS through the Church. The center where he went in Lusaka has also counseled 36 nuns and 11 priests. Most report that superiors had coerced them to be tested for HIV. When they came to the center, they were emotionally unprepared to deal with a positive test. Some did not know that their blood was being tested for HIV and the results would go directly to their superiors. The superiors provided economic reasons to justify the HIV testing. The center concluded that no one should be coerced to undergo HIV testing pre and post test counseling should be provided, HIV test results must be confidential between the counselor and the patient, churches should be in the forefront of reducing the stigma linked to HIV/AIDS while exhibiting love and compassion, and HIV- positive religious leaders are not liabilities but can offer up to 10 years of valuable service. PMID:12318857
Baggaley, R
Perspectives on literacy, gender and change: a case for Zambia.
This study examines illiterate participants' perceptions of literacy training that was conducted after 6-12 months of training in one urban Copperbelt province and one center in rural Luapula province in Zambia. Interviews were conducted among 29 female and 11 male participants and 15 male and 3 female officials. Analysis is based on interviews, observations, and written records. The researcher identified five broad areas of change: affective, attitudinal, pedagogic, economic, and sociopolitical. This study shows that literacy in rural areas is beneficial to people personally, to gender relations, and to socioeconomic development. The findings support the arguments advanced by Rockhill (1987), Bhola (1981), Freire (1970), and Nyerere (1978) about the need to reduce the fears and insecurities associated with being illiterate and the gain from developing people and not just production. The literacy training did not enrich people culturally nor did it alleviate poverty; it concentrated on integrating people into new modes of production. Affective changes included changes in self-esteem and feeling happier. Attitudinal changes included positive learning experiences about child care among both men and women. Nutrition and sanitation improved. Couples reported a greater effort at demonstrating polite behavior and respect toward each other. Literacy increased their status among friends and was accepted in steps, such as being proud of knowing how to write their name. Some participants changed their attitudes toward family planning, and clinic attendance increased. Literacy gave some more confidence and awareness of social relations. Literacy helped read seed and fertilizer labels. Lack of reading materials was a problem. Participants reported reading the Bible and magazines and writing letters. Participants tended to participate in church or literacy groups rather than political ones. PMID:12292075
Mwansa, D M
The reach and impact of social marketing and reproductive health communication campaigns in Zambia
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.
Van Rossem, Ronan; Meekers, Dominique
Barriers to the care of HIV-infected children in rural Zambia: a cross-sectional analysis
BACKGROUND: Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia. METHODS: Cross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected
Janneke H van Dijk; Catherine G Sutcliffe; Bornface Munsanje; Francis Hamangaba; Philip E Thuma; William J Moss
Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
Introduction As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. Methods In 2010, we conducted a qualitative study among adolescents aged 10�19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents� disclosure of their status to others; and the impact of both forms of disclosure on adolescents. Results Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents� disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents� sexual relationships, although it did not always lead to rejection. Conclusions There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.
Mburu, Gitau; Hodgson, Ian; Kalibala, Sam; Haamujompa, Choolwe; Cataldo, Fabian; Lowenthal, Elizabeth D; Ross, David
An Intervention to Decrease Intravaginal Practices in HIV-Infected Women in Zambia: A Pilot Study
Intravaginal practices (IVP) are those in which women introduce products inside the vagina for hygienic, health, or sexuality reasons. IVP are associated with bacterial vaginosis (BV) and potentially implicated in HIV transmission. This report presents the results of a pilot study of a behavioral intervention to decrease IVP in HIV-infected women in Zambia. At baseline, all of the enrolled women (n = 40) engaged in IVP and rates of BV were high. Women receiving the intervention reported a decrease of the insertion of water and cloths inside the vagina. Communication with sexual partners regarding IVP was higher for women receiving the intervention. Results from this study suggest that a behavioral intervention could decrease IVP in HIV-infected women in Zambia and this may have an impact in decreasing HIV transmission from women to sexual partners and newborns.
Alcaide, Maria L.; Mumbi, Miriam; Chitalu, Ndashi; Jones, Deborah L.
Implementing a hospital based injury surveillance system in Zambia: a preliminary report.
The University Teaching Hospital in Lusaka, Zambia, is the nation's premier tertiary referral hospital and a teaching centre for the University of Zambia as well as a research centre of excellence. It was one of the five sites chosen as part of a multinational injury surveillance project conceived to provide preliminary data in response to observations made by public health agencies such as the World Health Organization, and the United States Centres for Disease Control and Prevention (CDC) on the paucity of such data from third world settings. The study covering a period of 6 months from January 2007 to June 2007, used a pre-tested survey instrument crafted by the Ponce School of Medicine in Puerto Rico in close consultation with the CDC and the Pan-American Health Organization (PAHO). A 24-hour system collected a total of 2714 cases, with due care taken to ensure that all the parameters were entered as required. PMID:19065868
Mtonga, Robert E; Zavala, Diego E
Living as an adolescent with HIV in Zambia � lived experiences, sexual health and reproductive needs
HIV services in developing countries are often ill-equipped to address the specific needs of HIV-positive adolescents. Studies suggest a lack of consistent, age-appropriate support regarding sexuality, relationships and transitioning to adulthood. The aims of this study were to explore and document the informational, psychosocial, sexual and reproductive health (SRH) needs of adolescents (aged 10�19 years) living with HIV in Zambia,
Ian Hodgson; Julia Ross; Choolwe Haamujompa; D. Gitau-Mburu
Integrating family planning messages into immunization services: a cluster-randomized trial in Ghana and Zambia.
OBJECTIVE To determine whether integrating family planning (FP) messages and referrals into facility-based, child immunization services increase contraceptive uptake in the 9- to 12-month post-partum period. METHODS A cluster-randomized trial was used to test an intervention where vaccinators were trained to provide individualized FP messages and referrals to women presenting their child for immunization services. In each of 2 countries, Ghana and Zambia, 10 public sector health facilities were randomized to control or intervention groups. Shortly after the introduction of the intervention, exit interviews were conducted with women 9-12 months postpartum to assess contraceptive use and related factors before and after the introduction of the intervention. In total, there were 8892 participants (Control Group Ghana, 1634; Intervention Group Ghana, 1129; Control Group Zambia, 3751; Intervention Group Zambia, 2468). Intervention effects were evaluated using logistic mixed models that accounted for clustering in data. In addition, in-depth interviews were conducted with vaccinators, and a process assessment was completed mid-way through the implementation of the intervention. RESULTS In both countries, there was no significant effect on non-condom FP method use (Zambia, P = 0.56 and Ghana, P = 0.86). Reported referrals to FP services did not improve nor did women's knowledge of factors related to return of fecundity. Some providers reported having made modifications to the intervention; they generally provided FP information in group talks and not individually as they had been trained to do. CONCLUSION Rigorous evidence of the success of integrated immunization services in resource poor settings remains weak. PMID:23570834
Vance, Gwyneth; Janowitz, Barbara; Chen, Mario; Boyer, Brooke; Kasonde, Prisca; Asare, Gloria; Kafulubiti, Beatrice; Stanback, John
Reforming Pensions in Zambia: An Analysis of Existing Schemes and Options for Reform
January 1997The design of new pension systems in African countries requires choices between defined benefit and defined contribution schemes, between funding or pay-as-you-go schemes, and between public and private management. But those choices are less important than the basic challenge of improving macroeconomic stability, regulatory capabilities, and the ability to extend coverage to citizens.All of Zambia's pension schemes are deficient
Monika Queisser; Clive Bailey; John Woodall
Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia
Background Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT), a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. Methods A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT) was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. Results Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5) than either microscopy (US$ 11.9) or clinical diagnosis (US$ 17.1) for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. Conclusion RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.
Chanda, Pascalina; Castillo-Riquelme, Marianela; Masiye, Felix
Structural study and geochronology in the Hook Batholith, Central Zambia
NASA Astrophysics Data System (ADS)
The Pan-African Hook batholith is emplaced N of the Mwembeshi dislocation, a regional scale structure at the contact between Zambezi Belt and Lufilian Arc in Central Zambia. Exposed over 12000 km2 the batholith is composed mainly of fine-grained and coarse-grained porphyritic granites and leucogranites affected by solid-state deformation along high-strain zones. Two main zones of deformation were investigated - the Itezhi-Tezhi Zone (ITZ) in the SW part of the batholith and the Nalusanga Zone (NZ) to the NE. The 2.5 km wide, N-S trending, subvertical ITZ is a medium-grade, pure shear dominated structure, reflecting probably regional scale E-W shortening. In the central part of the zone, augen-gneiss textures developed. Mineral lineations plunging ~40� S are recorded occasionally. The deformed feldspar porphyroclasts show symmetrical tails and rarely sinistral stair-stepping. In the SE part of the Hook batholith the continuation of the ITZ trends E-W. This orientation can be explained by rotation of the original ITZ trend by N-S shortening that also has been recorded in the siliciclastic metasediments S of the contact. S dipping, up to 15 cm wide thrust zones observed in the ITZ area were probably formed during this tectonic event. The 3 km wide NZ is a subvertical to steeply SSW dipping structure, parallel to the NE contact of the batholith, with well-developed foliation and mineral stretching lineations. Field and microstructural analyses defined the NZ as a medium-grade, non-coaxial, sinistral strike-slip shear zone. The transition from weak foliated granite to S-C mylonites and ultramylonites was observed. The sinistral shearing is consistent with E-W shortening in agreement with the tectonic framework of the ITZ. The low grade metasediments to the E of the granite are folded in N to NNW trending structures also implying E-W shortening. Temperature conditions during the deformation in ITZ and NZ inferred from microstructural analyses are about 500�-550�C. The metamorphism in the country rocks E of the batholith is in the lower greenschist facies indicating that deformation along the ITZ and NZ occurred during the cooling of the granite. U-Pb zircon LA-SF-ICP-MS analyses reveal that the coarse-grained and fine-grained granites in the NE part of the batholith have the same age of 549�2 Ma. The age of an undeformed aplite that truncates the NZ's foliation brackets the strike-slip shearing between 549�2 Ma and 541�3 Ma. In the SE margin of the batholith deformed coarse-grained granite is dated at 544�2 Ma and an undeformed granitic vein gave an age of 543�3 Ma, thus relating the fabric formation to the same time interval. To the SW the deformed granite in the ITZ is dated at 533�3 Ma indicating that the E-W shortening was still active at this time. This study reports two deformational stages recorded in the Hook batholith and its country rocks. E-W shortening folded the sediments form the E margin of the granite and formed the solid-state fabric in the batholith. The following N-S shortening cold be related to the final docking of the Zambezi sequence to the Lufilian Arc along the Mwembeshi dislocation.
Naydenov, K.; Lehmann, J.; Saalmann, K.; Milani, L.; Kinnaird, J.; Charlesworth, G.; Frei, D.
Ecology and epidemiology of anthrax in cattle and humans in Zambia.
Anthrax is endemic in Western and North-western Provinces of Zambia. The disease occurs throughout the year and impacts negatively on the economy of the livestock industry and public health in Zambia. During 1989-1995, there were 1626 suspected cases of anthrax in cattle in Western province and of these 51 were confirmed. There were 220 cases of human anthrax cases in 1990 alone and 248 cases during 1991-1998 with 19.1% and 7.7% case fatality rates, respectively. Interplay of the ecology of affected areas and anthropogenic factors seem to trigger anthrax epidemics. Anthrax has drawn considerable attention in recent years due to its potential use as a biological weapon. In this paper, the history, current status and approaches towards the control of the disease in Zambia are discussed. Quarantine measures restrict trade of livestock and exchange of animals for draught power resulting in poor food security at household levels. Challenges of anthrax control are complex and comprise of socio-political, economical, environmental and cultural factors. Inadequate funding, lack of innovative disease control strategies and lack of cooperation from stakeholders are the major constraints to the control of the disease. It is hoped that the information provided here will stimulate continued awareness for the veterinary and medical authorities to maintain their surveillance and capabilities against the disease. This may lead to a culminating positive impact on livestock and human health in the southern African region. PMID:16786974
Siamudaala, Victor M; Bwalya, John M; Munang'andu, Hetron M; Munag'andu, Hetron M; Sinyangwe, Peter G; Banda, Fred; Mweene, Aaron S; Takada, Ayato; Kida, Hiroshi
Underperformance of African Protected Area Networks and the Case for New Conservation Models: Insights from Zambia
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 recommendations are relevant for many of the under-funded PAs occurring in other African countries.
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
Genetic diversity among Trypanosoma (Duttonella) vivax strains from Zambia and Ghana, based on cathepsin L-like gene
Understanding the evolutionary relationships of Trypanosoma (Duttonella) vivax genotypes between West Africa and Southern Africa can provide information on the epidemiology and control of trypanosomosis. Cattle blood samples from Zambia and Ghana were screened for T. vivax infection using specie-specific PCR and sequencing analysis. Substantial polymorphism was obtained from phylogenetic analysis of sequences of cathepsin L-like catalytic domains. T. vivax from Ghana clustered together with West African and South American sequences, while T. vivax from Zambia formed one distinct clade and clustered with East African and Southern African sequences. This study suggests existence of distinct genetic diversity between T. vivax genotypes from West Africa and Zambia as per their geographical origins.
Nakayima, Jesca; Nakao, Ryo; Alhassan, Andy; Hayashida, Kyoko; Namangala, Boniface; Mahama, Charles; Afakye, Kofi; Sugimoto, Chihiro
Geographical patterns and predictors of malaria risk in Zambia: Bayesian geostatistical modelling of the 2006 Zambia national malaria indicator survey (ZMIS)
Background The Zambia Malaria Indicator Survey (ZMIS) of 2006 was the first nation-wide malaria survey, which combined parasitological data with other malaria indicators such as net use, indoor residual spraying and household related aspects. The survey was carried out by the Zambian Ministry of Health and partners with the objective of estimating the coverage of interventions and malaria related burden in children less than five years. In this study, the ZMIS data were analysed in order (i) to estimate an empirical high-resolution parasitological risk map in the country and (ii) to assess the relation between malaria interventions and parasitaemia risk after adjusting for environmental and socio-economic confounders. Methods The parasitological risk was predicted from Bayesian geostatistical and spatially independent models relating parasitaemia risk and environmental/climatic predictors of malaria. A number of models were fitted to capture the (potential) non-linearity in the malaria-environment relation and to identify the elapsing time between environmental effects and parasitaemia risk. These models included covariates (a) in categorical scales and (b) in penalized and basis splines terms. Different model validation methods were used to identify the best fitting model. Model-based risk predictions at unobserved locations were obtained via Bayesian predictive distributions for the best fitting model. Results Model validation indicated that linear environmental predictors were able to fit the data as well as or even better than more complex non-linear terms and that the data do not support spatial dependence. Overall the averaged population-adjusted parasitaemia risk was 20.0% in children less than five years with the highest risk predicted in the northern (38.3%) province. The odds of parasitaemia in children living in a household with at least one bed net decreases by 40% (CI: 12%, 61%) compared to those without bed nets. Conclusions The map of parasitaemia risk together with the prediction error and the population at risk give an important overview of the malaria situation in Zambia. These maps can assist to achieve better resource allocation, health management and to target additional interventions to reduce the burden of malaria in Zambia significantly. Repeated surveys will enable the evaluation of the effectiveness of on-going interventions.
Operational scale entomological intervention for malaria control: strategies, achievements and challenges in Zambia
Background While consensus on malaria vector control policy and strategy has stimulated unprecedented political-will, backed by international funding organizations and donors, vector control interventions are expansively being implemented based on assumptions with unequaled successes. This manuscript reports on the strategies, achievements and challenges of the past and contemporary malaria vector control efforts in Zambia. Case description All available information and accessible archived documentary records on malaria vector control in Zambia were reviewed. Retrospective analysis of routine surveillance data from the Health Management Information System (HMIS), data from population-based household surveys and various operations research reports was conducted to assess the status in implementing policies and strategies. Discussion and evaluation Empirical evidence is critical for informing policy decisions and tailoring interventions to local settings. Thus, the World Health Organization (WHO) encourages the adoption of the integrated vector management (IVM) strategy which is a rational decision making process for optimal use of available resources. One of the key features of IVM is capacity building at the operational level to plan, implement, monitor and evaluate vector control and its epidemiological and entomological impact. In Zambia, great progress has been made in implementing WHO-recommended vector control policies and strategies within the context of the IVM Global Strategic framework with strong adherence to its five key attributes. Conclusions The country has solid, consistent and coordinated policies, strategies and guidelines for malaria vector control. The Zambian experience demonstrates the significance of a coordinated multi-pronged IVM approach effectively operationalized within the context of a national health system.
Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in zambia
Background Malaria is the leading cause of morbidity and the second leading cause of mortality in Zambia. Perceptions of fairness and legitimacy of decisions relating to treatment of malaria cases within public health facilities and distribution of ITNs were assessed in a district in Zambia. The study was conducted within the framework of REsponse to ACcountable priority setting for Trust in health systems (REACT), a north-south collaborative action research study, which evaluates the Accountability for Reasonableness (AFR) approach to priority setting in Zambia, Tanzania and Kenya. Methods This paper is based on baseline in-depth interviews (IDIs) conducted with 38 decision-makers, who were involved in prioritization of malaria services and ITN distribution at district, facility and community levels in Zambia, one Focus Group Discussion (FGD) with District Health Management Team managers and eight FGDs with outpatients' attendees. Perceptions and attitudes of providers and users and practices of providers were systematized according to the four AFR conditions relevance, publicity, appeals and leadership. Results Conflicting criteria for judging fairness were used by decision-makers and patients. Decision-makers argued that there was fairness in delivery of malaria treatment and distribution of ITNs based on alleged excessive supply of free malaria medicines, subsidized ITNs, and presence of a qualified health-provider in every facility. Patients argued that there was unfairness due to differences in waiting time, distances to health facilities, erratic supply of ITNs, no responsive appeal mechanisms, inadequate access to malaria medicines, ITNs and health providers, and uncaring providers. Decision-makers only perceived government bodies and donors/NGOs to be legitimate stakeholders to involve during delivery. Patients found government bodies, patients, indigenous healers, chiefs and politicians to be legitimate stakeholders during both planning and delivery. Conclusion Poor status of the AFR conditions of relevance, publicity, appeals and leadership corresponds well to the differing perceptions of fairness and unfairness among outpatient attendees and decision-makers. This may have been re-enforced by existing disagreements between the two groups regarding who the legitimate stakeholders to involve during service delivery were. Conflicts identified in this study could be resolved by promoting application of approaches such as AFR during priority setting in the district.
Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia
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.
Lohela, Terhi J.; Campbell, Oona M. R.; Gabrysch, Sabine
Is the Bangweulu Basin in Zambia the Eroded Remnant of a Large, Multiring Impact Crater?
NASA Astrophysics Data System (ADS)
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, surrounded by an arcuate high south of the Luongo Fold Belt [7,8]. There are few heat flow measurements in Zambia [9], but there is no indication that the Bangweulu Basin has abnormally high heat flow, which is present in the Luangwaand Upper Zambezi rifts, as evidenced by numerous hot springs and historical geysers [10]. Satellite imagery of Central Africa clearly shows a roughly circular outline of the Bangweulu Basin, including the lakes and swamps, surrounded by a concentric ring of uplifts. The concentric islands in Lake Bangweulu are reminiscent of the multiple concentric rings around impact basins in other planetary bodies, e.g., Valhalla and Asgard structures on the jovian moon of Callisto. Lunar craters Eratosthenes, Aristarchus, and others also have similar terraced morphologies with concentric rings. Based on the above geomorphological and geophysical features, it is postulated that the Bangweulu Basin represents the eroded remnant of a large multiring impact structure that postdates the Katangan Supergroup. Any possible connection between the Bangweulu structure and the Lukanga swamp (a postulated astrobleme in central Zambia [11]) is unknown at this stage. Ground search for macro- and microscopic shock features in the Bangweulu Basin is planned for 1994. References: [1] Debenham F. (1947) Geog. Rev., 37, 351-368. [2] Thieme J. G. and Johnson R. L. (1976) The 1:1,000,000 Scale Geological Map of the Republic of Zambia, Geol. Surv. Zambia. [3] Andersen L. S. and Unrug R. (1984) Precambrian Res., 25, 187-212. [4] Bram K. (1972). Bull. Seis. Soc. Am., 62, 1211-1216. [5] Fairhead J. D. and Henderson N. B. (1977) Tectonophysics, 41, 19-26. [6] Saviaro K. (1979) Bull. Geol. Surv. Botswana, 22, 159-181. [7] Mazac O. (1974) Tech. Rept. Geol. Surv. Zambia, 76, 40 pp. [8] Cowan I. M. and Pollack H. N. (1977) Nature, 266, 615-617. [9] Chapman D. S. and Pollack H. N. (1975) Nature, 256, 28-30. [10] Legg C. A. (1974) Econ. Rept. Geol. Surv. Zambia, 50, 60 pp. [11] Vrana S. (1985) Meteoritics, 20, 125-139.
Master, S.
A Qualitative Assessment of the Risk of Introducing Peste des Petits Ruminants into Northern Zambia from Tanzania
A qualitative risk assessment was performed to evaluate the risk of introducing Peste des petits ruminants virus into northern Zambia from Tanzania via live goat trade. Data was collected during a mission to Tanzania and northern Zambia and also from literature and interviews with experts. The risk of PPRV introduction was evaluated as a function of the probability of hazard (PPRV) release, exposure of susceptible hosts, and the consequences of spread using the following parameters: prevalence of infection, volume of trade, C-ELISA and quarantine screening missing an infected animal, PPRV viability (remaining infective) in transit, and the virus potential for infection. The magnitude of the consequences was derived from the probability of transmission and spread and the impact of PPRV introduction and establishment. Accordingly, the probability of occurrence of PPRV in northern Zambia from Tanzania was rated as �high� and the economic consequences were also rated as �high.� Finally, the overall risk of introducing PPRV into northern Zambia from Tanzania at the time of the assessment was rated �high.� It was concluded that import of goats and sheep be prohibited until efficient and adequate measures to reduce the risk have been put in place.
Chazya, R.; Muma, J. B.; Mwacalimba, K. K.; Karimuribo, E.; Mkandawire, E.; Simuunza, M.
The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia
We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10
Alison M. Elliott; Benita Halwiindi; Richard J. Hayes; Nkandu Luo; Alwyn G. Mwinga; George Tembo; Lieve Machiels; Ger Steenbergen; Joseph O. M. Pobee; Paul Nunn; Keith P. W. J. McAdam
Beyond Time: Temporal and Extra-Temporal Functions of Tense and Aspect Marking in Totela, a Bantu Language of Zambia
ERIC Educational Resources Information Center
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�
Crane, Thera Marie
An outbreak of East Coast fever in a herd of Sanga cattle in Lutale, Central Province of Zambia
An outbreak of East Coast fever (ECF) occurred in an experimental herd of Sanga cattle maintained under a traditional rangeland grazing system at Lutale, Central Province of Zambia. Two groups of cattle had been kept under different tick-control regimens for several years prior to the introduction of the disease and epidemiological information on the outbreak were recorded. Weekly tick control
B Minjauw; M. J Otte; A. D James; J. J de Castro; A Permin; G Di Giulo
Community attitudes towards childbearing and abortion among HIV-positive women in Nigeria and Zambia.
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. PMID:23173695
Kavanaugh, Megan L; Moore, Ann M; Akinyemi, Odunayo; Adewole, Isaac; Dzekedzeke, Kumbutso; Awolude, Olutosin; Arulogun, Oyedunni
Higher Levels of Neutralizing Antibodies against KSHV in KS Patients Compared to Asymptomatic Individuals from Zambia
Kaposi sarcoma-associated herpesvirus (KSHV) is the etiologic agent for Kaposi Sarcoma (KS), the most common cancer diagnosed in HIV- infected patients. The role of neutralizing antibodies in KS pathogenesis and in KSHV infected individuals is not clearly understood. The goal of this study was to investigate and compare the prevalence and titers of neutralizing antibodies in plasma samples from KS patients and KSHV infected asymptomatic individuals from Zambia, a KS endemic region in sub-Saharan Africa. Plasma samples (N?=?267) consisting of KS patients (group 1) and asymptomatic individuals (group 2) were collected from Lusaka, Zambia. A flow cytometry based quantitative neutralization assay utilizing recombinant KSHV expressing GFP was used to detect KSHV neutralizing antibodies. Our results show that the overall prevalence of neutralizing antibodies in KS patients (group 1) was 66.7% which was significantly higher than the prevalence of 6.5% present in KSHV infected asymptomatic individuals (group 2). Total antibody titers as well as neutralizing antibodies titers were found to be significantly higher among KS patients. It is likely that higher neutralizing antibodies prevalence and titers in KS patients result from higher levels of antigenic stimulation over time. This study is first to compare prevalence and titers of neutralizing antibodies in participants with and without disease from a KSHV endemic region.
Minhas, Veenu; Marimo, Clemence; Shea, Danielle M.; Kankasa, Chipepo; Wood, Charles
Lusaka, Zambia during SAFARI-2000: A Collection Point for Ozone Pollution
NASA Technical Reports Server (NTRS)
In August and September, throughout south central Africa, seasonal clearing of dry vegetation and other fire-related activities lead to intense smoke haze and ozone formation. The first ozone soundings in the heart of the southern African burning region were taken at Lusaka, Zambia (155 deg S, 28 deg E) in early September 2000. Over 90 ppbv ozone was recorded at the surface (1.3 km elevation) and column tropospheric ozone was greater than 50 DU during a stagnant period. These values are much higher than concurrent measurements over Nairobi (1 deg S, 38 deg E) and Irene (25 deg S, 28 deg E, near Pretoria). The heaviest ozone pollution layer (800-500 hPa) over Lusaka is due to recirculated trans-boundary ozone. Starting out over Zambia, Angola, and Namibia, ozone heads east to the Indian Ocean, before turning back over Mozambique and Zimbabwe, heading toward Lusaka. Thus, Lusaka is a collection point for pollution, consistent with a picture of absolutely stable layers recirculating in a gyre over southern Africa.
Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tal; Phahlane, N. Agnes; Coetzee, G. J. R.; Bhartia, P. K. (Technical Monitor)
Strengthening faculty recruitment for health professions training in basic sciences in zambia.
Zambia is facing a crisis in its human resources for health, with deficits in the number and skill mix of health workers. The University of Zambia School of Medicine (UNZA SOM) was the only medical school in the country for decades, but recently it was joined by three new medical schools-two private and one public. In addition to expanding medical education, the government has also approved several allied health programs, including pharmacy, physiotherapy, biomedical sciences, and environmental health. This expansion has been constrained by insufficient numbers of faculty. Through a grant from the Medical Education Partnership Initiative (MEPI), UNZA SOM has been investing in ways to address faculty recruitment, training, and retention. The MEPI-funded strategy involves directly sponsoring a cohort of faculty at UNZA SOM during the five-year grant, as well as establishing more than a dozen new master's programs, with the goal that all sponsored faculty are locally trained and retained. Because the issue of limited basic science faculty plagues medical schools throughout Sub-Saharan Africa, this strategy of using seed funding to build sustainable local capacity to recruit, train, and retain faculty could be a model for the region. PMID:25072591
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
Antiretroviral adherence in rural Zambia: the first year of treatment availability.
We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence. PMID:19346397
Birbeck, Gretchen L; Chomba, Elwyn; Kvalsund, Michelle; Bradbury, Richard; Mang'ombe, Charles; Malama, Kennedy; Kaile, Trevor; Byers, Peter A; Organek, Natalie
Non-Sexual Transmission of Trichomonas vaginalis in Adolescent Girls Attending School in Ndola, Zambia
Objectives To identify risk factors for trichomoniasis among young women in Ndola, Zambia. Method The study was a cross-sectional study among adolescent girls aged 13-16 years in Ndola, Zambia. Study participants were recruited from schools in selected administrative areas that represented the different socio-economic strata in town. Consenting participants were interviewed about their socio-demographic characteristics; sexual behaviour; and hygiene practices. Self-administered vaginal swabs were tested for Trichomonas vaginalis. HSV-2 antibodies were determined on serum to validate the self-reported sexual activity. Results A total of 460 girls participated in the study. The overall prevalence of trichomoniasis was 27.1%, 33.9% among girls who reported that they had ever had sex and 24.7% among virgins. In multivariate analysis the only statistically significant risk factor for trichomoniasis was inconsistent use of soap. For the virgins, none of the risk factors was significantly associated with trichomoniasis, but the association with use of soap (not always versus always) and type of toilet used (pit latrine/bush versus flush toilet) was of borderline significance. Conclusion We found a high prevalence of trichomoniasis in girls in Ndola who reported that they had never had sex. We postulate that the high prevalence of trichomoniasis in virgins in Ndola is due to non-sexual transmission of trichomoniasis via shared bathing water and inconsistent use of soap.
Crucitti, Tania; Jespers, Vicky; Mulenga, Chanda; Khondowe, Shepherd; Vandepitte, Judith; Buve, Anne
The construction and testing of a solar food drier in Zambia
A small scale, forced convection, indirect solar food drier was designed, built and tested in Zambia. The drier consisted of five modules: a solar collector, a drying cabinet, a fan housing, a heat storage and a control unit. The construction methods and materials used were selected so as to match the level of technological development in the denser populated areas of Zambia. Practically all the materials were acquired locally. The drier could be run in three main operating modes (straight-through, heat storage, heat recovery) and a number of air recycling submodes by means of manipulating simple slide valves. The food was dried indirectly. A set of eight experiments was first carried out to determine the energy collection and heat transfer characteristics of the equipment in its various operating modes and submodes. Okra, cabbage and beef were then dried. Although the experiments were done during the Zambian 'winter', these foods could be dried to below 15% moisture in two or three operating days.
Kok, R.; Kwendakwema, N.
The effect of seasonal variation on anthrax epidemiology in the upper Zambezi floodplain of western Zambia
Anthrax has become endemic throughout the upper Zambezi floodplain located in the Western Province of Zambia over the recent years. To date, no comprehensive study has been carried out to determine whether recurrence of anthrax outbreaks may be linked to differences in precipitation and human activities. Retrospective data for the period 1999 to 2007 showed that a total of 1,216 bovine cases of anthrax were reported. During the same period, 1,790 human anthrax cases and a corresponding case fatality rate of 4.63% (83/1,790) was documented in the upper Zambezi floodplain. Occurrence of human cases was highly correlated with cattle outbreaks (r = 0.94, p < 0.001). Differences in precipitation were significantly associated with the occurrence of anthrax outbreaks (?2 = 4.75, p < 0.03), indicating that the likelihood of outbreaks occurring was higher during the dry months when human occupancy of the floodplain was greater compared to the flooding months when people and livestock moved out of this region. Human dependency on the floodplain was shown to significantly influence the epidemiology of anthrax in the upper Zambezi floodplain of western Zambia. Methods for mitigating anthrax outbreaks by disrupting the cycle of transmission are herein highlighted.
Banda, Fredrick; Siamudaala, Victor Mukulule; Munyeme, Musso; Kasanga, Christopher Jacob; Hamududu, Byman
Pregnancy loss: spontaneous and induced abortions among young women in Lusaka, Zambia.
An estimated 60% of all adolescent pregnancies in low-income countries are unintended. The present study was carried out at the university hospital in Lusaka, Zambia over a four-month period in 2005. The aim was to explore experiences of pregnancy loss and to ascertain the girl's contraceptive knowledge and use and their partner's involvement in the pregnancy/abortion. Eighty-seven girls aged 13-19 years admitted to hospital for incomplete abortions were interviewed. Of these girls, 53 (61%) had had a spontaneous abortion and 34 (39%) had undergone an unsafe induced abortion. Significantly more girls with an unsafe induced abortion were single, students, had completed more years in school and were in less stable relationships. Girls' overall contraceptive knowledge and use was low and most pregnancies were unplanned. Partners played a decisive role in terminating pregnancy through unsafe induced abortion. Traditional healers, girls themselves and health professionals were the main abortion providers. Young women's health risks due to unprotected sex and lack of contraceptive services should urgently be addressed. The existence of the abortion law and access to emergency contraception should be better publicized in Zambia. PMID:19904649
Dahlb�ck, Elisabeth; Maimbolwa, Margaret; Yamba, C Bawa; Kasonka, Lackson; Bergstr�m, Staffan; Ransj�-Arvidson, Anna-Berit
Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia
Background The diagnosis of abdominal tuberculosis (TB) is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary) TB in HIV infected adults attending the University Teaching Hospital, Zambia. Methods We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples. Results Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71%) had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size), and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts <100 cells/?L. Conclusion The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.
Characterization of Mycobacterium bovis from Humans and Cattle in Namwala District, Zambia
Tuberculosis remains a major public health problem in Zambia. While human to human transmission of Mycobacterium tuberculosis is of major importance in driving the tuberculosis epidemic, the impact of Mycobacterium bovis transmission from infected cattle is largely unknown. This cross-sectional study aimed at molecular characterization of M. bovis in humans and cattle. A total of 100 human sputum samples and 67 bovine tissues were collected and analyzed for the presence of mycobacteria. Of 65 human samples that harbored acid fast bacteria (AFB), 55 isolates were obtained of which 34 were identified as M. tuberculosis and 2 as M. bovis. AFB-positive bovine samples (n = 67) yielded 47 mycobacterial isolates among which 25 were identified as M. bovis and no M. tuberculosis was found. Among the M. bovis isolates, spoligotyping revealed a high homogeneity in genotypes circulating in Namwala district. Human and cattle isolates shared identical MIRU-VNTR genotypes, suggesting that transmission between the two hosts may occur. Therefore, this study has documented zoonotic TB in human patients in Namwala district of Zambia. However, further molecular epidemiological studies in the study area are recommended.
Johansen, Tone Bjordal; Muma, John Bwalya; Munyeme, Musso; Mbulo, Grace; Muwonge, Adrian; Dj?nne, Berit
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
HIV and AIDS still pose a major public health problem to most countries in sub-Saharan Africa, Zambia included. The objective of the paper is to determine changes in selected sexual behaviour and practice and HIV prevalence indicators between 2001�2002 and 2007. We used the Demographic and Health Survey Indicators Database for the computation of the selected indicators. We further used STATA 10.0 to compute significance tests to test for statistical difference in the indicators. The results indicate some changes in sexual behaviour, as indicated by an increase in abstinence, use of condoms and the decrease in multiple partnerships. The overall percentage of abstinence among never-married young men and women aged 15�24 years in Zambia increased significantly by 15.2% (p = .000) and 5.9% (p = .001) respectively, between 2001�2002 and 2007. A statistically significant increase of 6.6% (p = .029) was observed in the percentage of young women who reported having used a condom during the last time they had had premarital sex. A statistically significant decrease of 11.0% (p = .000) and 1.4% (p = .000) was observed among young men and women, respectively, who reported having multiple partners in the preceding 12 months. The factorial decomposition using multivariate analysis reveals that the indicators which contributed to the statistically significant 2.6% decline in HIV prevalence among young women aged 15�24 years in Zambia include proportion reporting condom use during premarital sex (+6.6%), abstinence (+5.9%), sex before age 15 (� 4.5%), premarital sex (� 2.6%), sex before age 18 (� 2.4%) and proportion reporting multiple partnerships (� 1.4%). Remarkable strides have been achieved towards promoting responsible sexual behaviour and practice among young people in Zambia. Further research focusing on factors that predispose young women in Zambia to higher risk of infection from HIV is required. The results from this paper should be useful in the design of programmes to control the spread of HIV and AIDS, particularly among young people in Zambia and other sub-Saharan countries.
Kembo, Joshua
Efficacy of sulphadoxine-pyrimethamine for intermittent preventive treatment of malaria in pregnancy, Mansa, Zambia
Background Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) decreases adverse effects of malaria during pregnancy. Zambia implemented its IPTp-SP programme in 2003. Emergence of SP-resistant Plasmodium falciparum threatens this strategy. The quintuple mutant haplotype (substitutions in N51I, C59R, S108N in dhfr and A437G and K540E in dhps genes), is associated with SP treatment failure in non-pregnant patients with malaria. This study examined efficacy of IPTp-SP and presence of the quintuple mutant among pregnant women in Mansa, Zambia. Methods In Mansa, an area with high malaria transmission, HIV-negative pregnant women presenting to two antenatal clinics for the 1st dose of IPTp-SP with asymptomatic parasitaemia were enrolled and microscopy for parasitaemia was done weekly for five weeks. Outcomes were parasitological failure and adequate parasitological response (no parasitaemia during follow-up). Polymerase chain reaction assays were employed to distinguish recrudescence from reinfection, and identify molecular markers of SP resistance. Survival analysis included those who had reinfection and incomplete follow-up (missed at least one follow-up). Results Of the 109 women included in the study, 58 (53%) completed all follow-up, 34 (31%) had incomplete follow-up, and 17 (16%) were lost to follow-up after day 0. Of those who had complete follow-up, 15 (26%, 95% confidence interval [CI] [16�38]) had parasitological failure. For the 92 women included in the survival analysis, median age was 20�years (interquartile range [IQR] 18�22), median gestational age was 22�weeks (IQR range 20�24), and 57% were primigravid. There was no difference in time to failure in primigravid versus multigravid women. Of the 84 women with complete haplotype data for the aforementioned loci of the dhfr and dhps genes, 53 (63%, 95% CI [50�70]) had quintuple mutants (two with an additional mutation in A581G of dhps). Among women with complete follow-up and quintuple mutants, 22% had parasitological failure versus 0% without (p?=?0.44). Conclusions While underpowered, this study found 26% failure rates of SP given the moderate prevalence of the quintuple mutant haplotype. Despite the presence of resistance, SP retained some efficacy in clearing parasites in pregnant women, and may remain a viable option for IPTp in Zambia.
Underperformance of african protected area networks and the case for new conservation models: insights from zambia.
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 recommendations are relevant for many of the under-funded PAs occurring in other African countries. PMID:24847712
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
Molecular Epidemiology of Paramyxoviruses in Frugivorous Eidolon helvum Bats in Zambia
ABSTRACT In this study, we describe the detection of novel paramyxoviruses from the Eidolon helvum species of fruit bats. We extracted RNA from 312 spleen samples from bats captured in Zambia over a period of 4 years (2008�2011). Semi-nested RT-PCR detected a total of 25 (8%) positive samples for paramyxoviruses which were then directly sequenced and analyzed using phylogenetic analysis. Among the positive samples, seven novel paramyxoviruses were detected. Five viruses were closely related to the genus Henipavirus, while two viruses were related to the unclassified Bat paramyxoviruses from Ghana and Congo Brazzaville. Our study identified novel Henipavirus-related and unrelated viruses using RT-PCR in fruit bats from Kansaka National Park and indicated the presence of similar Bat paramyxoviruses originating from wide geographic areas, suggesting the ability of bats to harbor and transmit viruses. The presence of these viruses in fruit bats might pose a public health risk.
MULEYA, Walter; SASAKI, Michihito; ORBA, Yasuko; ISHII, Akihiro; THOMAS, Yuka; NAKAGAWA, Emiko; OGAWA, Hirohito; HANG'OMBE, Bernard; NAMANGALA, Boniface; MWEENE, Aaron; TAKADA, Ayato; KIMURA, Takashi; SAWA, Hirofumi
Un/doing Gender? a Case Study of School Policy and Practice in Zambia
NASA Astrophysics Data System (ADS)
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.
Bajaj, Monisha
Intention to use the female condom following a mass-marketing campaign in Lusaka, Zambia.
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.
Agha, S
Children's Roles in Tuberculosis Treatment Regimes: Constructing childhood and kinship in urban Zambia
In Zambia, the burden of HIV-related diseases such as tuberculosis has received substantial international attention. Zambians experience and participate in a range of globally produced programs to manage TB and cure TB sufferers. Guided by the WHO�s Directly Observed Treatment, Short-course (DOTS) protocol, TB treatment regimens now emphasize adherence to medications as the primary way to achieve cure. This article aims to understand how adherence models enter into the daily lives of children who live with and care for adult TB patients in an area disproportionately affected by the disease. I suggest that children domesticate adherence models, using them as strategies to safeguard identities, relationships, livelihoods, and futures that are increasingly under threat in the age of HIV. They draw on TB treatment and the hope and agency it affords to hold onto a version of childhood in which they are cared for by adults who will advocate for their wellbeing.
Hunleth, Jean
Identifying antecedent conditions responsible for the high rate of mining injuries in Zambia.
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. PMID:17168220
Miller, Hugh B; Sinkala, Thomson; Renger, Ralph F; Peacock, Erin M; Tabor, Joseph A; Burgess, Jefferey L
Trypanosoma brucei Infection in Asymptomatic Greater Kudus (Tragelaphus strepsiceros) on a Game Ranch in Zambia
Trypomastogotes of Trypanosoma brucei were detected from 4 asymptomatic kudus (Tragelaphus strepsiceros) on a game ranch located approximately 45 km north east of Lusaka, Zambia. Blood smears examined from 14 wildlife species comprising of the impala (Aepyceros melampus), Kafue lechwe (kobus leche kafuensis), sable antelope (Hippotragus niger), tsessebe (Damaliscus lunatus), warthog (Phacochoerus aethiopicus), puku (Kobus vardoni), zebra (Equus burchelli), waterbuck (Kobus ellipsiprymnus), bushbuck (Tragelaphus scriptus), reedbuck (Redunca arundinum), wilderbeest (Connochaetes taurinus), hartebeest (Alcephelus lichtensteini), African buffalo (Syncerus caffer), and kudu (Tragelaphus strepsiceros) showed that only the kudu had T. brucei. Although game ranching has emerged to be a successful ex-situ conservation strategy aimed at saving the declining wildlife population in the National Parks, our findings suggest that it has the potential of aiding the re-distribution of animal diseases. Hence, there is a need for augmenting wildlife conservation with disease control strategies aimed at reducing the risk of disease transmission between wildlife and domestic animals.
Siamudaala, Victor; Munyeme, Musso; Nambota, Andrew; Mutoloki, Stephen; Matandiko, Wigganson
Trypanosoma brucei Infection in asymptomatic greater Kudus (Tragelaphus strepsiceros) on a game ranch in Zambia.
Trypomastogotes of Trypanosoma brucei were detected from 4 asymptomatic kudus (Tragelaphus strepsiceros) on a game ranch located approximately 45 km north east of Lusaka, Zambia. Blood smears examined from 14 wildlife species comprising of the impala (Aepyceros melampus), Kafue lechwe (kobus leche kafuensis), sable antelope (Hippotragus niger), tsessebe (Damaliscus lunatus), warthog (Phacochoerus aethiopicus), puku (Kobus vardoni), zebra (Equus burchelli), waterbuck (Kobus ellipsiprymnus), bushbuck (Tragelaphus scriptus), reedbuck (Redunca arundinum), wilderbeest (Connochaetes taurinus), hartebeest (Alcephelus lichtensteini), African buffalo (Syncerus caffer), and kudu (Tragelaphus strepsiceros) showed that only the kudu had T. brucei. Although game ranching has emerged to be a successful ex-situ conservation strategy aimed at saving the declining wildlife population in the National Parks, our findings suggest that it has the potential of aiding the re-distribution of animal diseases. Hence, there is a need for augmenting wildlife conservation with disease control strategies aimed at reducing the risk of disease transmission between wildlife and domestic animals. PMID:20333288
Munang'andu, Hetron Mweemba; Siamudaala, Victor; Munyeme, Musso; Nambota, Andrew; Mutoloki, Stephen; Matandiko, Wigganson
Molecular Epidemiology of Paramyxoviruses in Frugivorous Eidolon helvum Bats in Zambia.
In this study, we describe the detection of novel paramyxoviruses from the Eidolon helvum species of fruit bats. We extracted RNA from 312 spleen samples from bats captured in Zambia over a period of 4 years (2008-2011). Semi-nested RT-PCR detected a total of 25 (8%) positive samples for paramyxoviruses which were then directly sequenced and analyzed using phylogenetic analysis. Among the positive samples, seven novel paramyxoviruses were detected. Five viruses were closely related to the genus Henipavirus, while two viruses were related to the unclassified Bat paramyxoviruses from Ghana and Congo Brazzaville. Our study identified novel Henipavirus-related and unrelated viruses using RT-PCR in fruit bats from Kansaka National Park and indicated the presence of similar Bat paramyxoviruses originating from wide geographic areas, suggesting the ability of bats to harbor and transmit viruses. The presence of these viruses in fruit bats might pose a public health risk. PMID:24389743
Muleya, Walter; Sasaki, Michihito; Orba, Yasuko; Ishii, Akihiro; Thomas, Yuka; Nakagawa, Emiko; Ogawa, Hirohito; Hang'ombe, Bernard; Namangala, Boniface; Mweene, Aaron; Takada, Ayato; Kimura, Takashi; Sawa, Hirofumi
Sexual behaviour and sexually transmitted diseases among young men in Zambia.
Sexually transmitted diseases (STDs) are an increasing public health problem in Zambia. About 200 000 cases of STDs are treated annually in the formal health sector. Young people are the most affected by STDs. High-risk sexual behaviour has been identified as the major risk factor for STDs among young people. We conducted interviews and focus group discussions with a purposely selected sample of 126 young men aged between 16 and 26 in Chiawa, rural Zambia. The aim of the interviews and focus group discussions was to explore views about sexual practices and attitudes towards STD. Fifty-eight (59%) young men reported having had pre-marital or extra-marital sexual partners during the past year. The maximum number was five partners for six individuals. Forty-two (43%) had pre-marital or extra-marital sexual partners at the time of the interviews. Focus group discussions revealed that perceptions of manhood encouraged multiple sexual relationships. Twenty-two (23%) reported having suffered from an STD in the past. Seventy-nine (81%) said they were likely to inform their sexual partners if they had an STD. Although condoms were believed to give protection against STDs by the majority (94%), only 6% said they always used condoms. The data suggest that condoms were perceived to affect male potency. These results show that STDs, multiple sexual relationships and unprotected sex are common among the young men of Chiawa. Perceptions that emphasize manhood are widespread and these may negatively affect efforts for positive behavioural change. Health messages that target the young men should take into account the local perceptions and values that seem to sustain risky sexual behaviour. PMID:11238437
Ndubani, P; H�jer, B
Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions
Background 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. Methods 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. Results 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. Conclusion 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.
Mental health policy process: a comparative study of Ghana, South Africa, Uganda and Zambia
Background Mental illnesses are increasingly recognised as a leading cause of disability worldwide, yet many countries lack a mental health policy or have an outdated, inappropriate policy. This paper explores the development of appropriate mental health policies and their effective implementation. It reports comparative findings on the processes for developing and implementing mental health policies in Ghana, South Africa, Uganda and Zambia as part of the Mental Health and Poverty Project. Methods The study countries and respondents were purposively selected to represent different levels of mental health policy and system development to allow comparative analysis of the factors underlying the different forms of mental health policy development and implementation. Data were collected using semi-structured interviews and document analysis. Data analysis was guided by conceptual framework that was developed for this purpose. A framework approach to analysis was used, incorporating themes that emerged from the data and from the conceptual framework. Results Mental health policies in Ghana, South Africa, Uganda and Zambia are weak, in draft form or non-existent. Mental health remained low on the policy agenda due to stigma and a lack of information, as well as low prioritisation by donors, low political priority and grassroots demand. Progress with mental health policy development varied and respondents noted a lack of consultation and insufficient evidence to inform policy development. Furthermore, policies were poorly implemented, due to factors including insufficient dissemination and operationalisation of policies and a lack of resources. Conclusions Mental health policy processes in all four countries were inadequate, leading to either weak or non-existent policies, with an impact on mental health services. Recommendations are provided to strengthen mental health policy processes in these and other African countries.
Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.
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. PMID:24605698
Fiedler, John L; Lividini, Keith; Kabaghe, Gladys; Zulu, Rodah; Tehinse, John; Bermudez, Odilia I; Jallier, Vincent; Guyondet, Christophe
Causes of stillbirth, neonatal death and early childhood death in rural Zambia by verbal autopsy assessments
Summary OBJECTIVES To describe specific causes of the high rates of stillbirth, neonatal death and early child childhood death in Zambia. METHODS We conducted a household-based survey in rural Zambia. Socio-demographic and delivery characteristics were recorded, alongside a maternal HIV test. Verbal autopsy questionnaires were administered to elicit mortality-related information and independently reviewed by three experienced paediatricians who assigned a cause and contributing factor to death. For this secondary analysis, deaths were categorized into: stillbirths (foetal death ?28 weeks of gestation), neonatal deaths (?28 days) and early childhood deaths (>28 days to <2 years). RESULTS Among 1679 households, information was collected on 148 deaths: 34% stillbirths, 26% neonatal and 40% early childhood deaths. Leading identifiable causes of stillbirth were intrauterine infection (26%) and birth asphyxia (18%). Of 32 neonatal deaths, 38 (84%) occurred within the first week of life, primarily because of infections (37%) and prematurity (34%). The majority of early childhood deaths were caused by suspected bacterial infections (82%). HIV prevalence was significantly higher in mothers who reported an early childhood death (44%) than mothers who did not (17%; P < 0.01). Factors significantly associated with mortality were lower socio-economic status (P < 0.01), inadequate water or sanitation facilities (P < 0.01), home delivery (P = 0.04) and absence of a trained delivery attendant (P < 0.01). CONCLUSION We provide community-level data about the causes of death among children under 2 years of age. Infectious etiologies for mortality ranked highest. At a public health level, such information may have an important role in guiding prevention and treatment strategies to address perinatal and early childhood mortality.
Turnbull, Eleanor; Lembalemba, Mwila K.; Guffey, M. Brad; Bolton-Moore, Carolyn; Mubiana-Mbewe, Mwangelwa; Chintu, Namwinga; Giganti, Mark J.; Nalubamba-Phiri, Mutinta; Stringer, Elizabeth M.; Stringer, Jeffrey S. A.; Chi, Benjamin H.
Worlds apart 3: Botswana and Zambia. Zambian women's needs not being met.
Zambia has not been as successful as neighboring Botswana in reducing fertility. Zambian fertility only declined from 7.1 to 6.5 between 1972 and 1992. Only 15% use modern contraception, even though 87% have knowledge of modern contraception and a source of supply. A major obstacle to fertility decline is the lack of government endorsement of family planning (FP), even though the Planned Parenthood Association of Zambia has promoted FP since 1972. Contraception was feared and perceived as the persecution of Black Africans by White colonists. State hospitals did not begin accepting FP until the late 1970s, and foreign aid was directed to maternal and child health services. In 1989, a national population policy was adopted, and goals were set to attain 30% contraceptive prevalence by the year 2000. Health services lacked trained personnel to provide FP services. Teenagers were particularly unaware of contraception in a country where, in 1992, 66% of women were either mothers or pregnant by the age of 19 years. Unmet need was estimated at 33% of women who desired a delay in childbearing or no more children. Service accessibility was an obstacle, since many remote areas were 20-25 km from a health center. Other obstacles to good health were contaminated water supplies, lack of hygienic practices, and air pollution. 71% of the population lived in absolute poverty in 1990. Overcrowding in urban areas and lack of educational facilities contributed to the lack of social development. The tropical climate and shortages of arable land coupled with high fertility resulted in a difficult existence. Cultural support for a large family was still strong. Donor and government support is currently directed to contraceptive logistics, communications, contraceptive social marketing, community- and employment-based distribution, operations research, and safe abortions, which are legal but cumbersome because of bureaucratic procedures and the lack of an informed population. PMID:12345837
Hermans, T
A 12-Month Study of Food Crops Contaminated by Heavy Metals, Lusaka, Zambia
NASA Astrophysics Data System (ADS)
We investigate heavy-metal contamination of irrigation water used for urban agriculture and subsequent contamination of food crops in Chunga, NW Lusaka, the capital of Zambia. Inhabitants of the Chunga area rely on urban agriculture as both a major source of income and food. From August 2004 to July 2005, monthly samples of irrigation water used and edible portions of food crops were taken from a farmer's plot at Chunga. The food crops (cabbage, Chinese cabbage, pumpkin leaves, rape, sweet potato leaves and tomatoes) are grown using irrigation throughout the year. Irrigation water samples and digested food crop samples were analysed using ICP-MS at the Department of Geology, Colgate University, USA for Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Cd, Ba, Hg, Tl, Pb, and U. We find heavy-metal concentrations present in both irrigation water and food crop samples. Zambian sample concentrations were compared to Zambian and international legislative and guideline limits for concentrations of heavy metals in industrial effluent, heavy metals in irrigation water and heavy metals in foods. In irrigation water samples recommended national and/or international legislative limits for Al, Cr, Mn, Fe, Cu, Hg, Pb and U were exceeded. Limits for Hg were exceeded by up to 130 times. There were heavy-metal concentrations above recommended limits in food crops for Cr, Fe, Ni, Cu, Zn, Cd, Hg and Pb throughout the different food crops grown and throughout the year. In all 14 samples recommended limits for Cr, Fe and Hg were exceeded. Zambian legislated limits for food crops were exceeded by up to 16 times for Pb and 58 times for Hg. The results of this study show that heavy metal contamination is present in irrigation water used and food crops grown in urban agriculture in Chunga, Lusaka, Zambia. Recommended maximum limits for heavy metals in irrigation water and food are exceeded in some samples indicating there may be a risk to health.
Holden, J. A.; Malamud, B. D.; Chishala, B. H.; Kapungwe, E.; Volk, J.; Harpp, K. S.
Unexpected Anthropophily in the Potential Secondary Malaria Vectors Anopheles coustani s.l. and Anopheles squamosus in Macha, Zambia
Abstract 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.
Norris, Laura C.; Franco, Veronica; Norris, Douglas E.
Lead Isotopic and Metallic Pollution Record in Tree Rings from the Copperbelt Mining�Smelting Area, Zambia
The composition of tree rings and soils was studied at several locations affected by smelting and transportation in the vicinity\\u000a of Kitwe (Copperbelt, Zambia). The contents of cobalt (Co), copper (Cu), manganese (Mn), and lead (Pb) and the 206Pb\\/207Pb isotope ratios in the tree rings were interpreted in relation to potential sources of contamination such as smelter production,\\u000a acidification of
Martin Mihaljevi?; Vojt?ch Ettler; Ond?ej �ebek; Ondra Sracek; Bohdan K?�bek; Tom� Kyncl; Vladim�r Majer; Franti�ek Veselovsk�
Applications of geospatial analysis to surveillance data: a spatial examination of HIV\\/AIDS prevalence in Zambia
Techniques of spatial statistics and GIS are applied to socio-economic, demographic and HIV sentinel data to characterize\\u000a the geographical distribution of HIV prevalence in Zambia and to estimate current prevalence rates. Maps of the 4�years under\\u000a study (i.e. 1994, 1998, 2002 and 2004) reveal a spatial variation in HIV prevalence with urban and provincial districts having\\u000a higher prevalence than rural
Imelda K. Moise; Ezekiel Kalipeni
Rhipicephalus appendiculatus and R. zambeziensis (Acari: Ixodidae) from Zambia: a molecular reassessment of their species status and identification
The closely related species Rhipicephalus appendiculatus and R. zambeziensis co-occur in a wide area in Zambia. In this area, specimens of both species have been collected on the same individual host\\u000a at the same time. In addition, specimens that are morphologically intermediate between R. appendiculatus and R. zambeziensis have been found in this area. These observations cast some doubt on
J. Mtambo; M. Madder; W. Van Bortel; D. Berkvens; T. Backeljau
Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia
Background Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts. This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets (ITNs) conducted in partnership with a Zambian agribusiness, and its cost-effectiveness from the perspective of the National Malaria Control Programme (NMCP). Methods The study was designed as a cluster-randomized controlled trial. A list of 81,597 cotton farmers was obtained from Dunavant, a contract farming company in Zambia�s cotton sector, in December 2010. 39,963 (49%) were randomly selected to obtain one ITN each. Follow-up interviews were conducted with 438 farmers in the treatment and 458 farmers in the control group in June and July 2011. Treatment and control households were compared with respect to bed net ownership, bed net usage, self-reported fever, and self-reported confirmed malaria. Cost data was collected throughout the programme. Results The distribution effectively reached target beneficiaries, with approximately 95% of households in the treatment group reporting that they had received an ITN through the programme. The average increase in the fraction of household members sleeping under an ITN the night prior to the interview was 14.6 percentage points (p-value <0.001). Treatment was associated with a 42 percent reduction in the odds of self-reported fever (p-value <0.001) and with a 49 percent reduction in the odds of self-reported malaria (p-value 0.002). This was accomplished at a cost of approximately five US$ per ITN to Zambia�s NMCP. Conclusions The results illustrate that existing private sector networks can efficiently control malaria in remote rural regions. The intra-household allocation of ITNs distributed through this channel was comparable to that of ITNs received from other sources, and the health impact remained substantial.
Developing the national community health assistant strategy in Zambia: a policy analysis
Background In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process. Methodology Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed. Results The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers. Conclusions This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors� power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.
Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia
Background Provider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia�s Southern Province, and serving a catchment area of 1.2 million people. Methods and Principal Findings Our retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n?=?5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n?=?4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital�s inpatient and outpatient departments (n?=?1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital�s bolstered antiretroviral supply chain, package of on-site HIV services, and follow-up care for children and families improved the continuum of service uptake. Conclusions and Significance The clinical impact and operational experience emphasizes that institutional PITC is a feasible strategy for increasing access to paediatric HIV care, particularly in generalized epidemic settings.
Mutanga, Jane N.; Raymond, Juliette; Towle, Megan S.; Mutembo, Simon; Fubisha, Robert Captain; Lule, Frank; Muhe, Lulu
Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia
Background Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia. Methods This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15�24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners). Results HIV prevalence among young women aged 15�24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women. Conclusion The findings suggested structural effects on HIV prevalence. Future research should include more detailed mapping of neighbourhood factors of relevance to HIV transmission as part of the effort to better understand the causal mechanisms involved.
Kayeyi, Nkomba; Sand?y, Ingvild F; Fylkesnes, Knut
Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia
Background In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared with the standard practice has a net benefit for HIV-free survival of children. Methods We enrolled 958 HIV-infected women and their infants in Lusaka, Zambia. All the women planned to breast-feed exclusively to 4 months; 481 were randomly assigned to a counseling program that encouraged abrupt weaning at 4 months, and 477 to a program that encouraged continued breast-feeding for as long as the women chose. The primary outcome was either HIV infection or death of the child by 24 months. Results In the intervention group, 69.0% of the mothers stopped breast-feeding at 5 months or earlier; 68.8% of these women reported the completion of weaning in less than 2 days. In the control group, the median duration of breast-feeding was 16 months. In the overall cohort, there was no significant difference between the groups in the rate of HIV-free survival among the children; 68.4% and 64.0% survived to 24 months without HIV infection in the intervention and control groups, respectively (P = 0.13). Among infants who were still being breast-fed and were not infected with HIV at 4 months, there was no significant difference between the groups in HIV-free survival at 24 months (83.9% and 80.7% in the intervention and control groups, respectively; P = 0.27). Children who were infected with HIV by 4 months had a higher mortality by 24 months if they had been assigned to the intervention group than if they had been assigned to the control group (73.6% vs. 54.8%, P = 0.007). Conclusions Early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants. (ClinicalTrials.gov number, NCT00310726.)
Kuhn, Louise; Aldrovandi, Grace M.; Sinkala, Moses; Kankasa, Chipepo; Semrau, Katherine; Mwiya, Mwiya; Kasonde, Prisca; Scott, Nancy; Vwalika, Cheswa; Walter, Jan; Bulterys, Marc; Tsai, Wei-Yann; Thea, Donald M.
Health Inequities, Environmental Insecurity and the Attainment of the Millennium Development Goals in Sub-Saharan Africa: The Case Study of Zambia
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.
Anyangwe, Stella C. E.; Mtonga, Chipayeni; Chirwa, Ben
Bovine Tuberculosis and Brucellosis in Traditionally Managed Livestock in Selected Districts of Southern Province of Zambia
A study was performed in 2008 to estimate the prevalence of tuberculosis and brucellosis in traditionally reared cattle of Southern Province in Zambia in four districts. The single comparative intradermal tuberculin test (SCITT) was used to identify TB reactors, and the Rose Bengal test (RBT), followed by confirmation with competitive enzyme-linked immunosorbent assay (c-ELISA), was used to test for brucellosis. A total of 459 animals were tested for tuberculosis and 395 for brucellosis. The overall prevalence of BTB based on the 4?mm and 3?mm cutoff criteria was 4.8% (95% CI: 2.6�7.0%) and 6.3% (95% CI: 3.8�8.8%), respectively. Change in skin thickness on SCITT was influenced by initial skin-fold thickness at the inoculation site, where animals with thinner skin had a tendency to give a larger tuberculin response. Brucellosis seroprevalence was estimated at 20.7% (95% CI: 17.0�24.4%). Comparison between results from RBT and c-ELISA showed good agreement (84.1%) and revealed subjectivity in RBT test results. Differences in brucellosis and tuberculosis prevalence across districts were attributed to type of husbandry practices and ecological factors. High prevalence of tuberculosis and brucellosis suggests that control programmes are necessary for improved cattle productivity and reduced public health risk.
Muma, J. B.; Syakalima, M.; Munyeme, M.; Zulu, V. C.; Simuunza, M.; Kurata, M.
Accumulation of metals in the liver and kidneys of cattle from agricultural areas in Lusaka, Zambia.
Intensive agricultural practices are recognized as significant sources of metal pollution in soils and pasture. This study investigated metal contamination in cattle offal from an agricultural area in Zambia, where inorganic fertilizers, agricultural lime, and pesticides are routinely applied. The highest median values (mg/kg, wet weight) of Cu (40.9), Zn (35.2), Cr (1.35) and Ni (0.594) were recorded in the liver, whereas the highest median values of Pb (0.061) and Cd (0.049) were found in kidneys. Maximum levels of Hg, As and Co were under 0.2 mg/kg in both organs. Pb and Cd did not exceed the benchmark values in cattle offal for human consumption and did not pose immediate health risks. Concentrations of Ni and Cr could present a public health concern. Monitoring of metal accumulations in offal of cattle, not only from well-known polluted environments but also agricultural areas, should be done regularly for the health of human consumers. PMID:22672843
Yabe, John; Nakayama, Shouta M M; Ikenaka, Yoshinori; Muzandu, Kaampwe; Ishizuka, Mayumi; Umemura, Takashi
Spatial Heteogeneity of Methane Ebullition in a Large Tropical Reservoir (Lake Kariba, Zambia/Zimbabwe)
NASA Astrophysics Data System (ADS)
While ebullition has the capacity to be a significant methane (CH4) release pathway from reservoirs, it has not been systematically studied in most surveyed systems, due in part to ebullition's high spatiotemporal variability. We hypothesized that CH4 ebullition from littoral areas that are influenced by riverine organic carbon inputs contributes disproportionately to overall CH4 emissions from Lake Kariba (Zambia-Zimbabwe border), one of the world's largest reservoirs. Hydroacoustic measurements and traditional surface chamber surveys revealed substantially higher fluxes in river deltas (~10^3 mg CH4 m-2 d-1) compared to littoral zones with no river input (< 100 mg CH4 m-2 d-1). Hydroacoustic measurements additionally showed that ebullition frequency varied strongly between all sites and that flux events varied over several orders of magnitude (up to 10^5 mg CH4 m-2 d-1) in the ebullition hot spots. An ebullition estimate for the largest subbasin of Lake Kariba was two orders of magnitude more than potential atmospheric CH4 emissions from turbine degassing and surface diffusion combined. Thus, we suggest that CH4 ebullition emissions from river deltas should be explored in greater detail and their contribution included in the CH4 budgets of reservoirs, including even large tropical reservoirs.
Del Sontro, T.; Kunz, M.; Wuest, A.; Wehrli, B.; Senn, D. B.
Risk Reduction Among HIV-Seroconcordant and -Discordant Couples: The Zambia NOW2 Intervention.
Abstract Heterosexual HIV transmission remains the leading cause of HIV incidence in adult men and women in sub-Saharan Africa. This study assessed whether an HIV risk-reduction intervention would be more likely to increase sexual barrier acceptability and decrease risk behavior when delivered to couples in gender concordant groups or in an individual format. This study also examined the mutual impact of couple members as a source of influence on acceptability, and assessed whether product acceptability, intimate partner violence (IPV), and/or partner communication predicted sexual barrier use. HIV seroconcordant and serodiscordant couples (n=216) were recruited in Lusaka, Zambia, and randomized to a four session gender-concordant intervention. Participants were assessed at baseline, 6, and 12 months. Willingness to use barriers (p=0.012), acceptability (p<0.001), and barrier use (p<0.001) increased over time in both conditions, and were influenced by gender preferences. IPV decreased (p=0.040) and positive communication increased (p<0.001) in both conditions. Individual and gender concordant group sessions achieved similar increases in sexual barrier use following the intervention. Results highlight the influence of partners as well as product acceptability as predictors of sexual barrier use among couples in sub-Saharan Africa. Future prevention studies should consider both product acceptability and partner influence to achieve optimal sexual risk behavior outcomes. PMID:24983201
Jones, Deborah; Kashy, Deborah; Chitalu, Ndashi; Kankasa, Chipepo; Mumbi, Mirriam; Cook, Ryan; Weiss, Stephen
eC3--A Modern Telecommunications Matrix for Cervical Cancer Prevention in Zambia
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.
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.
HIV testing and tolerance to gender based violence: a cross-sectional study in Zambia.
This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR = 2.48 95% CI = 1.00-6.19); tolerance to gender-based violence (OR = 2.10 95% CI = 1.05-4.32) and fear of social rejection (OR = 1.48 95% CI = 1.23-1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families. PMID:23991005
Gari, Sara; Malungo, Jacob R S; Martin-Hilber, Adriane; Musheke, Maurice; Schindler, Christian; Merten, Sonja
Life cycle assessment to evaluate the environmental impact of biochar implementation in conservation agriculture in Zambia.
Biochar amendment to soil is a potential technology for carbon storage and climate change mitigation. It may, in addition, be a valuable soil fertility enhancer for agricultural purposes in sandy and/or weathered soils. A life cycle assessment including ecological, health and resource impacts has been conducted for field sites in Zambia to evaluate the overall impacts of biochar for agricultural use. The life cycle impacts from conservation farming using cultivation growth basins and precision fertilization with and without biochar addition were in the present study compared to conventional agricultural methods. Three different biochar production methods were evaluated: traditional earth-mound kilns, improved retort kilns, and micro top-lit updraft (TLUD) gasifier stoves. The results confirm that the use of biochar in conservation farming is beneficial for climate change mitigation purposes. However, when including health impacts from particle emissions originating from biochar production, conservation farming plus biochar from earth-mound kilns generally results in a larger negative effect over the whole life cycle than conservation farming without biochar addition. The use of cleaner technologies such as retort kilns or TLUDs can overcome this problem, mainly because fewer particles and less volatile organic compounds, methane and carbon monoxide are emitted. These results emphasize the need for a holistic view on biochar use in agricultural systems. Of special importance is the biochar production technique which has to be evaluated from both environmental/climate, health and social perspectives. PMID:23272937
Sparrevik, Magnus; Field, John L; Martinsen, Vegard; Breedveld, Gijs D; Cornelissen, Gerard
HIV Testing and Tolerance to Gender Based Violence: A Cross-Sectional Study in Zambia
This paper explores the effect of social relations and gender-based conflicts on the uptake of HIV testing in the South and Central provinces of Zambia. We conducted a community-based cross-sectional study of 1716 randomly selected individuals. Associations were examined using mixed-effect multivariable logistic regression. A total of 264 men (64%) and 268 women (56%) had never tested for HIV. The strongest determinants for not being tested were disruptive couple relationships (OR?=?2.48 95% CI?=?1.00�6.19); tolerance to gender-based violence (OR?=?2.10 95% CI?=?1.05�4.32) and fear of social rejection (OR?=?1.48 95% CI?=?1.23�1.80). In the Zambian context, unequal power relationships within the couple and the community seem to play a pivotal role in the decision to test which until now have been largely underestimated. Policies, programs and interventions to rapidly increase HIV testing need to urgently address gender-power inequity in relationships and prevent gender-based violence to reduce the negative impact on the lives of couples and families.
Gari, Sara; Malungo, Jacob R. S.; Martin-Hilber, Adriane; Musheke, Maurice; Schindler, Christian; Merten, Sonja
Health systems analysis of eye care services in Zambia: evaluating progress towards VISION 2020 goals
Background VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. The objective of this study was to undertake a situation analysis of the Zambian eye health system and assess VISION 2020 process indicators on human resources, equipment and infrastructure. Methods All eye health care providers were surveyed to determine location, financing sources, human resources and equipment. Key informants were interviewed regarding levels of service provision, management and leadership in the sector. Policy papers were reviewed. A health system dynamics framework was used to analyse findings. Results During 2011, 74 facilities provided eye care in Zambia; 39% were public, 37% private for-profit and 24% owned by Non-Governmental Organizations. Private facilities were solely located in major cities. A total of 191 people worked in eye care; 18 of these were ophthalmologists and eight cataract surgeons, equivalent to 0.34 and 0.15 per 250,000 population, respectively. VISION 2020 targets for inpatient beds and surgical theatres were met in six out of nine provinces, but human resources and spectacles manufacturing workshops were below target in every province. Inequalities in service provision between urban and rural areas were substantial. Conclusion Shortage and maldistribution of human resources, lack of routine monitoring and inadequate financing mechanisms are the root causes of underperformance in the Zambian eye health system, which hinder the ability to achieve the VISION 2020 goals. We recommend that all VISION 2020 process indicators are evaluated simultaneously as these are not individually useful for monitoring progress.
Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka, Zambia.
Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants. PMID:24815904
Cook, Ryan; Hayden, Robert; Weiss, Stephen M; Jones, Deborah L
Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia
Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ?6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider's perspective and are reported in 2011 USD. Results. For the patients who initiated ART ?6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ?6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs.
Iyer, Hari S.; Scott, Callie A.; Lembela Bwalya, Deophine; Meyer-Rath, Gesine; Moyo, Crispin; Bolton Moore, Carolyn; Larson, Bruce A.
Epidemic cholera in urban Zambia: hand soap and dried fish as protective factors.
Between 28 November 2003 and 23 February 2004, 4343 cases and 154 deaths from cholera (case-fatality rate 3.5%) were reported in Lusaka, Zambia. A case-control study was conducted in February 2004 to assess potential transmission routes and prevention strategies. Consumption of raw vegetables was significantly associated with cholera [adjusted odds ratio (aOR) 4.7, 95% confidence interval (CI) 1.7-13, P=0.003). Consumption of a local sardine-like fish was protective (aOR 0.3, 95% CI 0.1-0.7, P=0.008). Hand soap was present in 90% of control homes and 58% of case homes. Observed hand soap was a strongly protective factor (aOR 0.1, 95% CI 0.04-0.4, P=0.001). No water source or treatment practice was significantly associated with cholera. This study documents the importance of foodborne transmission of cholera, illustrates the protective role of hand washing in an epidemic setting, and identifies a novel possible protective factor, a local fish, which warrants further research. PMID:16623992
DuBois, A E; Sinkala, M; Kalluri, P; Makasa-Chikoya, M; Quick, R E
Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study.
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
Murray, Laura K; Haworth, Alan; Semrau, Katherine; Singh, Mini; Aldrovandi, Grace M; Sinkala, Moses; Thea, Donald M; Bolton, Paul A
Individual-level predictors for HIV testing among antenatal attendees in Lusaka, Zambia.
Despite the availability of antiretroviral prophylaxis, roughly one-fifth of public-sector antenatal patients decline HIV testing in Lusaka, Zambia. We administered a survey to determine individual-level predictors of HIV testing. Of 1064 antenatal attendees approached after pretest counseling, 1060 (>99%) participated. Of these, 686 (65%) agreed to HIV testing. On bivariate analysis controlling for clinic of attendance, women younger than 20 years old (adjusted RR [ARR] = 1.14), unmarried (ARR = 1.14), pregnant for the first time (ARR = 1.14), with lower educational attainment (ARR = 1.15), and with lower income (ARR = 1.14) were all more likely to undergo testing. When HIV risk was considered, women with low self-perceived risk were most likely to undergo HIV testing. As risk perception increased, likelihood for testing decreased (P for trend < 0.001). Although not statistically predictive, we identified prevalent community beliefs that may act as barriers to testing. Because individual-level characteristics were only weakly predictive of HIV testing, future work should concentrate on community-level factors. PMID:16845236
Thierman, Sara; Chi, Benjamin H; Levy, Jens W; Sinkala, Moses; Goldenberg, Robert L; Stringer, Jeffrey S A
Violence and Abuse Among HIV-Infected Women and Their Children in Zambia
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.
Murray, Laura K.; Haworth, Alan; Semrau, Katherine; Singh, Mini; Aldrovandi, Grace M.; Sinkala, Moses; Thea, Donald M.; Bolton, Paul A.
Genital tract infections among HIV-infected pregnant women in Malawi, Tanzania and Zambia
Summary The aim of this study was to compare the prevalence and factors associated with genital tract infections among HIV-infected pregnant women from African sites. Participants were recruited from Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. Genital tract infections were assessed at baseline. Of 2627 eligible women enrolled, 2292 were HIV-infected. Of these, 47.8% had bacterial vaginosis (BV), 22.4% had vaginal candidiasis, 18.8% had trichomoniasis, 8.5% had genital warts, 2.6% had chlamydia infection, 2.2% had genital ulcers and 1.7% had gonorrhoea. The main factors associated with genital tract infections included genital warts (adjusted odds ratio [AOR] 1.8, 95% CI 1.2�2.7), genital ulcers (AOR 2.4, 95% CI 1.2�5.1) and abnormal vaginal discharge (AOR 2.5, 95% CI 1.9�3.3) for trichomoniasis. BV was the most common genital tract infection followed by candidiasis and trichomoniasis. Differences in burdens and risk factors call for enhanced interventions for identification of genital tract infections among HIV-infected women.
Aboud, S; Msamanga, G; Read, J S; Mwatha, A; Chen, Y Q; Potter, D; Valentine, M; Sharma, U; Hoffmann, I; Taha, T E; Goldenberg, R L; Fawzi, W W
The political economy of maize production and poverty reduction in Zambia: analysis of the last 50 years.
Poverty and food security are endemic issues in much of sub-Saharan Africa. To eradicate extreme poverty and hunger in the region remains a key Millennium Development Goal. Many African governments have pursued economic reforms and agricultural policy interventions in order to accelerate economic growth that reduces poverty faster. Agricultural policy regimes in Zambia in the last 50 years (1964�2008) are examined here to better understand their likely impact on food security and poverty, with an emphasis on the political economy of maize subsidy policies. The empirical work draws on secondary sources and an evaluation of farm household data from three villages in the Kasama District of Zambia from 1986/87 and 1992/93 to estimate a two-period econometric model to examine the impact on household welfare in a pre- and post-reform period. The analysis shows that past interventions had mixed effects on enhancing the production of food crops such as maize. While such reforms were politically popular, it did not necessarily translate into household-level productivity or welfare gains in the short term. The political economy of reforms needs to respond to the inherent diversity among the poor rural and urban households. The potential of agriculture to generate a more pro-poor growth process depends on the creation of new market opportunities that most benefit the rural poor. The state should encourage private sector investments for addressing infrastructure constraints to improve market access and accelerate more pro-poor growth through renewed investments in agriculture, rural infrastructure, gender inclusion, smarter subsidies and regional food trade. However, the financing of such investments poses significant challenges. There is a need to address impediments to the effective participation of public private investors to generate more effective poverty reduction and hunger eradication programmes. This article also explores the opportunities for new public�private investments through South�South cooperation and Asia-driven growth for reducing poverty in Zambia. PMID:22213879
Hanjra, Munir A; Culas, Richard J
High burden of malaria following scale-up of control interventions in Nchelenge District, Luapula Province, Zambia
Background Malaria control interventions have been scaled-up in Zambia in conjunction with a malaria surveillance system. Although substantial progress has been achieved in reducing morbidity and mortality, national and local information demonstrated marked heterogeneity in the impact of malaria control across the country. This study reports the high burden of malaria in Nchelenge District, Luapula Province, Zambia from 2006 to 2012 after seven years of control measures. Methods Yearly aggregated information on cases of malaria, malaria deaths, use of malaria diagnostics, and malaria control interventions from 2006 to 2012 were obtained from the Nchelenge District Health Office. Trends in the number of malaria cases, methods of diagnosis, malaria positivity rate among pregnant women, and intervention coverage were analysed using descriptive statistics. Results Malaria prevalence remained high, increasing from 38% in 2006 to 53% in 2012. Increasing numbers of cases of severe malaria were reported until 2010. Intense seasonal malaria transmission was observed with seasonal declines in the number of cases between April and August, although malaria transmission continued throughout the year. Clinical diagnosis without accompanying confirmation declined from 95% in 2006 to 35% in 2012. Intervention coverage with long-lasting insecticide-treated nets and indoor residual spraying increased from 2006 to 2012. Conclusions Despite high coverage with vector control interventions, the burden of malaria in Nchelenge District, Zambia remained high. The high parasite prevalence could accurately reflect the true burden, perhaps in part as a consequence of population movement, or improved access to care and case reporting. Quality information at fine spatial scales will be critical for targeting effective interventions and measurement of progress.
Decline in Sexual Risk Behaviours among Young People in Zambia (2000-2009): Do Neighbourhood Contextual Effects Play a Role?
Objective This study examined trends in premarital sex, multiple partnership and condom use among young people (15�24 years) in Zambia from 2000 to 2009, and assessed the effects of individual and neighbourhood variables on these sexual behaviour indicators in 2000 and 2009. Methodology We analysed data from the Zambia Sexual Behaviour Survey, conducted in 2000, 2003, 2005 and 2009. Multi-stage cluster sampling was used to select 385 neighbourhoods, giving a population sample of 6,500 young people. Using linear-by-linear trend test, trends in the three indicators were examined. Multilevel logistic regression was used to assess the effects of individual and neighbourhood variables on the indicators. Results Premarital sex among young people decreased significantly from 51 to 42% between 2000 and 2009. Multiple partnerships of men also decreased from 26 to 14% during the same period. The use of condoms by young people remained stable during this period. Full multilevel regression models explained 29 and 34% of the neighbourhood variance of premarital sex in 2000 and 2009. For multiple partnerships and condom use, the explained variance was 29 and 18% in 2000; whereas in 2009 it was extremely low. Urban residence and living in neighbourhood with higher average duration of residence were associated with low premarital sex and higher condom use. Living in a neighbourhood with higher average level of comprehensive knowledge of HIV was associated with less risky sexual behaviour. Conclusion Declining trends in premarital sex and multiple partnerships are among the factors that might explain the decrease in HIV incidence in Zambia among young people. However, condom use among young people has remained low and stable over the years. The results also suggest that behaviour change interventions should take stock of the social context when introducing individual-level programmes because neighbourhood factors play a considerable role in influencing sexual behaviour.
Kayeyi, Nkomba; Fylkesnes, Knut; Wiium, Nora; Sand?y, Ingvild F.
Barriers to the care of HIV-infected children in rural Zambia: a cross-sectional analysis
Background Successful antiretroviral treatment programs in rural sub-Saharan Africa may face different challenges than programs in urban areas. The objective of this study was to identify patient characteristics, barriers to care, and treatment responses of HIV-infected children seeking care in rural Zambia. Methods Cross-sectional analysis of HIV-infected children seeking care at Macha Hospital in rural southern Zambia. Information was collected from caretakers and medical records. Results 192 HIV-infected children were enrolled from September 2007 through September 2008, 28% of whom were receiving antiretroviral therapy (ART) at enrollment. The median age was 3.3 years for children not receiving ART (IQR 1.8, 6.7) and 4.5 years for children receiving ART (IQR 2.7, 8.6). 91% travelled more than one hour to the clinic and 26% travelled more than 5 hours. Most participants (73%) reported difficulties accessing the clinic, including insufficient money (60%), lack of transportation (54%) and roads in poor condition (32%). The 54 children who were receiving ART at study enrollment had been on ART a median of 8.6 months (IQR: 2.7, 19.5). The median percentage of CD4+ T cells was 12.4 (IQR: 9.2, 18.6) at the start of ART, and increased to 28.6 (IQR: 23.5, 36.1) at the initial study visit. However, the proportion of children who were underweight decreased only slightly, from 70% at initiation of ART to 61% at the initial study visit. Conclusion HIV-infected children in rural southern Zambia have long travel times to access care and may have poorer weight gain on ART than children in urban areas. Despite these barriers, these children had a substantial rise in CD4+ T cell counts in the first year of ART although longer follow-up may indicate these gains are not sustained.
The economic value of an improved malaria treatment programme in Zambia: results from a contingent valuation survey
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.
Masiye, Felix; Rehnberg, Clas
Remote Sensing of Aquatic Vegetation Coverage in the Kafue River, Zambia and Comparison to Climatic Variables
NASA Astrophysics Data System (ADS)
The Kafue River is the longest river in Zambia and is a major tributary of the Zambezi River. It is a vital source of fish, transportation, drinking water, and hydropower for much of Zambia's population, over half of whom live in the Kafue River basin. Like many important water bodies in developing countries the Kafue and its ecosystems face pollution from industrial, mining, agricultural, and domestic/sewage discharge. The Kafue River forms a wide and shallow wetland (the Kafue Flats) during the rainy season (Nov. - Apr.) which serves as habitat for diverse groups of birds and mammals. In recent years the unprecedented emergence of invasive aquatic vegetation such as the water hyacinth (Eichhornia crassipes) and Salvinia molesta have choked the river, degrading its ability to provide adequate habitat to promote biodiversity, ecosystem services, and hydropower. In addition, these plants provide additional habitat for mosquitoes (vectors for malaria) and aquatic snails (vectors of schistosomiasis). Nutrient-rich effluents are widely believed to contribute to the proliferation and explosive growth of this floating aquatic vegetation. The general methods for managing these aquatic weeds have included mechanical and physical removal, herbicides, and bio-control agents which have had very little impact. However, as in neighboring Lake Victoria, total weed coverage has fluctuated dramatically from year to year making evaluation of the efficacy of management programs difficult. The objectives of this study were to (1) generate the first record of aquatic plant coverage for a section of the Kafue River which is immediately downstream of a sugar plantation (a major source of nitrogen and phosphorus to the river) and (2) determine if plant coverage is correlated with any major climatic (ENSO, temperature, rainfall) or management (introduction of bio-control agents) indices. We utilized remote sensing techniques in conjunction with Landsat 4-5 TM and Landsat 7 ETM imagery for the time range 1990 to 2013 to identify the extent of aquatic vegetation in the dry season for all years available within the time range using spectral data. We derived rainfall for the time period from TRMM data and temperature from MODIS LST data. Overall weed coverage tended to increase from 1990 to 2013. There was no significant correlation between rainfall (as measured by TRMM) and water hyacinth coverage. However there was a significant positive correlation between minimum October temperatures (the warmest month of the year) and weed coverage (exponential fit, R2 = 0.81). There was no indication that the release of bio-control agents reduced weed coverage. Water hyacinth is known to be sensitive to temperature, with cooler temperatures retarding growth. In the Kafue River, aquatic plant coverage varies mainly with October low temperatures indicating an overall control of temperature on weed coverage. Increasing low temperatures in the region would be expected to exacerbate problems associated with aquatic weeds.
Mischler, J. A.; Abdalati, W.; Hussein, K.; Townsend, A. R.
Some Ministries of Health in Africa plan to make blood slide microscopy available in peripheral health centers to improve malaria diagnosis over the current practice, which relies solely on clinical findings. To assess whether microscopy improves the management of febrile persons in health centers, we prospectively reviewed medical records of all outpatients visiting six health centers with laboratories in Zambia
Maternal schooling and comprehension of child health information in urban Zambia: is literacy a missing link in the maternal schooling-child health relationship?
This paper examines the relationship between literacy skills and comprehension of health information by studying mothers of young children in a high-density urban area in Zambia. Both decontextualized language and print literacy skills were assessed for each woman and the resulting scores were related to her comprehension of both broadcast and printed health information. The results indicate that fluency in
Kathleen W. Stuebing
Cattle owners' awareness of bovine tuberculosis in high and low prevalence settings of the wildlife-livestock interface areas in Zambia
BACKGROUND: Awareness of bovine tuberculosis (BTB) by cattle owners is of extreme importance to policy makers when considering mitigation. However, to our knowledge, little is known on cattle owners' awareness of BTB in Zambia. Similarly, such knowledge is uncommon within and outside Africa. The current study investigates the epidemiological characteristics of BTB in Zambian cattle in relation to awareness by
Musso Munyeme; John B Muma; Hetron M Munang'andu; Clovice Kankya; Eystein Skjerve; Morten Tryland
Adherence Support Workers: A Way to Address Human Resource Constraints in Antiretroviral Treatment Programs in the Public Health Setting in Zambia
BackgroundIn order to address staff shortages and improve adherence counseling for people on antiretroviral therapy (ART), the Zambia Prevention, Care and Treatment Partnership (ZPCT) developed an innovative strategy of training community volunteers to provide adherence support at the health facility and community levels. The objective of this study was to assess the effectiveness of these �adherence support workers� (ASWs) in
Kwasi E. Torpey; Mushota E. Kabaso; Liya N. Mutale; Mpuma K. Kamanga; Albert J. Mwango; James Simpungwe; Chiho Suzuki; Ya Diul Mukadi; Madhukar Pai
Adherence Support Workers: A Way to Address Human Resource Constraints in Antiretroviral Treatment Programs in the Public Health Setting in Zambia
Background: In order to address staff shortages and improve adherence counseling for people on antiretroviral therapy (ART), the Zambia Prevention, Care and Treatment Partnership (ZPCT) developed an innovative strategy of training community volunteers to provide adherence support at the health facility and community levels. The objective of this study was to assess the effectiveness of these 'adherence support workers' (ASWs)
Kwasi E. Torpey; Mushota E. Kabaso; Liya N. Mutale; Mpuma K. Kamanga; Albert J. Mwango; James Simpungwe; Chiho Suzuki; Ya Diul Mukadi
Early Childhood Infection by Human Herpesvirus 8 in Zambia and the Role of Human Immunodeficiency Virus Type 1 Coinfection in a Highly Endemic Area
Kaposi's sarcoma occurs at high incidence among Zambian adults and children, but there is a paucity of data on human herpesvirus 8 (HHV-8) incidence and routes of infection, especially in children. Between 1998 and 2004, the authors conducted a prospective study of viral transmission in a cohort of 684 children in Lusaka, Zambia, to estimate the annual incidence of HHV-8
Veenu Minhas; Kay L. Crabtree; Ann Chao; Tendai J. M'soka; Chipepo Kankasa; Marc Bulterys; Charles D. Mitchell; Charles Wood
Failure to detect tuberculosis in Black lechwe antelopes (Kobus leche smithemani) in Zambia
Background Two types of lechwe antelopes exclusively exist in their natural ecosystems in Zambia; the Black lechwe (Kobus leche smithemani) and the Kafue lechwe (Kobus leche kafuensis). Despite inhabiting similar ecosystems, tuberculosis has been reported in Kafue lechwe without its documentation in Black lechwe antelopes. However, the past few decades have seen a drastic decline in both lechwe populations. Whereas studies have postulated that infectious diseases such as tuberculosis are having a negative impact on the Kafue lechwe population, no information is available on Black lechwe antelopes. Thus this study was conducted to investigate tuberculosis in Black lechwe antelopes of the Bangweulu swamps in comparison with the Kafue lechwe antelopes of Lochinvar. Findings A total of 44 lechwe antelopes (Black (n = 30): Kafue (n = 14) were sampled from Bangweulu and Lochinvar respectively. A positive case was defined with findings of gross lesions with Ziehl Nielsen and culture confirmation. Out of the 14 animals examined in Lochinvar, 21.4% [95% CI: 15.4, 44.4%] had necropsy lesions consistent with tuberculosis. The corresponding samples from 30 Black lechwe of Bangweulu yielded negative results on all the three tests. Conclusions Current findings from this study intimate the possible absence of tuberculosis in Black lechwe antelopes whilst confirming the presence of tuberculosis in Kafue lechwe of the Kafue basin. The absence of tuberculosis in the Black lechwe suggests that the observed population decline may not be caused by tuberculosis. However, without detailed molecular epidemiological studies it is not possible to determine the association of M. bovis infection in sympatric animal populations. The possible role of transmission of tuberculosis between wildlife and cattle is discussed herein. Findings
Gastroenterology training in a resource-limited setting: Zambia, Southern Africa
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 as a mechanism to improve disease awareness in areas where resources are limited.
Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul
Effect of baseline renal function on tenofovir-containing antiretroviral therapy outcomes in zambia.
Background.?Although tenofovir disoproxil fumarate (TDF) use has increased as part of first-line antiretroviral therapy (ART) across sub-Saharan Africa, renal outcomes among patients receiving TDF remain poorly understood. We assessed changes in renal function and mortality in patients starting TDF- or non-TDF-containing ART in Lusaka, Zambia. Methods.?We included patients aged ?16 years who started ART from 2007 onward, with documented baseline weight and serum creatinine. Renal dysfunction was categorized as mild (estimated glomerular filtration rate [eGFR], 60-89 mL/min), moderate (30-59 mL/min), or severe (<30 mL/min) according to the chronic kidney disease-epidemiology (CKD-EPI) formula. Differences in eGFR during ART were analyzed using linear mixed-effect models. The odds of developing moderate or severe eGFR decrease and mortality were assessed using logistic and competing risk regression, respectively. Results.?We included 62 230 adults, of which 38 716 (62.2%) initiated a TDF-based regimen. The proportion with moderate or severe renal dysfunction at baseline was lower in the TDF than in the non-TDF group (1.9% vs 4.0%). Among patients with no or mild renal dysfunction, those receiving TDF were more likely to develop moderate (adjusted odds ratio, 3.11; 95% confidence interval, 2.52-3.87) or severe ( 2.43; 1.80-3.28) eGFR decrease, although the incidence in such episodes was low. Among patients with moderate or severe renal dysfunction at baseline, renal function improved independently of ART regimen, and mortality rates were similar in both treatment groups. Conclusions.?TDF use did not attenuate renal function recovery or increase the mortality rate in patients with renal dysfunction. Further studies are needed to determine the role of routine renal function monitoring before and during ART use in Africa. PMID:24585558
Mulenga, Lloyd; Musonda, Patrick; Mwango, Albert; Vinikoor, Michael J; Davies, Mary-Ann; Mweemba, Aggrey; Calmy, Alexandra; Stringer, Jeffrey S; Keiser, Olivia; Chi, Benjamin H; Wandeler, Gilles
A Bayesian Geostatistical Moran Curve Model for Estimating Net Changes of Tsetse Populations in Zambia
For the first time a Bayesian geostatistical version of the Moran Curve, a logarithmic form of the Ricker stock recruitment curve, is proposed that is able to give an estimate of net change in population demographic rates considering components such as fertility and density dependent and density independent mortalities. The method is applied to spatio-temporally referenced count data of tsetse flies obtained from fly-rounds. The model is a linear regression with three components: population rate of change estimated from the Moran curve, an explicit spatio-temporal covariance, and the observation error optimised within a Bayesian framework. The model was applied to the three main climate seasons of Zambia (rainy � January to April, cold-dry � May to August, and hot-dry � September to December) taking into account land surface temperature and (seasonally changing) cattle distribution. The model shows a maximum positive net change during the hot-dry season and a minimum between the rainy and cold-dry seasons. Density independent losses are correlated positively with day-time land surface temperature and negatively with night-time land surface temperature and cattle distribution. The inclusion of density dependent mortality increases considerably the goodness of fit of the model. Cross validation with an independent dataset taken from the same area resulted in a very accurate estimate of tsetse catches. In general, the overall framework provides an important tool for vector control and eradication by identifying vector population concentrations and local vector demographic rates. It can also be applied to the case of sustainable harvesting of natural populations.
Sedda, Luigi; Mweempwa, Cornelius; Ducheyne, Els; De Pus, Claudia; Hendrickx, Guy; Rogers, David J.
Creating a Knowledge Translation Platform: nine lessons from the Zambia Forum for Health Research
The concept of the Knowledge Translation Platform (KTP) provides cohesion and leadership for national�level knowledge translation efforts. In this review, we discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. Lessons from ZAMFOHR�s organizational development include the necessity of selecting a multi-stakeholder and -sectoral Board of Directors; performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche; and selecting a leader that bridges the worlds of research and policy. Programmatic lessons include focusing on building the capacity of both policy-makers and researchers; building a database of local evidence and national-level actors involved in research and policy; and catalyzing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence, and fostering the next generation by mentoring both up-and-coming researchers and policy�makers. Ultimately, ZAMFOHR�s experience shows that an African KTP must pay significant attention to its organizational details. A KTP must also invest in the skill base of the wider community and, more importantly, of its own staff. Given the very real deficit of research-support skills in most low-income countries � in synthesis, in communications, in brokering, in training � a KTP must spend significant time and resources in building these types of in-house expertise. And lastly, the role of networking cannot be underestimated. As a fully-networked KTP, ZAMFOHR has benefited from the innovations of other KTPs, from funding opportunities and partnerships, and from invaluable technical support from both African and northern colleagues.
Creating a Knowledge Translation Platform: nine lessons from the Zambia Forum for Health Research.
The concept of the Knowledge Translation Platform (KTP) provides cohesion and leadership for national-level knowledge translation efforts. In this review, we discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. Lessons from ZAMFOHR's organizational development include the necessity of selecting a multi-stakeholder and -sectoral Board of Directors; performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche; and selecting a leader that bridges the worlds of research and policy. Programmatic lessons include focusing on building the capacity of both policy-makers and researchers; building a database of local evidence and national-level actors involved in research and policy; and catalyzing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence, and fostering the next generation by mentoring both up-and-coming researchers and policy-makers. Ultimately, ZAMFOHR's experience shows that an African KTP must pay significant attention to its organizational details. A KTP must also invest in the skill base of the wider community and, more importantly, of its own staff. Given the very real deficit of research-support skills in most low-income countries - in synthesis, in communications, in brokering, in training - a KTP must spend significant time and resources in building these types of in-house expertise. And lastly, the role of networking cannot be underestimated. As a fully-networked KTP, ZAMFOHR has benefited from the innovations of other KTPs, from funding opportunities and partnerships, and from invaluable technical support from both African and northern colleagues. PMID:23034056
Kasonde, Joseph M; Campbell, Sandy
Risk factors for subclinical mastitis among HIV-infected and uninfected women in Lusaka, Zambia.
Subclinical mastitis, defined as raised milk sodium/potassium (Na/K) ratio, is associated with poor infant growth and, among HIV-infected women, with increased milk HIV viral load. We conducted a longitudinal cohort study in Lusaka, Zambia, in order to investigate the relative importance of several potential causes of subclinical mastitis: maternal infection, micronutrient deficiencies and poor lactation practice. Women (198 HIV-infected, 189 HIV-uninfected) were recruited at 34 weeks' gestation and followed up to 16 weeks postpartum for collection of information on their health, their infant's health, infant growth and infant feeding practices. Milk samples were collected from each breast at 11 postpartum visits and blood at recruitment and 6 weeks postpartum. The geometric mean milk Na/K ratio and the proportion of women with Na/K ratio > 1.0 in one or both breasts were significantly higher among HIV-infected than among uninfected women. Other factors associated with the higher mean Na/K ratio in univariable analyses were primiparity, high maternal alpha(1)-acid glycoprotein (AGP) at 6 weeks, maternal overall morbidity and specific breast symptoms, preterm delivery, low infant weight or length, infant thrush and non-exclusive breast feeding. In multivariable analyses, primiparity, preterm delivery, breast symptoms, HIV status and raised AGP were associated with the raised Na/K ratio. Thus the main factors associated with subclinical mastitis that are amenable to intervention are poor maternal overall health and breast health. The impact of improved postpartum health care, especially management of maternal infections and especially in primiparous women, on the prevalence of subclinical mastitis and its consequences requires investigation. PMID:16911016
Kasonka, Lackson; Makasa, Mpundu; Marshall, Tom; Chisenga, Molly; Sinkala, Moses; Chintu, Chifumbe; Kaseba, Christine; Kasolo, Francis; Gitau, Rachel; Tomkins, Andrew; Murray, Susan; Filteau, Suzanne
A Bayesian geostatistical Moran Curve model for estimating net changes of tsetse populations in Zambia.
For the first time a Bayesian geostatistical version of the Moran Curve, a logarithmic form of the Ricker stock recruitment curve, is proposed that is able to give an estimate of net change in population demographic rates considering components such as fertility and density dependent and density independent mortalities. The method is applied to spatio-temporally referenced count data of tsetse flies obtained from fly-rounds. The model is a linear regression with three components: population rate of change estimated from the Moran curve, an explicit spatio-temporal covariance, and the observation error optimised within a Bayesian framework. The model was applied to the three main climate seasons of Zambia (rainy--January to April, cold-dry--May to August, and hot-dry--September to December) taking into account land surface temperature and (seasonally changing) cattle distribution. The model shows a maximum positive net change during the hot-dry season and a minimum between the rainy and cold-dry seasons. Density independent losses are correlated positively with day-time land surface temperature and negatively with night-time land surface temperature and cattle distribution. The inclusion of density dependent mortality increases considerably the goodness of fit of the model. Cross validation with an independent dataset taken from the same area resulted in a very accurate estimate of tsetse catches. In general, the overall framework provides an important tool for vector control and eradication by identifying vector population concentrations and local vector demographic rates. It can also be applied to the case of sustainable harvesting of natural populations. PMID:24755848
Sedda, Luigi; Mweempwa, Cornelius; Ducheyne, Els; De Pus, Claudia; Hendrickx, Guy; Rogers, David J
The Integrated Rural Nutrition Project, Kawambwa, Zambia: successes of a nutrition education programme.
This article presents some findings from an evaluation of the Integrated Rural Nutrition Project (IRNP) in Kawambwa, Zambia. The IRNP was initiated in 1985. The program relied on a multisectoral approach by the Ministries of Health, Education, Agriculture, and Community Development. The program aimed to reduce the rate of malnutrition. Breast feeding was encouraged, and farmers were encouraged to increase production of beans and groundnuts. Extension workers were trained. Findings indicate that nutrition education programs had a significant, positive effect on the nutritional status of children aged under 5 years. The nutrition education component, which aimed at improving knowledge, attitudes, and practices, was more successful than the activities that aimed at increasing food availability. A continuing question was raised by program staff about whether training of extension workers, social marketing, mass education, or direct extension were capable of having an impact on nutrition without addressing food productivity issues. The availability of legumes improved throughout the intervention period. The length of the hunger season was shortened. However, increased food availability did not improve anthropometric measurements, and some children, who were not part of the seed multiplication program, showed improved anthropometric measurements. Children in the intervention area were exposed to better breast-feeding practices: breast feeding for longer periods and fewer introductions to non-milk liquids. After the first month, under 20% of children in the project area and 80-95% in the non-project areas had received breast milk substitutes. Young children in the project area had better weight-for-height, after controlling for wealth, access to services, maternal and paternal education, gender, and age. 3-year-old children in the project area weighed 0.3 of a z-score more than non-project children. PMID:12293178
Friedrich, J
Life-circumstances, working conditions and HIV risk among street and nightclub-based sex workers in Lusaka, Zambia.
The principal objective of this study was to conduct formative research among sex workers in Lusaka, Zambia, to understand how sex workers' perceptions of their personal identity influences safer sex practices. In-depth interviews were conducted with 20 sex workers in Lusaka, Zambia, including both nightclub and street-based sex workers. Findings indicate important differences of self perception and identity between nightclub-based sex workers and street-based sex workers. The latter have a professional identity and are willing to be publicly acknowledged as sex workers. This makes it easier for them to convince clients to use condoms. In contrast, nightclub-based sex workers are less likely to wish to be identified as sex workers. They are motivated by the desire to meet a man who will perhaps marry them and change their lives. As a consequence, they do not publicly acknowledge their risk of STI/HIV infection and many go against their better judgement by not using condoms. Factors such as the stigmatization of sex work, the harassment of sex workers and the lack of protection available to them interact with sex workers' perceptions of their personal identities and influence their ability to take precautions during high-risk sexual encounters. PMID:21972903
Agha, Sohail; Chulu Nchima, Mwaba
Gastric adenocarcinoma in Zambia: a case-control study of HIV, lifestyle risk factors, and biomarkers of pathogenesis
Background Gastric cancer is a leading cause of cancer deaths worldwide but there are few data from Africa. We have recently observed a trend towards diagnosis in younger patients. Objective To test the hypothesis that HIV may have altered risk factors for acquisition of gastric cancer, in a case-control study in the University Teaching Hospital, Lusaka, Zambia. Methods Cases (n=52) with confirmed gastric adenocarcinoma and controls (n=94) undergoing endoscopy but with no macroscopic gastric pathology. Established risk factors and HIV status were compared. Results HIV status did not differ significantly in cases and controls (Odds Ratio 1�03; 95% CI 0�2�4�3; P=1�00) and seroprevalence in cases was similar to the Zambian population. Smoking, regular alcohol intake, and gastric atrophy were all associated with cancer in univariate and multivariate analysis. H. pylori serology was positive in 84% of patients studied and cagA serology in 66%; neither serological marker was associated with cancer. Atrophy, assessed serologically, was common in cases (57%) and controls (30%). In controls, both smoking and alcohol use were associated with atrophy, and intestinal metaplasia was present in 17% but was not associated with atrophy. Conclusions HIV was not associated with gastric cancer and does not explain the apparent change in age distribution in Zambia. Atrophy was common and was not essential for the development of intestinal metaplasia, suggesting that gastric carcinogenesis in Africa does not always follow the Correa pathway.
Kayamba, Violet; Asombang, Akwi W; Mudenda, Victor; Lisulo, Mpala Mwanza; Sinkala, Edford; Mwanamakondo, Stayner; Mweemba, Isaac; Kelly, Paul
Evaluation of alternative mosquito sampling methods for malaria vectors in Lowland South - East Zambia
Background Sampling malaria vectors and measuring their biting density is of paramount importance for entomological surveys of malaria transmission. Human landing catch (HLC) has been traditionally regarded as a gold standard method for surveying human exposure to mosquito bites. However, due to the risk of human participant exposure to mosquito-borne parasites and viruses, a variety of alternative, exposure-free trapping methods were compared in lowland, south-east Zambia. Methods Centres for Disease Control and Prevention miniature light trap (CDC-LT), Ifakara Tent Trap model C (ITT-C), resting boxes (RB) and window exit traps (WET) were all compared with HLC using a 3?�?3 Latin Squares design replicated in 4 blocks of 3 houses with long lasting insecticidal nets, half of which were also sprayed with a residual deltamethrin formulation, which was repeated for 10 rounds of 3 nights of rotation each during both the dry and wet seasons. Results The mean catches of HLC indoor, HLC outdoor, CDC-LT, ITT-C, WET, RB indoor and RB outdoor, were 1.687, 1.004, 3.267, 0.088, 0.004, 0.000 and 0.008 for Anopheles quadriannulatus Theobald respectively, and 7.287, 6.784, 10.958, 5.875, 0.296, 0.158 and 0.458, for An. funestus Giles, respectively. Indoor CDC-LT was more efficient in sampling An. quadriannulatus and An. funestus than HLC indoor (Relative rate [95% Confidence Interval]?=?1.873 [1.653, 2.122] and 1.532 [1.441, 1.628], respectively, P?0.001 for both). ITT-C was the only other alternative which had comparable sensitivity (RR?=?0.821 [0.765, 0.881], P?0.001), relative to HLC indoor other than CDC-LT for sampling An. funestus. Conclusions While the two most sensitive exposure-free techniques primarily capture host-seeking mosquitoes, both have substantial disadvantages for routine community-based surveillance applications: the CDC-LT requires regular recharging of batteries while the bulkiness of ITT-C makes it difficult to move between sampling locations. RB placed indoors or outdoors and WET had consistently poor sensitivity so it may be useful to evaluate additional alternative methods, such as pyrethrum spray catches and back packer aspirators, for catching resting mosquitoes.
Hope and despair: community health assistants' experiences of working in a rural district in Zambia
Background In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work. Methods A phenomenological approach was used to examine CHAs� experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach. Results Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs� ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs� ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA�s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs� ability to deliver services. Conclusions Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.
Women as food producers and suppliers in the twentieth century. The case of Zambia.
It is argued in this discussion that women's ability to produce and supply food has been deteriorating over time. Although this may have begun in precolonial times, particularly with the advent of merchant capital, 20th century economic and political developments have accelerated the process. This situation applies to peasant production as a whole, but discussion is limited to food production and supply. The discussion attempts to understand and discuss the position of women as food producers and suppliers within the framework of the social relations of production, distribution, and surplus appropriation. Land and labor issues have affected women's food production capabilities adversely, and their ability to supply food has been deteriorating. In those countries where their husbands are wage laborers, women have both fed themselves and their children and have supplemented their husbands' wages through food gifts and by maintaining them during their stay at home before the cycle begins again. Despite the fact that they could not adequately do so, men were obligated to start partially maintaining their families "back home" through cash remittances, but cash came at irregular intervals, or it was insufficient, mainly because of small wages. Some women have tried to increase their food supply capacities by going into seasonal wage labor, but often the wages are too low and the prices of food too high for this strategy to work. The time spent in wage labor could be better spent in their own production, provided the factors of production are favorable to them. The intensification of cash crop production has drawn land and labor away from food crops resulting in local food shortages. This process was realized earlier in West Africa when the colonial government started to import rice from China. Gradually, this became an acceptable food crop, but attempts to grow it in sufficient quantities have benefited only men. With the growing urban population rice became a viable marketable crop, to the disadvantage of sufficient food supplies for the producers themselves. The case of Zambia is presented, and it is concluded that the situation of women producers and of food production worsened at a pace responding to the nature of capitalist appropriation of land and labor and the intensification of cash crop production. Thus the phenomenon became more marked after 1945 when colonial states intensified cash crop production. The situation persisted after formal independence. Another Development must tackle the problem areas of land, labor, the sexual division of labor, the state, and men. PMID:12279571
Muntemba, S
Risk factors for brucellosis in indigenous cattle reared in livestock-wildlife interface areas of Zambia.
We conducted this cross-sectional study to investigate risk factors of Brucella seropositivity in cattle herds reared in livestock-wildlife interface areas of Blue Lagoon and Lochinvar National Parks in Zambia between August 2003 and September 2004. Sera were collected from cattle aged > or =2 years from 124 herds. Data on husbandry practices, grazing strategies, and herd structure (sex and age composition) were also collected. Sera were screened for anti-Brucella antibodies using the Rose Bengal test (RBT) as a presumptive test and a competitive-ELISA (c-ELISA) as a confirmatory test. A herd was classified as Brucella seropositive if at least one animal tested positive on both RBT and c-ELISA in series testing. Risk factors for herd-level brucellosis seropositivity were tested using multivariable logistic regression; risk factors for increases in the within-herd counts of seropositive cattle were analyzed using the negative binomial regression model with the number of seropositive animals as outcome and total number of cattle tested in a herd as the population at risk (exposure). Of the 110 herds tested, 68 (62; 95% CI: 53, 71% after adjusting for clustering by area) tested seropositive for exposure to Brucella spp. The final logistic-regression model identified geographical area, with Lochinvar (OR=3.4; CI: 0.97, 12) and Kazungula (OR=4.3; CI: 0.91, 20) recording higher odds of Brucella infections compared to Blue Lagoon. Herds coming in contact with wildlife had higher odds compared to those without contact (OR=3.4; CI: 1, 11). Similarly, the odds of Brucella infection were progressively higher in the larger herd categories (26-40 cattle, OR=2.6; CI: 0.70, 10; 41-82 cattle, OR=4.9; CI: 0.93, 26; >82 cattle, OR=9.4; CI: 1.7-51) compared to the smallest herd category (10-25). The negative binomial regression model identified geographical area, contact with wildlife, and herd size as having significant effect on counts of seropositive cattle in a herd. PMID:17481753
Muma, J B; Samui, K L; Oloya, J; Munyeme, M; Skjerve, E
The geology and geochemistry of the Lumwana Cu (� Co � U) deposits, NW Zambia
NASA Astrophysics Data System (ADS)
The Lumwana Cu (� Co � U) deposits of NW Zambia are large, tabular, disseminated ore bodies, hosted within the Mwombezhi Dome of the Lufilian Arc. The host rocks to the Lumwana deposits are two mineralogically similar but texturally distinct gneisses, a granitic to pegmatitic gneiss and a banded to augen gneiss which both comprise quartz-feldspar � biotite � muscovite � haematite � amphibole and intervening quartz-feldspar � biotite schist. The sulphide ore horizons are typically developed within a biotite-muscovite-quartz-kyanite schist, although mineralization locally occurs within internal gneiss units. Contacts between the ore and host rocks are transitional and characterized by a loss of feldspar. Kinematic indicators, such as S-C fabrics and pressure shadows on porphyroblasts, suggest a top to the north shear sense. The sulphides are deformed by a strong shear fabric, enclosed within kyanite or concentrated into low strain zones and pressure shadows around kyanite porphyroblasts. This suggests that the copper mineralization was introduced either syn- or pre-peak metamorphism. In addition to Cu and Co, the ores are also characterized by enrichments in U, V, Ni, Ba and S and small, discrete zones of uranium mineralization, occur adjacent to the hanging wall and footwall of the copper ore bodies or in the immediate footwall to the copper mineralization. Unlike typical Copperbelt mineralization, unmineralized units show very low background copper values. Whole rock geochemical analyses of the interlayered schist and ore schist, compared to the gneiss, show depletions in Ca, Na and Sr and enrichments in Mg and K, consistent with replacement of feldspar by biotite. The mineral chemistry of muscovite, biotite and chlorite reflect changes in the bulk rock chemistry and show consistent increases in X Mg as the schists develop. ?34S for copper sulphides range from +2.3 � to +18.5 �, with pyrite typically restricted to values between +3.9 � and +6.2 �. These values are atypical of sulphides precipitated by bacteriogenic sulphate reduction. ?34S data for Chimiwungo (Cu + Co) show a broader range and increased ?34S values compared to the Malundwe (Cu) mineralization. The Lumwana deposits show many characteristics which distinguish them from classical Copperbelt mineralization and which suggests that they are formed by metasomatic alteration, mineralization and shearing of pre-Katangan basement. Although this style of mineralization is reported elsewhere in the Copperbelt, sometimes associated with the more widely reported stratiform ores of the Lower Roan, none of the previously reported occurrences have so far developed the tonnages of ore reported at Lumwana.
Bernau, Robin; Roberts, Stephen; Richards, Mike; Nisbet, Bruce; Boyce, Adrian; Nowecki, James
An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
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 on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
Lactation-associated postpartum weight changes among HIV-infected women in Zambia
Background There are concerns about effects of lactation on postpartum weight changes among HIV-infected women because low weight may increase risks of HIV-related disease progression. Methods This analysis of postpartum maternal weight change is based on a trial evaluating the effects of shortened breastfeeding on postpartum mother-to-child transmission of HIV in Lusaka, Zambia, in which 958 HIV-infected women were randomized to breastfeed for a short duration (4 months) or for a duration of their own informed choosing (median 16 months). Among 768 women who met inclusion criteria, we compared across the two groups change in weight (kg) and the percent underweight [body mass index (BMI) <18.5] through 24 months. We also examined the effect of breastfeeding in two high-risk groups: those with low BMI and those with low CD4 counts. Results Overall, women in the long-duration group gained less weight compared with those in the short-duration group from 4�24 months {1.0 kg [95% confidence interval (CI): 0.3�1.7] vs 2.3 kg (95% CI: 1.6�2.9), P = 0.01}. No association was found between longer breastfeeding and being underweight (odds ratio 1.1; 95% CI: 0.8�1.6; P = 0.40). Effects of lactation in underweight women and women with low CD4 counts were similar to the effects in women with higher BMI and higher CD4 counts. Women with low baseline BMI tended to gain more weight from 4 to 24 months than those with higher BMI, regardless of breastfeeding duration (2.1 kg, 95% CI: 1.3�2.9; P < 0.01). Conclusions In this study of HIV-infected breastfeeding women in a low-resource setting, the average change in weight from 4 to 24 months postpartum was a net gain rather than loss. Although longer duration breastfeeding was associated with less weight gain, breastfeeding duration was not associated with being underweight (BMI < 18.5). Weight change associated with longer breastfeeding may be metabolically regulated so that women with low BMI and at risk of wasting are protected from excess weight loss.
Murnane, Pamela M; Arpadi, Stephen M; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Kasonde, Prisca; Thea, Donald M; Aldrovandi, Grace M; Kuhn, Louise
Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia
Background Sexual violence against children is a major global health and human rights problem. In order to address this issue there needs to be a better understanding of the issue and the consequences. One major challenge in accomplishing this goal has been a lack of validated child mental health assessments in low-resource countries where the prevalence of sexual violence is high. This paper presents results from a validation study of a trauma-focused mental health assessment tool - the UCLA Post-traumatic Stress Disorder - Reaction Index (PTSD-RI) in Zambia. Methods The PTSD-RI was adapted through the addition of locally relevant items and validated using local responses to three cross-cultural criterion validity questions. Reliability of the symptoms scale was assessed using Cronbach alpha analyses. Discriminant validity was assessed comparing mean scale scores of cases and non-cases. Concurrent validity was assessed comparing mean scale scores to a traumatic experience index. Sensitivity and specificity analyses were run using receiver operating curves. Results Analysis of data from 352 youth attending a clinic specializing in sexual abuse showed that this adapted PTSD-RI demonstrated good reliability, with Cronbach alpha scores greater than .90 on all the evaluated scales. The symptom scales were able to statistically significantly discriminate between locally identified cases and non-cases, and higher symptom scale scores were associated with increased numbers of trauma exposures which is an indication of concurrent validity. Sensitivity and specificity analyses resulted in an adequate area under the curve, indicating that this tool was appropriate for case definition. Conclusions This study has shown that validating mental health assessment tools in a low-resource country is feasible, and that by taking the time to adapt a measure to the local context, a useful and valid Zambian version of the PTSD-RI was developed to detect traumatic stress among youth. This valid tool can now be used to appropriately measure treatment effectiveness, and more effectively and efficiently triage youth to appropriate services.
Remotely-sensed, nocturnal, dew point correlates with malaria transmission in Southern Province, Zambia: a time-series study
Background Plasmodium falciparum transmission has decreased significantly in Zambia in the last decade. The malaria transmission is influenced by environmental variables. Incorporation of environmental variables in models of malaria transmission likely improves model fit and predicts probable trends in malaria disease. This work is based on the hypothesis that remotely-sensed environmental factors, including nocturnal dew point, are associated with malaria transmission and sustain foci of transmission during the low transmission season in the Southern Province of Zambia. Methods Thirty-eight rural health centres in Southern Province, Zambia were divided into three zones based on transmission patterns. Correlations between weekly malaria cases and remotely-sensed nocturnal dew point, nocturnal land surface temperature as well as vegetation indices and rainfall were evaluated in time-series analyses from 2012�week 19 to 2013�week 36. Zonal as well as clinic-based, multivariate, autoregressive, integrated, moving average (ARIMAX) models implementing environmental variables were developed to model transmission in 2011�week 19 to 2012�week 18 and forecast transmission in 2013�week 37 to week 41. Results During the dry, low transmission season significantly higher vegetation indices, nocturnal land surface temperature and nocturnal dew point were associated with the areas of higher transmission. Environmental variables improved ARIMAX models. Dew point and normalized differentiated vegetation index were significant predictors and improved all zonal transmission models. In the high-transmission zone, this was also seen for land surface temperature. Clinic models were improved by adding dew point and land surface temperature as well as normalized differentiated vegetation index. The mean average error of prediction for ARIMAX models ranged from 0.7 to 33.5%. Forecasts of malaria incidence were valid for three out of five rural health centres; however, with poor results at the zonal level. Conclusions In this study, the fit of ARIMAX models improves when environmental variables are included. There is a significant association of remotely-sensed nocturnal dew point with malaria transmission. Interestingly, dew point might be one of the factors sustaining malaria transmission in areas of general aridity during the dry season.
Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia's Copperbelt
Background Maternal mortality in developing countries is high and international targets for reduction are unlikely to be met. Zambia's maternal mortality ratio was 591 per 100,000 live births according to survey data (2007) while routinely collected data captured only about 10% of these deaths. In one district in Zambia medical staff reviewed deaths occurring in the labour ward but no related recommendations were documented nor was there evidence of actions taken to avert further deaths. The Investigate Maternal Deaths and Act (IMDA) approach was designed to address these deficiencies and is comprised of four components; identification of maternal deaths; investigation of factors contributing to the deaths; recommendations for action drawn up by multiple stakeholders and monitoring of progress through existing systems. Methods A pilot was conducted in one district of Zambia. Maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. The information was summarized and presented at eleven data sharing meetings to key decision makers, during which recommendations for action were drawn up. An output indicator to monitor progress was included in the routine performance assessment tool. High impact interventions were identified using frequency analysis. Results A total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Sixty three recommendations were drawn up by key decision-makers of which two thirds were implemented by the end of the pilot period. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood. Conclusion In resource constrained settings the IMDA approach promotes the use of existing systems to reduce maternal mortality. In turn the capacity of local health officers to use data to determine, plan and implement relevant interventions that address the local factors contributing to maternal deaths is strengthened. Monitoring actions taken against the defined recommendations within the routine performance assessment ensures sustainability. Suggestions for further research are provided.
An occurrence of stomach impaction in ostriches (Struthio camelus) on a farm in Zambia associated with high mortality.
Fifty-one ostriches (Struthio camelus), 6 weeks old, were imported from Namibia and introduced onto a farm in Zambia. Soon after introduction, most of the birds manifested clinical symptoms such as anorexia and diarrhea and 19 birds died within 1 week. The proventriculus and gizzard in the 4 dead birds were full of solid masses of lucerne hay mixed with maize and consequently the gizzard was extremely impacted by them. Neither pathogenic bacteria nor parasites were detected from the autopsied birds and 8 fecal samples. After diagnosis, the ostrich feed was improved and a demulcent was given immediately; then all ostriches that remained on the farm recovered. In conclusion, these data confirmed that the present case was stomach impaction in ostriches. PMID:7999912
Sato, Y; Yasuda, J; Sinsungwe, H; Chimana, H; Sato, G
Detection of Salmonella invA by isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) in Zambia.
The isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) is a new isothermal DNA amplification method composed of exo Bca DNA polymerase, RNaseH and DNA-RNA chimeric primers. We detected invA of Salmonella from chicken carcasses, egg yolk and cattle fecal samples. Fifty-three of 59 isolates were invA-positive in ICAN-chromatostrip detection. The result was consistent with those obtained by standard PCR. Salmonella invA was detected in 12 of 14 carcass rinses by ICAN, while in 7 of 14 rinses by standard PCR. These results indicate that ICAN is an efficient, sensitive and simple system to detect invA of Salmonella species in developing countries such as Zambia. PMID:16293310
Isogai, Emiko; Makungu, Chitwambi; Yabe, John; Sinkala, Patson; Nambota, Andrew; Isogai, Hiroshi; Fukushi, Hideto; Silungwe, Manda; Mubita, Charles; Syakalima, Michelo; Hang'ombe, Bernard Mudenda; Kozaki, Shunji; Yasuda, Jun
'Worse than HIV' or 'not as serious as other diseases'? Conceptualization of cervical cancer among newly screened women in Zambia.
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
White, Heather L; Mulambia, Chishimba; Sinkala, Moses; Mwanahamuntu, Mulindi H; Parham, Groesbeck P; Moneyham, Linda; Grimley, Diane M; Chamot, Eric
Defining the malaria burden in Nchelenge District, northern Zambia using the World Health Organization malaria indicators survey
Background Malaria is considered as one of the major public health problems and among the diseases of poverty. In areas of stable and relatively high transmission, pregnant women and their newborn babies are among the higher risk groups. A multicentre trial on the safety and efficacy of several formulations of artemisinin-based combination therapy (ACT) during pregnancy is currently on-going in four African countries, including Zambia, whose study site is in Nchelenge district. As the study outcomes may be influenced by the local malaria endemicity, this needs to be characterized. A cross-sectional survey to determine the prevalence and intensity of infection among <10�years old was carried out in March-April 2012 in Nchelenge district. Methods The sampling unit was the household where all children?10�years of age were included in the survey using simple random household selection on a GPS coded list. A blood sample for determining haemoglobin concentration and identifying malaria infection was collected from each recruited child. Results Six hundred thirty households were selected and 782 children tested for malaria and anaemia. Prevalence of malaria infection was 30.2% (236/782), the large majority (97.9%, 231/236) being Plasmodium falciparum and the remaining ones (2.1%, 5/236) Plasmodium malariae. Anaemia, defined as haemoglobin concentration <11�g/dl, was detected in 51.2% (398/782) children. Conclusion In Zambia, despite the reported decline in malaria burden, pockets of high malaria endemicity, such as Nchelenge district, still remain. This is a border area and significant progress can be achieved only by concerted efforts aimed at increasing coverage of current control interventions across the border.
Millennium development goal 6 and HIV infection in Zambia: what can we learn from successive household surveys?
Background Geographic location represents an ecological measure of HIV status and is a strong predictor of HIV prevalence. Given the complex nature of location effects, there is limited understanding of their impact on policies to reduce HIV prevalence. Methods Participants were 3,949 and 10,874 respondents from two consecutive Zambia Demographic and Health Surveys from 2001/7 (mean age for men and women: 30.3 and 27.7 years, HIV prevalence 14.3% in 2001/2002; 30.3 and 28.0 years, HIV prevalence of 14.7% in 2007). A Bayesian geo-additive mixed model based on Markov Chain Monte Carlo techniques was used to map the change in the spatial distribution of HIV/AIDS prevalence at the provincial level during the six-year period, accounting for important risk factors. Findings Overall HIV/AIDS prevalence changed little over the 6-year period, but the mapping of residual spatial effects at the provincial level suggested different regional patterns. A pronounced change in odds ratios in Lusaka and Copperbelt provinces in 2001/2 and in Lusaka and Central provinces in 2007 were observed following adjustment for spatial autocorrelation. Western province went from a lower prevalence area in 2001 (13.4%) to a higher prevalence area in 2007 (17.3%). Southern province went from the highest prevalence area in 2001 (17.3%) to a lower prevalence area in 2007 (15.9%). Interpretation Findings from two consecutive surveys corroborate the Zambian government�s effort to achieve MDG 6. The novel finding of increased prevalence in Western province warrants further investigation. Spatially-adjusted provincial-level HIV/AIDS prevalence maps are a useful tool for informing policies to achieve MDG 6 in Zambia.
Kandala, Ngianga-Bakwin; Brodish, Paul; Buckner, Bates; Foster, Susan; Madise, Nyovani
Local Perceptions, Cultural Beliefs and Practices That Shape Umbilical Cord Care: A Qualitative Study in Southern Province, Zambia
Background Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices. Methods and Findings This study consisted of 36 focus group discussions with breastfeeding mothers, grandmothers, and traditional birth attendants, and 42 in-depth interviews with key community informants. Semi-structured field guides were used to lead discussions and interviews at urban and rural sites. A wide variation in knowledge, beliefs, and practices surrounding cord care was discovered. For home deliveries, cords were cut with non-sterile razor blades or local grass. Cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g., Vaseline, cooking oil, used motor oil) and agents intended for medicinal/protective purposes (e.g., breast milk, cow dung, chicken feces). Concerns regarding the length of time until cord detachment were universally expressed. Blood clots in the umbilical cord,�bulongo-longo, were perceived to foreshadow neonatal illness. Management of�bulongo-longo�or infected umbilical cords included multiple traditional remedies and treatment at government health centers. Conclusion Umbilical cord care practices and beliefs were diverse. Dry cord care, as recommended by the World Health Organization at the time of the study, is not widely practiced in Southern Province, Zambia. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions.
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.
Coprological survey of alimentary tract parasites in dogs from Zambia and evaluation of a coproantigen assay for canine echinococcosis.
Faecal samples were collected from the rectum of 540 domestic dogs from four districts (Lusaka, Katete, Petauke and Luangwa) in Zambia between 2005 and 2006 and prevalences of canine alimentary tract parasites were determined by coprological examination. Thirteen different ova and parasites including strongyle (43.3%), Spirocerca lupi (18.7%), taeniid (13.1%), Toxocara canis (7.6%), Sarcocystis sp.* (7.5%), Isospora sp.* (5.7%), Physaloptera sp.* (4.6%), Capillaria sp.* (2.8%), Dipylidium caninum (2.2%), Mesocestoides sp.* (2.0%), Ascaris sp.* (1.7%), Trichuris vulpis* (0.4%) and Schistosoma mansoni* (0.4%) were detected, Ascaris and Schistosoma probably originating from coprophagy. The species with asterisks and later-described Taenia multiceps are for the first time reported from dogs in Zambia. A coproantigen enzyme-linked immunosorbent assay (CoproAg-ELISA) developed for Echinococcus spp. revealed 43 positive dogs and 37 of these harboured taeniid eggs. From 63 of the 71 taeniid egg-positive samples, eggs and DNA thereof were isolated and subjected to a multiplex polymerase chain reaction for differentiating E. granulosus sensu lato, E. multilocularis and Taenia spp. Amplicons indicative for Taenia spp. were obtained from 60 samples. Sequencing of amplicons spanning part of the mitochondrial cytochrome c oxidase subunit 1 gene, which was possible with 38 samples, revealed 35 infections with T. hydatigena and 3 with T. multiceps. Therefore, the CoproAg-ELISA showed some positives, but concrete evidence for the existence of canine E. granulosus infection could not be established. Comparison of the results of the CoproAg-ELISA and Taenia species identification indicated that the CoproAg-ELISA cross-reacts with patent infections of T. hydatigena (57%) and T. multiceps (33%). PMID:22185947
Nonaka, N; Nakamura, S; Inoue, T; Oku, Y; Katakura, K; Matsumoto, J; Mathis, A; Chembesofu, M; Phiri, I G K
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.
White, Heather L.; Mulambia, Chishimba; Sinkala, Moses; Mwanahamuntu, Mulindi H.; Parham, Groesbeck P.; Moneyham, Linda; Grimley, Diane M.; Chamot, Eric
Gender Equality and Education: Increasing the Uptake of HIV Testing among Married Women in Kenya, Zambia and Zimbabwe
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 associations between education (a key input needed for gender equality) and key gender equality measures (financial decision-making and attitudes towards violence) with ever tested for HIV and tested for HIV in the past year. The study focused on currently married women ages 15�24 and 25�34 in three countries - Kenya, Zambia and Zimbabwe. The data came from the Demographic and Health Surveys (DHS). 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 15�24 (p<0.01). The belief that gender-based violence is unacceptable was positively associated with testing for women 25�34 in all three countries though 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 25�34 in Zimbabwe only (among women reporting ever being tested: OR 1.66, p< 0.01). Overall the findings indicate that 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.
Singh, Kavita; Luseno, Winnie; Haney, Erica
Protocol-driven primary care and community linkages to improve population health in rural Zambia: the Better Health Outcomes through Mentoring and Assessment (BHOMA) project
Introduction Zambia�s under-resourced public health system will not be able to deliver on its health-related Millennium Development Goals without a substantial acceleration in mortality reduction. Reducing mortality will depend not only upon increasing access to health care but also upon improving the quality of care that is delivered. Our project proposes to improve the quality of clinical care and to improve utilization of that care, through a targeted quality improvement (QI) intervention delivered at the facility and community level. Description of implementation The project is being carried out 42 primary health care facilities that serve a largely rural population of more than 450,000 in Zambia�s Lusaka Province. We have deployed six QI teams to implement consensus clinical protocols, forms, and systems at each site. The QI teams define new clinical quality expectations and provide tools needed to deliver on those expectations. They also monitor the care that is provided and mentor facility staff to improve care quality. We also engage community health workers to actively refer and follow up patients. Evaluation design Project implementation occurs over a period of four years in a stepped expansion to six randomly selected new facilities every three months. Three annual household surveys will determine population estimates of age-standardized mortality and under-5 mortality in each community before, during, and after implementation. Surveys will also provide measures of childhood vaccine coverage, pregnancy care utilization, and general adult health. Health facility surveys will assess coverage of primary health interventions and measures of health system effectiveness. Discussion The patient-provider interaction is an important interface where the community and the health system meet. Our project aims to reduce population mortality by substantially improving this interaction. Our success will hinge upon the ability of mentoring and continuous QI to improve clinical service delivery. It will also be critical that once the quality of services improves, increasing proportions of the population will recognize their value and begin to utilize them.
�We are Zambians�Don�t Tell Us How to Fish!� Institutional Change, Power Relations and Conflicts in the Kafue Flats Fisheries in Zambia
Many scholars claim that open access due to the effective absence of state control is the major reason for the overuse of\\u000a common-pool resources such as fisheries. Based on data from the Kafue Flats fisheries in Zambia, we argue that the main problem\\u000a in open-access situations is the paradox of a state that is simultaneously absent and present: present in
Tobias Haller; Sonja Merten
Health inequities, environmental insecurity and the attainment of the millennium development goals in sub-Saharan Africa: the case study of Zambia.
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. PMID:16968967
Anyangwe, Stella C E; Mtonga, Chipayeni; Chirwa, Ben
Five-fold increase in Trypanosoma congolense isolates resistant to diminazene aceturate over a seven-year period in Eastern Zambia
Two groups of Trypanosoma congolense isolates collected from cattle in 1996 (n=39) and 2003 (n=38) in the Eastern Province of Zambia were analyzed by BclI-PCR-RFLP to assess the evolution of diminazene aceturate (DA) resistance over a period of seven years. The results show a significant increase of DA resistance in this relatively short period of time. In 1996, among the
Vincent Delespaux; Hunduma Dinka; Justin Masumu; Peter Van den Bossche; Stanny Geerts
Detection of Trypanosoma congolense and T. brucei subspecies in cattle in Zambia by polymerase chain reaction from blood collected on a filter paper
To facilitate epidemiology studies of African trypanosomiasis in cattle in Zambia, we adapted a polymerase chain reaction (PCR) method using blood spotted on filter papers. For easy preparation of template DNA from the dried blood, we adapted a simple DNA extraction method using Chelex-100, an anion-exchange resin. Using primers directed for repetitive nuclear DNA sequences, species-specific DNA amplifications were detected
Ken Katakura; Clement Lubinga; Harrison Chitambo; Yusuke Tada
Promotion of couples' voluntary HIV counselling and testing in Lusaka, Zambia by influence network leaders and agents
Objectives Hypothesising that couples� voluntary counselling and testing (CVCT) promotions can increase CVCT uptake, this study identified predictors of successful CVCT promotion in Lusaka, Zambia. Design Cohort study. Setting Lusaka, Zambia. Participants 68 influential network leaders (INLs) identified 320 agents (INAs) who delivered 29?119 CVCT invitations to heterosexual couples. Intervention The CVCT promotional model used INLs who identified INAs, who in turn conducted community-based promotion and distribution of CVCT invitations in two neighbourhoods over 18?months, with a mobile unit in one neighbourhood crossing over to the other mid-way through. Primary outcome The primary outcome of interest was couple testing (yes/no) after receipt of a CVCT invitation. INA, couple and invitation characteristics predictive of couples� testing were evaluated accounting for two-level clustering. Results INAs delivered invitations resulting in 1727 couples testing (6% success rate). In multivariate analyses, INA characteristics significantly predictive of CVCT uptake included promoting in community-based (adjusted OR (aOR)=1.3; 95% CI 1.0 to 1.8) or health (aOR=1.5; 95% CI 1.2 to 2.0) networks versus private networks; being employed in the sales/service industry (aOR=1.5; 95% CI 1.0 to 2.1) versus unskilled manual labour; owning a home (aOR=0.7; 95% CI 0.6 to 0.9) versus not; and having tested for HIV with a partner (aOR=1.4; 95% CI 1.1 to 1.7) or alone (aOR=1.3; 95% CI 1.0 to 1.6) versus never having tested. Cohabiting couples were more likely to test (aOR=1.4; 95% CI 1.2 to 1.6) than non-cohabiting couples. Context characteristics predictive of CVCT uptake included inviting couples (aOR=1.2; 95% CI 1.0 to 1.4) versus individuals; the woman (aOR=1.6; 95% CI 1.2 to 2.2) or couple (aOR=1.4; 95% CI 1.0 to 1.8) initiating contact versus the INA; the couple being socially acquainted with the INA (aOR=1.6; 95% CI 1.4 to 1.9) versus having just met; home invitation 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.
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
Gender equality and education: Increasing the uptake of HIV testing among married women in Kenya, Zambia and Zimbabwe.
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. PMID:23438082
Singh, Kavita; Luseno, Winnie; Haney, Erica
Impact assessment of malaria vector control using routine surveillance data in Zambia: implications for monitoring and evaluation
Background Malaria vector control using long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with pyrethroids and DDT, to reduce malaria transmission has been expansively implemented in Zambia. The impact of these interventions on malaria morbidity and mortality has not previously been formally assessed at the population level in Zambia. Methods The impact of IRS (15 urban districts) and LLINs (15 rural districts) implementation on severe malaria cases, deaths and case fatality rates in children below the age of five years were compared. Zambian national Health Management Information System data from 2007 to 2008 were retrospectively analysed to assess the epidemiological impact of the two interventions using odds ratios to compare the pre-scaling up year 2007 with the scaling-up year 2008. Results Overall there were marked reductions in morbidity and mortality, with cases, deaths and case fatality rates (CFR) of severe malaria decreasing by 31%, 63% and 62%, respectively between 2007 and 2008. In urban districts with IRS introduction there was a significant reduction in mortality (Odds Ratio [OR] = 0.37, 95% CI = 0.31-0.43, P = 0.015), while the reduction in mortality in rural districts with LLINs implementation was not significant (OR = 0.83, 95% CI = 0.67-1.04, P = 0.666). A similar pattern was observed for case fatality rates with a significant reduction in urban districts implementing IRS (OR = 0.34, 95% CI = 0.33-0.36, P = 0.005), but not in rural districts implementing LLINs (OR = 0.96, 95% CI = 0.91-1.00, P = 0.913). No substantial difference was detected in overall reduction of malaria cases between districts implementing IRS and LLINs (P = 0.933). Conclusion Routine surveillance data proved valuable for determining the temporal effects of malaria control with two strategies, IRS and LLINs on severe malaria disease in different types of Zambian districts. However, this analysis did not take into account the effect of artemisinin-based combination therapy (ACT), which were being scaled up countrywide in both rural and urban districts.
Retention in care, resource utilization, and costs for adults receiving antiretroviral therapy in Zambia: a retrospective cohort study
Background Of the estimated 800,000 adults living with HIV in Zambia in 2011, roughly half were receiving antiretroviral therapy (ART). As treatment scale up continues, information on the care provided to patients after initiating ART can help guide decision-making. We estimated retention in care, the quantity of resources utilized, and costs for a retrospective cohort of adults initiating ART under routine clinical conditions in Zambia. Methods Data on resource utilization (antiretroviral [ARV] and non-ARV drugs, laboratory tests, outpatient clinic visits, and fixed resources) and retention in care were extracted from medical records for 846 patients who initiated ART at ?15�years of age at six treatment sites between July 2007 and October 2008. Unit costs were estimated from the provider�s perspective using site- and country-level data and are reported in 2011 USD. Results Patients initiated ART at a median CD4 cell count of 145 cells/?L. Fifty-nine percent of patients initiated on a tenofovir-containing regimen, ranging from 15% to 86% depending on site. One year after ART initiation, 75% of patients were retained in care. The average cost per patient retained in care one year after ART initiation was $243 (95% CI, $194-$293), ranging from $184 (95% CI, $172-$195) to $304 (95% CI, $290-$319) depending on site. Patients retained in care one year after ART initiation received, on average, 11.4�months� worth of ARV drugs, 1.5 CD4 tests, 1.3 blood chemistry tests, 1.4 full blood count tests, and 6.5 clinic visits with a doctor or clinical officer. At all sites, ARV drugs were the largest cost component, ranging from 38% to 84% of total costs, depending on site. Conclusions Patients initiate ART late in the course of disease progression and a large proportion drop out of care after initiation. The quantity of resources utilized and costs vary widely by site, and patients utilize a different mix of resources under routine clinical conditions than if they were receiving fully guideline-concordant care. Improving retention in care and guideline concordance, including increasing the use of tenofovir in first-line ART regimens, may lead to increases in overall treatment costs.
Heterogeneity and Changes in Inequality of Malaria Risk after Introduction of Insecticide-Treated Bed Nets in Macha, Zambia
In 2007, the first free mass distribution of insecticide-treated bed nets (ITNs) occurred in southern Zambia. To determine the effect of ITNs on heterogeneity in biting rates, human DNA from Anopheles arabiensis blood meals was genotyped to determine the number of hosts that had contributed to the blood meals. The multiple feeding rate decreased from 18.9% pre-ITN to 9.1% post-ITN, suggesting that mosquito biting had focused onto a smaller fraction of the population. Pre-ITN, 20% of persons in a household provided 40% of blood meals, which increased to 59% post-ITN. To measure heterogeneity over a larger scale, mosquitoes were collected in 90 households in two village areas. Of these households, 25% contributed 78.1% of An. arabiensis, and households with high frequencies of An. arabiensis were significantly spatially clustered. The results indicate that substantial heterogeneity in malaria risk exists at local and household levels, and household-level heterogeneity may be influenced by interventions, such as ITNs.
Norris, Laura C.; Norris, Douglas E.
'Big push' to reduce maternal mortality in Uganda and zambia enhanced health systems but lacked a sustainability plan.
In the past decade, "big push" global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program's implementation, its ownership by national ministries of health, and its effects on health systems. The project's impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large "dose" of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President's Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control. PMID:24889956
Kruk, Margaret E; Rabkin, Miriam; Gr�pin, Karen Ann; Austin-Evelyn, Katherine; Greeson, Dana; Masvawure, Tsitsi Beatrice; Sacks, Emma Rose; Vail, Daniel; Galea, Sandro
The Current Availability of Antiepileptic Drugs in Zambia: Implications for the ILAE/WHO "Out of the Shadows" Campaign
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.
Chomba, Elwyn Nachanya; Haworth, Alan; Mbewe, Edward; Atadzhanov, Masharip; Ndubani, Philimon; Kansembe, Henry; Birbeck, Gretchen Lano
Expansion of antiretroviral treatment to rural health centre level by a mobile service in Mumbwa district, Zambia
Abstract Problem Despite the Government�s effort to expand services to district level, it is still hard for people living with HIV to access antiretroviral treatment (ART) in rural Zambia. Strong demands for expanding ART services at the rural health centre level face challenges of resource shortages. Approach The Mumbwa district health management team introduced mobile ART services using human resources and technical support from district hospitals, and community involvement at four rural health centres in the first quarter of 2007. This paper discusses the uptake of the mobile ART services in rural Mumbwa. Local setting Mumbwa is a rural district with an area of 23?000�km2 and a population of 167?000. Before the introduction of mobile services, ART services were provided only at Mumbwa District Hospital. Relevant changes The mobile services improved accessibility to ART, especially for clients in better functional status, i.e. still able to work. In addition, these mobile services may reduce the number of cases �lost to follow-up�. This might be due to the closer involvement of the community and the better support offered by these services to rural clients. Lessons learnt These mobile ART services helped expand services to rural health facilities where resources are limited, bringing them as close as possible to where clients live.
Dube, Christopher; Hayakawa, Tadao; Kakimoto, Kazuhiro; Yamada, Norio; Simpungwe, James B
Seroepidemiology of Hepatitis E Virus Infection in an Urban Population in Zambia: Strong Association With HIV and Environmental Enteropathy
Background.?Hepatitis E virus (HEV) infection causes major epidemics of infectious hepatitis, with high mortality rates in pregnant women. Recent reports indicate that HEV coinfections with human immunodeficiency virus (HIV) may have a more protracted course. However, the impact of HEV infections in communities heavily affected by HIV remains poorly studied. We set out to examine age-related seroprevalence in a community where we have previously carried out studies on environmental enteropathy. Methods.?Blood samples from 194 children and 106 adults were examined for immunoglobulin G and immunoglobulin M antibodies for HEV. HEV data were correlated with HIV status and morphometric analysis of small intestinal biopsies. Results.?Seroprevalence rose throughout childhood, from 8% in children aged 1�4 years, to 36% in children aged 10�14 years. In adults, the overall prevalence was 42%, with 28% in HIV-seronegative adults and 71% in HIV-seropositive adults (odds ratio, 6.2; 95% confidence interval, 2.2�18; P = .0001). In adults, villous height and crypt depth measurements showed that HEV seropositivity was associated with worse enteropathy (P = .05 and P = .005, respectively). Conclusions.?HEV infection is common in Zambia. In adults it is strongly associated with HIV status, and also with environmental enteropathy.
Jacobs, Choolwe; Chiluba, Clarance; Phiri, Cynthia; Lisulo, Mpala Mwanza; Chomba, Mumba; Hill, Philip C.; Ijaz, Samreen; Kelly, Paul
Urban and Rural Ozone Pollution Over Lusaka (Zambia, 15.5S, 25E) During SAFARI-2000 (September 2000)
NASA Technical Reports Server (NTRS)
In early September, throughout south central Africa, seasonal clearing of dry vegetation and the production of charcoal for cooking leads to intense smoke haze and ozone formation. Ozone soundings made over Lusaka during a six-day period in early September 2000 recorded layers of high ozone (greater than 125 ppbv at 5 km) during two stagnant periods, interspersed by a frontal passage that reduced boundary layer ozone by 30 percent. Smoke aerosol column variations aloft and total ozone were monitored by a sun photometer. During the 6-day measurement period, surface ozone concentrations ranged from 50-95 ppbv and integrated tropospheric ozone from the soundings was 39- 54 Dobson Units (note 1.3 km elevation at the launch site). High ozone concentrations above the mixed and inversion layers were advected from rural burning regions in western Zambia where SAFARI aircraft and ground-based instruments observed intense biomass fires and elevated aerosol and trace gas amounts. TOMS tropospheric ozone and smoke aerosols products show the distribution of biomass burning and associated pollution throughout southern Africa in September 2000. Animations of satellite images and trajectories confirm pollutant recirculation over south central African fires, exit of ozone from Mozambique and Tanzania to the Indian Ocean and the characteristic buildup of tropospheric ozone over the Atlantic from western African outflow.
Thompson, Anne M.; Herman, J. R.; Witte, J. C.; Phahlane, A.; Coetzee, G. J. R.; Mukula, C.; Hudson, R. D.; Frolov, A. D.; Bhartia, P. K. (Technical Monitor)
Urban and Rural Ozone Collect over Lusaka (Zambia, 15.5 S, 28 E) during SAFARI-2000 (September 2000)
NASA Technical Reports Server (NTRS)
In early September, throughout south central Africa, seasonal clearing of dry vegetation and the production of charcoal for cooking leads to intense smoke haze and ozone formation. Ozone soundings made over Lusaka in early September 2000 recorded layers of high ozone (greater than 125 ppbv at 5 km) during two stagnant periods, broken by a frontal passage that reduced boundary layer ozone by 30%. During the 6-day measurement period, surface ozone concentrations ranged from 50-95 ppbv and integrated tropospheric ozone from the soundings was 39-54 Dobson Units (note 1.3 km elevation at the launch site). A stable layer of high ozone at 2-5 km was advected from rural burning regions in western Zambia and neighboring countries, making Lusaka a collection point for transboundary pollution. This is confirmed by trajectories that show ozone leaving Angola, Namibia, Botswana and South Africa before heading toward the Indian Ocean and returning to Lusaka via Mozambique and Zimbabwe. Ozone in the mixed layer at Lusaka is heavily influenced by local sources.
Thompson, Anne M.; Witte, Jacquelyn C.; Freiman, M. Tai; Phalane, N. Agnes; Coetzee, Gert J. R.
Comparison of Surface and Satellite Derived Aerosol Optical Depth (AOD) Measurements in Finland, Estonia, Zambia and Brazil
NASA Astrophysics Data System (ADS)
Aerosol Optical Depth (AOD) values derived with the new MODIS retrieval algorithm over land (Collection 5) were compared with ground-based sun photometer measurements in northern Europe, Africa and South America. Sites in northern Europe were chosen to represent clean atmosphere, whereas locations in the southern hemisphere were heavily affected by biomass burning aerosols. In Finland (Jokioinen and Sodankyl�) measurements were done with Precision Filter Radiometer (PFR), while in Estonia (Toravere), Zambia (Mongu) and Brazil (Alta Floresta) level 2 AERONET data were used. Comparison results were generally good although in the aerosol model selection, particularly how dust is taken into account, there seems to be room for improvement. At all studied sites the MODIS algorithm selects occasionally dust aerosol model even though dust does not seem to be present and the air masses are not coming from arid regions. This happens especially when AOD values are small (<0.3) or during apparent cloud contamination. Moreover, the �ngstr�m exponent in Collection 5 data is no longer an independent parameter, thus caution is required when using it. However, it is an important parameter if one tries to estimate the anthropogenic component of aerosols. Collocated measurements from the AERONET sites with the largest absolute and relative differences were studied in more detail. Based on these case studies, it seems that cloud screening algorithms are the main reason for the largest differences between satellite and ground-based instruments.
Mielonen, T.; Aaltonen, V.; Arola, A.; Komppula, M.; Lihavainen, H.; Kolmonen, P.; Kaurila, T.; Lehtinen, K. E.
Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007.
A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m(2), and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable. PMID:19211930
Elema, Riekje; Mills, Clair; Yun, Oliver; Lokuge, Kamalini; Ssonko, Charles; Nyirongo, Nashiola; Mtonga, Velepi; Zulu, Henry; Tu, David; Verputten, Meggy; O'Brien, Daniel P
Heterogeneity in the trypanosomosis incidence in Zebu cattle of different ages and sex on the plateau of eastern Zambia.
On the plateau of eastern Zambia, trypanosomosis is endemic. Glossina morsitans morsitans Westwood (Diptera: Glossinidae), the only tsetse species present, is almost entirely dependent on livestock as its source of food with cattle being the most preferred host. To determine if tsetse challenge is distributed equally over the various age categories and sexes within a cattle herd, a longitudinal study of trypanosomosis incidence was conducted during the rainy season. A total of 354 head of cattle consisting of 40% oxen, 30% cows, 15% young stock, 13% calves and 2% bulls were sampled for three consecutive months and their infection statuses determined using the PCR-RFLP technique as diagnostic method. Results indicated that there were significant differences (P<0.001) in the proportion of infected animals between the various categories. In oxen, the risk of infection was 5.6 times higher than in calves. Those results suggest heterogeneity in the challenge by tsetse flies and are in line with entomological observations on the feeding preference of tsetse on cattle. The implications of these results for the control of trypanosomosis in Eastern Province and other epidemiologically related areas are discussed. PMID:17618594
Simukoko, H; Marcotty, T; Phiri, I; Vercruysse, J; Van den Bossche, P
Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study.
This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age (15-45 years), who gave birth within the last year; in-depth interviews comprised traditional leaders, mothers, fathers, community health workers and nurse-midwives. Perspectives on maternal health complications, health-seeking behaviour and barriers to utilization of maternal healthcare were explored. Most women showed insight into maternal health complications. Nevertheless, they started antenatal care visits late and did not complete the recommended schedule. Moreover, most women gave birth at home and did not use postnatal care. The main reasons for the low utilization were the low perceived quality of maternal healthcare services in clinics (negative attitude), negative opinion of important referents (subjective norms), physical and economic barriers such as long distances, high transport and indirect costs including money for baby clothes and other requirements. To improve, our findings suggest need for an integrated intervention to mitigate these barriers. Our findings also suggest need for further research to measure the elicited beliefs and determine their relevance and changeability. PMID:24663431
Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H; Ruiter, Robert A C
Early Weaning Increases Diarrhea Morbidity and Mortality Among Uninfected Children Born to HIV-infected Mothers in Zambia
Background.?Early weaning may reduce human immunodeficiency virus (HIV) transmission but may have deleterious consequences for uninfected children. Here we evaluate effects of early weaning on diarrhea morbidity and mortality of uninfected children born to HIV-infected mothers. Methods.?HIV-infected women in Lusaka, Zambia, were randomly assigned to breastfeeding for 4 months only or to continue breastfeeding until the mother decided to stop. Replacement and complementary foods were provided and all women were counseled around feeding and hygiene. Diarrhea morbidity and mortality were assessed in 618 HIV-uninfected singletons alive and still breastfeeding at 4 months. Intent-to-treat analyses and comparisons based on actual feeding practices were conducted using regression methods. Results.?Between 4 and 6 months, diarrheal episodes were 1.8-fold (95% confidence interval (CI), 1.3�2.4) higher in the short compared with long breastfeeding group. Associations were stronger based on actual feeding practices and persisted after adjustment for confounding. At older ages, only more severe outcomes, including diarrhea-related hospitalization or death (relative hazard [RH], 3.2, 95% CI, 2.1�5.1 increase 4�24 months), were increased among weaned children. Conclusions.?Continued breastfeeding is associated with reduced risk of diarrhea-related morbidity and mortality among uninfected children born to HIV-infected mothers in this low-resource setting despite provision of replacement and complementary food and counseling. ?Clinical Trials Registration.?NCT00310726.
Fawzy, Ashraf; Arpadi, Stephen; Kankasa, Chipepo; Sinkala, Moses; Mwiya, Mwiya; Thea, Donald M.; Aldrovandi, Grace M.
Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia
Background A previously reported association between prolonged lactation and maternal mortality has generated concern that breast-feeding may be detrimental for HIV-positive women. Methods As part of a trial conducted in Lusaka, Zambia, 653 HIV-positive women were randomly assigned either to a counseling program that encouraged abrupt cessation of breast-feeding at 4 months (group A) or to a program that encouraged prolonged breast-feeding for the duration of the woman�s own informed choice (group B). We examined whether mortality up to 2 years post-partum increased with breast-feeding for a longer duration. Results There was no difference in mortality 12 months after delivery between 326 HIV-positive women randomly assigned to short breast-feeding [group A: 4.93%; 95% confidence interval (CI), 2.42�7.46] versus 327 women assigned to long breast-feeding (group B: 4.89%; 95% CI, 2.38�7.40). Analysis based on actual practice, rather than random assignment, also demonstrated no increased mortality due to breast-feeding. Conclusions Although HIV-related mortality was high in this cohort of untreated HIV-positive women, prolonged lactation was not associated with increased mortality.
Kuhn, Louise; Kasonde, Prisca; Sinkala, Moses; Kankasa, Chipepo; Semrau, Katherine; Vwalika, Cheswa; Tsai, Wei-Yann; Aldrovandi, Grace M.; Thea, Donald M.
The rise and fall of a second-generation CBNRM project in Zambia: insights from a project perspective.
Since the advent of community-based natural resource management (CBNRM) in the mid-1980s, scholars and practitioners have sought to explain the uneven performance of CBNRM programs. Most CBNRM assessments examine the underlying principles of community-based conservation, the local social and ecological contexts, and connections with larger political and historical patterns. In this article, I argue that analysis of the potential and pitfalls of CBNRM also requires an understanding of the institutional history and internal dynamics of projects that implement CBNRM reforms. Drawing upon theory and methods from development ethnography and public policy, I examine the rise and fall of CONASA, a second-generation CBNRM project in Zambia that operated from 2001 to 2004. CONASA was constituted from a merger of organizations and discourses to provide continuity with previous projects. Its ambitious suite of activities included support for household livelihoods, community-based resource management, policy analysis, advocacy, and conservation enterprises at local, national, and transboundary levels. While individual activities were largely successful, CONASA's hybrid origins and logframe-centric management created fissures between its holistic design and operational logics, and hindered its ability to develop a broader narrative and maintain key alliances. This case study illustrates the importance of understanding the interplay between project design and operational context to fully appreciate the possibilities and limitations of project-mode conservation. PMID:23263566
Lyons, Andrew
Urban and Rural Ozone Pollution over Lusaka (Zambia, 15.5S, 25E) during SAFARI-2000 (September 2000)
NASA Astrophysics Data System (ADS)
In early September, throughout south central Africa, seasonal clearing of dry vegetation and the production of charcoal for cooking leads to intense smoke haze and ozone formation. Ozone soundings made over Lusaka during a six-day period in early September 2000 recorded layers of high ozone (> 125 ppbv at 5 km) during two stagnant periods, interspersed by a frontal passage that reduced boundary layer ozone by 30%. Smoke aerosol column variations aloft and total ozone were monitored by a sun photometer. During the 6-day measurement period, surface ozone concentrations ranged from 50-95 ppbv and integrated tropospheric ozone from the soundings was 39-54 Dobson Units (note 1.3 km elevation at the launch site). High ozone concentrations above the mixed and inversion layers were advected from rural burning regions in western Zambia where SAFARI aircraft and ground-based instruments observed intense biomass fires and elevated aerosol and trace gas amounts. TOMS tropospheric ozone and smoke aerosols products show the distribution of biomass burning and associated pollution throughout southern Africa in September 2000. Animations of satellite images and trajectories confirm pollutant recirculation over south central African fires, exit of ozone from Mozambique and Tanzania to the Indian Ocean and the characteristic buildup of tropospheric ozone over the Atlantic from western African outflow.
Thompson, A. M.; Witte, J. C.; Phahlane, A.; Coetzee, G. J.; Mukula, C.; Herman, J. R.; Hudson, R. D.; Frolov, A.
A quantitative risk assessment of bovine theileriosis entering Luapula Province from Central Province in Zambia via live cattle imports from traditional and commercial production sectors.
Theileriosis or East Coast Fever (ECF) is an important livestock disease widespread in Zambia except for some provinces such as Luapula. This freedom status has been achieved due to strict livestock movement regulations that only authorise cattle imports from commercial farms implementing strict ECF control regimens. Recent increases in both the demand and price of beef in Zambia are stimulating a policy change towards a more inclusive inter-provincial trade in live cattle. This may also encourage the introduction of breeding cattle from high production pastoral sectors such as Central Province to stimulate the beef industry in disease free low production areas such as the Luapula Province. To estimate and compare the risks linked with those potential introductions of cattle from the traditional or commercial production sectors of the Central Province, a quantitative risk assessment model was developed. This risk comparison was necessary because the traditional livestock production sector accounts for over 79% of breeding cattle trade in Central Province but is characterised by minimalistic tick-borne disease control and a higher prevalence of ECF. We estimate that should the importation of breeding cattle from Central into Luapula Province be permitted, we could expect to import ECF by the introduction of infected animals at a median rate (5th and 95th percentiles) of every 0.44 years (0.12, 2.60), from the traditional sector compared to every 3.57 years (0.37, 103.6) from the commercial sector. Infected ticks would be expected to enter every 3.46 (0.66, 43.8) years via traditional cattle imports. These risks are strongly influenced by the prevalence of infection, performance of pre-transport screening tests, and the effectiveness of pre-transport tick cleansing. This assessment is expected to provide a model for tick borne disease risk assessments in similar settings, as well as inform ECF control, cattle trade, and stock movement policies in Zambia. PMID:24974081
Makungu, C; Mwacalimba, K K
Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia
Background��This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of\\u000a the Center for Epidemiological Studies Depression scale (CES-D) and Alcohol Use Disorders Identification Test (AUDIT) against\\u000a a reference psychiatric diagnostic interview, in TB and anti-retroviral therapy (ART) patients in primary care in Zambia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��This was a cross-sectional study in 16 primary
Nathaniel Chishinga; Eugene Kinyanda; Helen A Weiss; Vikram Patel; Helen Ayles; Soraya Seedat
False beliefs about ART effectiveness, side effects and the consequences of non-retention and non-adherence among ART patients in Livingstone, Zambia.
Beliefs about antiretroviral treatment (ART) are crucial for treatment success but not well documented in sub-Sahara African countries. We studied the frequency of false beliefs about ART in 389 ART patients in Livingstone, Zambia. Despite intensive pre-ART counseling, we find that more than half of the patients hold at least one false belief about ART effectiveness, side effects, or the consequences of ART non-retention or non-adherence. Commonly held false beliefs-e.g., pastors can cure HIV infection through prayer and ART can be stopped without harmful effects while taking immune-boosting herbs-are likely to decrease ART adherence and retention. PMID:22714115
Nozaki, Ikuma; Kuriyama, Mika; Manyepa, Pauline; Zyambo, Matilda K; Kakimoto, Kazuhiro; B�rnighausen, Till
Weight and height z-scores improve after initiating ART among HIV-infected children in rural Zambia: a cohort study
Background��Deficits in growth observed in HIV-infected children in resource-poor settings can be reversed with antiretroviral treatment\\u000a (ART). However, many of the studies have been conducted in urban areas with older pediatric populations. This study was undertaken\\u000a to evaluate growth patterns after ART initiation in a young pediatric population in rural Zambia with a high prevalence of\\u000a undernutrition.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��Between 2007 and
Catherine G Sutcliffe; Janneke H van Dijk; Bornface Munsanje; Francis Hamangaba; Pamela Sinywimaanzi; Philip E Thuma; William J Moss
Are Staple Foods Becoming More Expensive For Urban Consumers In Eastern And Southern Africa? Trends in Food Prices, Marketing Margins, and Wage Rates in Kenya, Malawi, Mozambique, and Zambia
The world food and financial crises threaten to undermine the real incomes of urban consumers in eastern and southern Africa. This study investigates patterns in staple food prices, wage rates, and marketing margins for urban consumers in Kenya, Malawi, Mozambique, and Zambia between 1993 and 2009. There is high correlation among wage rate series for various government and private sector
Nicole M. Mason; Thomas S. Jayne; Cynthia Donovan; Antony Chapoto
Sector-Wide Approaches in Education: Issues for Donor Agencies Arising from Case Studies of Zambia and Mozambique. A Report from the Meeting of the International Working Group on Education (IWGE) (Lisbon, Portugal, November 19-21, 2001).
ERIC Educational Resources Information Center
This book contains two case studies--one from Zambia, one from Mozambique--of the implications for donors of pursuing sector-wide approaches (SWAps) in education. (A sector-wide approach is characterized as a sustained partnership led by national authorities involving different arms of government and, where relevant, donor agencies, with the goals�
Riddell, Abby
Evidence for participation of microbial mats in the deposition of the siliciclastic �ore formation� in the Copperbelt of Zambia
NASA Astrophysics Data System (ADS)
The Copperbelt of Zambia is the world's largest sediment-hosted stratiform copper province, hosted in siliciclastic sediments of the Roan Group, which forms the basal part of the Neoproterozoic-Paleozoic Katanga Supergroup. Much of the ore deposition occurred between 880 Ma and 780 Ma, on a rimmed platform consisting of a carbonate barrier, a lagoonal basin and tidal flats grading into sabkhas in the hinterland. Various sedimentary structures developed in the ore formation at the Mindola Open Pit mine, are herein considered to be microbially induced and are identified as microbial shrinkage cracks, wrinkle structures, mat deformation structures, petees, concentric microfaults, and microbial mat chips. The occurrence of these structures in all ore formation units at the Mindola Mine suggests microbial mats grew on the paleo-sediment surface throughout deposition of the cupriferous succession. As these structures require cohesive layers, the mats were likely of the cyanobacterial type, that grew in the well aerated intertidal to lower supratidal zones. Cyanobacterial mats typically consist of a surface layer of filamentous cyanobacteria underlain by anaerobic, heterotrophic sulfate reducing bacteria (SRB). A distinct sulfide mineral zonation, developed in all major deposits of the Copperbelt, ranges from barren supratidal (sabkha) sediments, through chalcocite in the lower supratidal zone, to bornite followed by chalcopyrite in the intertidal zone, and pyrite in the subtidal zone and anoxic lagoonal depotcentre. This sequence of minerals can be modelled as a paragenetic sequence of mineralization resulting from the progressive reduction of a source fluid, indicating that geochemical conditions of ore formation, at least, are produced by the activity of SRB.
Porada, H.; Druschel, G.
The burden of knowing: balancing benefits and barriers in HIV testing decisions. a qualitative study from Zambia
Background Client-initiated HIV counselling and testing has been scaled up in many African countries, in the form of voluntary counselling and testing (VCT). Test rates have remained low, with HIV-related stigma being an important barrier to HIV testing. This study explored HIV testing decisions in one rural and one urban district in Zambia with high HIV prevalence and available antiretroviral treatment. Methods Data were collected through 17 in-depth interviews and two focus group discussions with individuals and 10 in-depth interviews with counsellors. Interpretive description methodology was employed to analyse the data. Results 'To know your status' was found to be a highly charged concept yielding strong barriers against HIV testing. VCT was perceived as a diagnostic device and a gateway to treatment for the severely ill. Known benefits of prevention and early treatment were outweighed by a perceived burden of knowing your HIV status related to stigma and fear. The manner in which the VCT services were organised added to this burden. Conclusions This study draws on social stigma theory to enhance the understanding of the continuity of HIV related stigma in the presence of ART, and argues that the burden of knowing an HIV status and the related reluctance to get HIV tested can be understood both as a form of label-avoidance and as strong expressions of the still powerful embodied memories of suffering and death among non-curable AIDS patients over the last decades. Hope lies in the emerging signs of a reduction in HIV related stigma experienced by those who had been tested for HIV. Further research into innovative HIV testing service designs that do not add to the burden of knowing is needed.
Impact of organizational factors on adherence to laboratory testing protocols in adult HIV care in Lusaka, Zambia
Background Previous operational research studies have demonstrated the feasibility of large-scale public sector ART programs in resource-limited settings. However, organizational and structural determinants of quality of care have not been studied. Methods We estimate multivariate regression models using data from 13 urban HIV treatment facilities in Zambia to assess the impact of structural determinants on health workers� adherence to national guidelines for conducting laboratory tests such as CD4, hemoglobin and liver function and WHO staging during initial and follow-up visits as part of Zambian HIV care and treatment program. Results CD4 tests were more routinely ordered during initial history and physical (IHP) than follow-up (FUP) visits (93.0?% vs. 85.5?%; p?0.01). More physical space, higher staff turnover and greater facility experience with ART was associated with greater odds of conducting tests. Higher staff experience decreased the odds of conducting CD4 tests in FUP (OR 0.93; p?0.05) and WHO staging in IHP visit (OR 0.90; p?0.05) but increased the odds of conducting hemoglobin test in IHP visit (OR 1.05; p?0.05). Higher staff burnout increased the odds of conducting CD4 test during FUP (OR 1.14; p?0.05) but decreased the odds of conducting hemoglobin test in IHP visit (0.77; p?0.05) and CD4 test in IHP visit (OR 0.78; p?0.05). Conclusion Physical space plays an important role in ensuring high quality care in resource-limited setting. In the context of protocolized care, new staff members are likely to be more diligent in following the protocol verbatim rather than relying on memory and experience thereby improving adherence. Future studies should use prospective data to confirm the findings reported here.
Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia
Background Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. Methods The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level. Results The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV. Conclusion The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.
Ron Levey, Ilana; Wang, Wenjuan
Research-policy partnerships - experiences of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia
Background Partnerships are increasingly common in conducting research. However, there is little published evidence about processes in research-policy partnerships in different contexts. This paper contributes to filling this gap by analysing experiences of research-policy partnerships between Ministries of Health and research organisations for the implementation of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. Methods A conceptual framework for understanding and assessing research-policy partnerships was developed and guided this study. The data collection methods for this qualitative study included semi-structured interviews with Ministry of Health Partners (MOHPs) and Research Partners (RPs) in each country. Results The term partnership was perceived by the partners as a collaboration involving mutually-agreed goals and objectives. The principles of trust, openness, equality and mutual respect were identified as constituting the core of partnerships. The MOHPs and RPs had clearly defined roles, with the MOHPs largely providing political support and RPs leading the research agenda. Different influences affected partnerships. At the individual level, personal relationships and ability to compromise within partnerships were seen as important. At the organisational level, the main influences included the degree of formalisation of roles and responsibilities and the internal structures and procedures affecting decision-making. At the contextual level, political environment and the degree of health system decentralisation affected partnerships. Conclusions Several lessons can be learned from these experiences. Taking account of influences on the partnership at individual, organisation and contextual/system levels can increase its effectiveness. A common understanding of mutually-agreed goals and objectives of the partnership is essential. It is important to give attention to the processes of initiating and maintaining partnerships, based on clear roles, responsibilities and commitment of parties at different levels. Although partnerships are often established for a specific purpose, such as carrying out a particular project, the effects of partnership go beyond a particular initiative.
Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia
Objective To determine the population effectiveness of a city-wide perinatal HIV prevention program. Design An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP). Methods All 10 public-sector delivery centers in Lusaka, Zambia participated. All mother�infant pairs delivering during the 12-week surveillance period at the participating centers and who received antenatal care at a public-sector facility in Lusaka were included in the study. The main outcome measure was population NVP coverage, defined as the proportion of HIV-infected women and HIV-exposed infants in the population that ingested NVP. Results Of 8787 women in the surveillance population, 7204 (82%) had been offered antenatal HIV testing, of which 5149 (71%) had accepted, and of which 5129 (99%) had received a result. Overall, 2257 of 8787 (26%) were cord seropositive. Of the 1246 (55%) cord blood seropositive women who received an antenatal HIV test result, 1112 (89%) received a positive result; the other 134 comprise seroconverters and clerical errors. Only 751 of 1112 (68%) women who received a positive antenatal test result and a NVP tablet for ingestion at labor onset had NVP detected in the cord blood (i.e., maternal non-adherence rate was 32%). A total of 675 infants born to 751 adherent mothers (90%) received NVP before discharge. Thus, only 675 of 2257 (30%) seropositive mother�infant pairs in the surveillance population received both a maternal and infant dose of NVP. Conclusions Successful perinatal HIV prevention requires each mother�infant pair to negotiate a cascade of events that begins with offering HIV testing and continues through adherence to the prescribed regimen. This novel surveillance demonstrates that failures occur at each step, resulting in reduced coverage and diminished program effectiveness.
Stringer, Jeffrey S. A.; Sinkala, Moses; Maclean, Courtney C.; Levy, Jens; Kankasa, Chipepo; DeGroot, Alain; Stringer, Elizabeth M.; Acosta, Edward P.; Goldenberg, Robert L.; Vermund, Sten H.
Human Cytomegalovirus Infant Infection Adversely Affects Growth and Development in Maternally HIV-Exposed and Unexposed Infants in Zambia
Background.?Human immunodeficiency virus (HIV) and human cytomegalovirus (HCMV) coinfections have been shown to increase infant morbidity, mortality, and AIDS progression. In HIV-endemic regions, maternal HIV-exposed but HIV-uninfected infants, which is the majority of children affected by HIV, also show poor growth and increased morbidity. Although nutrition has been examined, the effects of HCMV infection have not been evaluated. We studied the effects of HCMV infection on the growth, development, and health of maternally HIV-exposed and unexposed infants in Zambia. Methods.?Infants were examined in a cohort recruited to a trial of micronutrient-fortified complementary foods. HIV-infected mothers and infants had received perinatal antiretroviral therapy to prevent mother-to-child HIV transmission. Growth, development, and morbidity were analyzed by linear regression analyses in relation to maternal HIV exposure and HCMV infection, as screened by sera DNA for viremia at 6 months of age and by antibody for infection at 18 months. Results.?All HCMV-seropositive infants had decreased length-for-age by 18 months compared with seronegative infants (standard deviation [z]-score difference: ?0.44 [95% confidence interval {CI}, ?.72 to ?.17]; P = .002). In HIV-exposed infants, those who were HCMV positive compared with those who were negative, also had reduced head size (mean z-score difference: ?0.72 [95% CI, ?1.23 to ?.22]; P = .01) and lower psychomotor development (Bayley test score difference: ?4.1 [95% CI, ?7.8 to ?.5]; P = .03). HIV-exposed, HCMV-viremic infants were more commonly referred for hospital treatment than HCMV-negative infants. The effects of HCMV were unaffected by micronutrient fortification. Conclusion.?HCMV affects child growth, development, and morbidity of African infants, particularly in those maternally exposed to HIV. HCMV is therefore a risk factor for child health in this region.
Larke, N.; Sanz-Ramos, M.; Bates, M.; Musonda, K.; Manno, D.; Siame, J.; Monze, M.; Filteau, S.
Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia
Background Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL) in pregnant women with malaria. Methods Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP). Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth). Results Data from 1,001 pregnant women (AL n = 495; SP n = 506) and 933 newborns (AL n = 466; SP n = 467) showed: perinatal mortality (AL 4.2%; SP 5.0%), comprised of early neonatal mortality (each group 2.3%), stillbirths (AL 1.9%; SP 2.7%); preterm deliveries (AL 14.1%; SP 17.4% of foetuses); and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%). Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment) was similar in both groups. Conclusions These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.
A seasonal survey of gastrointestinal parasites in captive wild impala antelope on a game facility south of Lusaka, Zambia.
Faecal samples (n = 1947) from captive wild impala (Aepyceros melampus melampus) were examined over a period of 14 months to determine quantitative seasonal helminth egg excretion patterns and qualitative protozoan oocyst excretion patterns. Geometric mean monthly faecal egg counts (FECs) ranged from 20 to 575 and coprocultures revealed three parasite genera, namely Trichostrongylus, Haemonchus and Strongyloides. Larvae of the Trichostrongylus spp. were most predominant from faecal cultures. No trematode eggs or lungworms were detected and eggs of the cestode Monezia were only seen in two samples during the entire study period. The nematode FECs showed a marked seasonal variation, being higher during the rainy season, moderate during the cool dry season and low during the hot dry season. The rainy season had significantly higher FECs than the dry season (P < 0.01). The percentage of helminth-egg positive faecal samples ranged from 90.6 to 100% in the rainy season and 72.4 to 85.6% in the dry season. Overall mean FECs in unpelleted faeces were significantly higher than in pelleted faeces (P < 0.01). However, the FECs were not significantly different among seasons in unpelleted faeces (P>0.05), but were significantly higher in pelleted faeces in the rainy season than the dry season (P < 0.05). Pellet size had a significant effect on FEC, with smaller pellets having higher FEC (P < 0.05). Strongyloides eggs and coccidia oocysts were only seen during the rainy season. This represents the first documentation of seasonal parasitic infestation in captive wild antelopes in Zambia. Treatment and control strategies for helminths in these captive wild impala are also suggested based on the findings from this study. PMID:22071007
Nalubamba, K S; Mudenda, N B; Malamo, M R
Comparative Intradermal Tuberculin Testing of Free-Ranging African Buffaloes (Syncerus caffer) Captured for Ex Situ Conservation in the Kafue Basin Ecosystem in Zambia.
Bovine tuberculosis (BTB) is endemic in African buffaloes (Syncerus caffer) in some National Parks in Southern Africa, whilst no studies have been conducted on BTB on buffalo populations in Zambia. The increased demand for ecotourism and conservation of the African buffalo on private owned game ranches has prompted the Zambian Wildlife Authority (ZAWA) and private sector in Zambia to generate a herd of "BTB-free buffaloes" for ex situ conservation. In the present study, 86 African buffaloes from four different herds comprising a total of 530 animals were investigated for the presence of BTB for the purpose of generating "BTB free" buffalo for ex-situ conservation. Using the comparative intradermal tuberculin test (CIDT) the BTB status at both individual animal and herd level was estimated to be 0.0% by the CIDT technique. Compared to Avian reactors only, a prevalence of 5.8% was determined whilst for Bovine-only reactors a prevalence of 0.0% was determined. These results suggest the likelihood of buffalo herds in the Kafue National Park being free of BTB. PMID:21776347
Munang'andu, Hetron Mweemba; Siamudaala, Victor; Matandiko, Wigganson; Nambota, Andrew; Muma, John Bwalya; Mweene, Aaron Simanyengwe; Munyeme, Musso
Detection of Trypanosoma congolense and T. brucei subspecies in cattle in Zambia by polymerase chain reaction from blood collected on a filter paper.
To facilitate epidemiology studies of African trypanosomiasis in cattle in Zambia, we adapted a polymerase chain reaction (PCR) method using blood spotted on filter papers. For easy preparation of template DNA from the dried blood, we adapted a simple DNA extraction method using Chelex-100, an anion-exchange resin. Using primers directed for repetitive nuclear DNA sequences, species-specific DNA amplifications were detected from the blood of rats infected with Zambian isolates of T. congolense and T. brucei subspecies. The method was sensitive enough to detect a single trypanosome for both species. In the Eastern Province of Zambia, 240 cattle were examined for motile flagellates in the buffy coat by the microhematocrit method, and 100 of them were positive for the test. These 100 animals were further examined by thin blood smears and PCR for species identification. The thin blood smear revealed 62 and 14 animals with T. congolense and T. brucei subspecies infection, respectively, whereas the PCR detected 73 of the former and 38 of the latter species. These results indicate that dried blood spots on filter papers are a useful source of DNA for detection of African trypanosomes by PCR. PMID:9089719
Katakura, K; Lubinga, C; Chitambo, H; Tada, Y
Comparative Intradermal Tuberculin Testing of Free-Ranging African Buffaloes (Syncerus caffer) Captured for Ex Situ Conservation in the Kafue Basin Ecosystem in Zambia
Bovine tuberculosis (BTB) is endemic in African buffaloes (Syncerus caffer) in some National Parks in Southern Africa, whilst no studies have been conducted on BTB on buffalo populations in Zambia. The increased demand for ecotourism and conservation of the African buffalo on private owned game ranches has prompted the Zambian Wildlife Authority (ZAWA) and private sector in Zambia to generate a herd of �BTB-free buffaloes� for ex situ conservation. In the present study, 86 African buffaloes from four different herds comprising a total of 530 animals were investigated for the presence of BTB for the purpose of generating �BTB free� buffalo for ex-situ conservation. Using the comparative intradermal tuberculin test (CIDT) the BTB status at both individual animal and herd level was estimated to be 0.0% by the CIDT technique. Compared to Avian reactors only, a prevalence of 5.8% was determined whilst for Bovine-only reactors a prevalence of 0.0% was determined. These results suggest the likelihood of buffalo herds in the Kafue National Park being free of BTB.
Munang'andu, Hetron Mweemba; Siamudaala, Victor; Matandiko, Wigganson; Nambota, Andrew; Muma, John Bwalya; Mweene, Aaron Simanyengwe; Munyeme, Musso
Measuring teamwork and taskwork of community-based "teams" delivering life-saving health interventions in rural Zambia: a qualitative study
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.
The Efficacy of Vectron 20 WP, Etofenprox, for Indoor Residual Spraying in Areas of High Vector Resistance to Pyrethroids and Organochlorines in Zambia
The selection of insecticide resistance in malaria vectors has the potential to compromise any insecticide-based vector control programme. To ensure that the insecticides used for indoor residual spraying and insecticide-treated nets in Zambia remain effective and their choice is evidence based, insecticide resistance surveillance and monitoring are essential. This study assessed and compared the residual efficacy of etofenprox (Vectron 20?WP), an ether pyrethroid, at 0.1?g/m2 with pyrethroids: bifenthrin (Bistar 10?WP) and lambda-cyhalothrin (Icon 10 CS) at 25?mg/m2 for indoor residual spraying. We also assessed the resistance status of etofenprox to local malaria vectors, An. funestus s.s and An. gambiae s.s, using World Health Organization standard protocols. The residual efficacy of Vectron 20?WP on cement, rendered walls of houses lasted for four months with 100% mortality. By the eighth month, the killing effect had reduced to 73.8% compared to 63.3% for bifenthrin and 77.0% for lambda-cyhalothrin. Susceptibility tests using standard World Health Organization assays on An. gambiae s.s showed susceptibility to etofenprox (0.1%) but some resistance was detected to Anopheles funestus s.s. The product is recommended as an ideal insecticide for indoor residual spraying for malaria control in Zambia as part of a resistance management programme in selected areas of the country.
Chanda, Emmanuel; Kandyata, Alister; Chanda, Javan; Phiri, Faustina N.; Muzia, Lucy; Kamuliwo, Mulakwa
Methods and baseline results of a repeated cross-sectional survey to assess the public health impact of antiretroviral therapy in Lusaka, Zambia.
Although the individual-level impact of antiretroviral therapy (ART) is well documented, there are few available data describing the public health impact of services for persons infected with human immunodeficiency virus in resource-constrained settings. We describe the methods and baseline results of a household survey that assessed the population-level impact of the national program for HIV care in Zambia and treatment in the city of Lusaka. The survey was timed with the staggered expansion of services and repeated cross-sectional surveys planned for pre-implementation and post-implementation comparisons made by community. In the initial survey round, which was performed during the early phases of the program (November-December 2004), 18,110 persons were enumerated from 3,600 households surveyed. Respondents were asked questions designed to evaluate community-level mortality and respondent knowledge and attitudes towards HIV. These findings will serve as a reliable reference in the future analysis of the population-level impact of this HIV treatment and care program in Zambia. PMID:20439984
Giganti, Mark J; Levy, Jens W; Banda, Yolan; Kusanthan, Thankian; Sinkala, Moses; Stringer, Jeffrey S A; Chi, Benjamin H
Methods and Baseline Results of a Repeated Cross-Sectional Survey to Assess the Public Health Impact of Antiretroviral Therapy in Lusaka, Zambia
Although the individual-level impact of antiretroviral therapy (ART) is well documented, there are few available data describing the public health impact of services for persons infected with human immunodeficiency virus in resource-constrained settings. We describe the methods and baseline results of a household survey that assessed the population-level impact of the national program for HIV care in Zambia and treatment in the city of Lusaka. The survey was timed with the staggered expansion of services and repeated cross-sectional surveys planned for pre-implementation and post-implementation comparisons made by community. In the initial survey round, which was performed during the early phases of the program (November�December 2004), 18,110 persons were enumerated from 3,600 households surveyed. Respondents were asked questions designed to evaluate community-level mortality and respondent knowledge and attitudes towards HIV. These findings will serve as a reliable reference in the future analysis of the population-level impact of this HIV treatment and care program in Zambia.
Giganti, Mark J.; Levy, Jens W.; Banda, Yolan; Kusanthan, Thankian; Sinkala, Moses; Stringer, Jeffrey S. A.; Chi, Benjamin H.
Detection of parasites and parasitic infections of free-ranging wildlife on a game ranch in zambia: a challenge for disease control.
Ex-situ conservancies are expanding alternatives to livestock production in Zambia albeit the lack of information on circulating infectious parasites from wildlife. Therefore, 12 wildlife species were examined on a game ranch were all species were found to be infected by Rhipecephalus spp. Haemoparasite infections were estimated at 7.37% (n = 95) with Babesia spp. detected in bushbuck (Tragelaphus scriptus); Anaplasma marginale in impala (Aepyceros melampus) and puku (Kobus vardonii) for the first time in Zambia. The majority of worm species isolated from bovids were not detected in equids and, vice versa. Our findings intimate ecological and behavioural patterns of some animals as deterministic to exposure. Kafue lechwe (Kobus leche kafuensis) had the widest range of worm species with more infected organs than other animals suggesting their semi aquatic nature contributory to prolonged worm exposure compared to other animals. On the other hand, Kafue lechwe had the least tick infections attributable more to shorter attachment periods as they spend prolonged periods submerged in water. Our findings indicate the vital role that wildlife plays in the epidemiology of parasitic diseases. To reduce the infection burden, control measures should be focused on reducing transmission to highly susceptible animal species as described herein. PMID:22701163
Munang'andu, Hetron Mweemba; Siamudaala, Victor M; Munyeme, Musso; Nalubamba, King Shimumbo
Detection of Parasites and Parasitic Infections of Free-Ranging Wildlife on a Game Ranch in Zambia: A Challenge for Disease Control
Ex-situ conservancies are expanding alternatives to livestock production in Zambia albeit the lack of information on circulating infectious parasites from wildlife. Therefore, 12 wildlife species were examined on a game ranch were all species were found to be infected by Rhipecephalus spp. Haemoparasite infections were estimated at 7.37% (n = 95) with Babesia spp. detected in bushbuck (Tragelaphus scriptus); Anaplasma marginale in impala (Aepyceros melampus) and puku (Kobus vardonii) for the first time in Zambia. The majority of worm species isolated from bovids were not detected in equids and, vice versa. Our findings intimate ecological and behavioural patterns of some animals as deterministic to exposure. Kafue lechwe (Kobus leche kafuensis) had the widest range of worm species with more infected organs than other animals suggesting their semi aquatic nature contributory to prolonged worm exposure compared to other animals. On the other hand, Kafue lechwe had the least tick infections attributable more to shorter attachment periods as they spend prolonged periods submerged in water. Our findings indicate the vital role that wildlife plays in the epidemiology of parasitic diseases. To reduce the infection burden, control measures should be focused on reducing transmission to highly susceptible animal species as described herein.
Munang'andu, Hetron Mweemba; Siamudaala, Victor M.; Munyeme, Musso; Nalubamba, King Shimumbo
Single genome amplification of proviral HIV-1 DNA from dried blood spot specimens collected during early infant screening programs in Lusaka, Zambia.
The ability to evaluate individual HIV-1 virions from the quasispecies of vertically infected infants was evaluated in a field setting at the Centre for Infectious Disease Research in Zambia. Infant heel-prick blood specimens were spotted onto dried blood spot (DBS) filter paper cards at government health clinics. Nucleic acid was extracted and used as a template for HIV-1 proviral DNA detection by a commercial Amplicor HIV-1 PCR test (Roche, version 1.5). On samples that tested positive by commercial diagnostic assay, amplification of DNA was performed using an in-house assay of the 5' and 3' region of the HIV-1 genome. Additionally, fragments covering 1200 nucleotides within pol (full length protease and partial reverse transcriptase) and 1400 nucleotides within env (variable 1-variable 5 region) were further analyzed by single genome amplification (SGA). In summary, we have demonstrated an in-house assay for amplifying the 5' and 3' proviral HIV-1 DNA as well as pol and env proviral DNA fragments from DBS cards collected and analyzed entirely in Zambia. In conclusion, this study shows the feasibility of utilizing DBS cards to amplify the whole proviral HIV-1 genome as well as perform SGA on key HIV-1 genes. PMID:24667303
Seu, Lillian; Mwape, Innocent; Guffey, M Bradford
Factors associated with health facility childbirth in districts of Kenya, Tanzania and Zambia: a population based survey
Background Maternal mortality continues to be a heavy burden in low and middle income countries where half of all deliveries take place in homes without skilled attendance. The study aimed to investigate the underlying and proximate determinants of health facility childbirth in rural and urban areas of three districts in Kenya, Tanzania and Zambia. Methods A population-based survey was conducted in 2007 as part of the �REsponse to ACcountable priority setting for Trust in health systems� (REACT) project. Stratified random cluster sampling was used and the data included information on place of delivery and factors that might influence health care seeking behaviour. A total of 1800 women who had childbirth in the previous five years were analysed. The distal and proximate conceptual framework for analysing determinants of maternal mortality was modified for studying factors associated with place of delivery. Socioeconomic position was measured by employing a construct of educational attainment and wealth index. All analyses were stratified by district and urban�rural residence. Results There were substantial inter-district differences in proportion of health facility childbirth. Facility childbirth was 15, 70 and 37% in the rural areas of Malindi, Mbarali and Kapiri Mposhi respectively, and 57, 75 and 77% in the urban areas of the districts respectively. However, striking socio-economic inequities were revealed regardless of district. Furthermore, there were indications that repeated exposure to ANC services and HIV related counselling and testing were positively associated with health facility deliveries. Perceived distance was negatively associated with facility childbirth in rural areas of Malindi and urban areas of Kapiri Mposhi. Conclusion Strong socio-economic inequities in the likelihood of facility childbirths were revealed in all the districts added to geographic inequities in two of the three districts. This strongly suggests an urgent need to strengthen services targeting disadvantaged and remote populations. The finding of a positive association between HIV counselling/testing and odds in favor of giving birth at a health facility suggests potential positive effects can be achieved by strengthening integrated approaches in maternal health service delivery.
Targeting condom distribution at high risk places increases condom utilization-evidence from an intervention study in Livingstone, Zambia
Background The PLACE-method presumes that targeting HIV preventive activities at high risk places is effective in settings with major epidemics. Livingstone, Zambia, has a major HIV epidemic despite many preventive efforts in the city. A baseline survey conducted in 2005 in places where people meet new sexual partners found high partner turnover and unprotected sex to be common among guests. In addition, there were major gaps in on-site condom availability. This study aimed to assess the impact of a condom distribution and peer education intervention targeting places where people meet new sexual partners on condom use and sexual risk taking among people socializing there. Methods The 2005 baseline survey assessed the presence of HIV preventive activities and sexual risk taking in places where people meet new sexual partners in Livingstone. One township was selected for a non-randomised intervention study on condom distribution and peer education in high risk venues in 2009. The presence of HIV preventive activities in the venues during the intervention was monitored by an external person. The intervention was evaluated after one year with a follow-up survey in the intervention township and a comparison township. In addition, qualitative interviews and focus group discussions were conducted. Results Young people between 17-32 years of age were recruited as peer educators, and 40% were females. Out of 72 persons trained before the intervention, 38 quit, and another 11 had to be recruited. The percentage of venues where condoms were reported to always be available at least doubled in both townships, but was significantly higher in the intervention vs. the control venues in both surveys (84% vs. 33% in the follow-up). There was a reduction in reported sexual risk taking among guests socializing in the venues in both areas, but reporting of recent condom use increased more among people interviewed in the intervention (57% to 84%) than in the control community (55% to 68%). Conclusions It is likely that the substantial increase in reported condom use in the intervention venues was partially due to the condom distribution and peer education intervention targeting these places. However, substantial changes were observed also in the comparison community over the five year period, and this indicates that major changes had occurred in overall risk taking among people socializing in venues where people meet new sexual partners in Livingstone. Trial registration ClinicalTrials.gov NCT01423357.
The seven Cs of the high acceptability of home-based VCT: results from a mixed methods approach in Zambia.
HIV testing and counselling is a critical gateway to prevention and treatment. Yet, coverage remains insufficient, few couples are tested together and gender differences in access exist. We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing (HB-VCT) in a pair-matched cluster-randomized trial in Zambia. A baseline survey included 1694 individuals in 36 clusters. Adults in 18 intervention clusters were offered HB-VCT by lay counsellors. Standard testing services were available in both trial arms. After the completion of the intervention, a follow-up survey was conducted in all trial clusters. In addition, 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm. Informants favoured the convenience, confidentiality and credibility of HB-VCT. Counsellors were perceived as trustworthy owing to their closeness and conduct, and the consent process was experienced as convincing. Couple testing was selected by 70% of cohabiting couples and was experienced as beneficial by both genders. Levels of first-time testing (68% vs. 29%, p < 0.0001) and re-testing (94% vs. 74%, p < 0.0001) were higher in the intervention than in the control arm. Acceptance of HIV testing and counselling is dependent on stigma, trust and gender. The confidentiality of home-based VCT was essential for overcoming stigma-related barriers, and the selection of local counsellors was important to ensure trust in the services. The high level of couple counselling within HB-VCT may contribute to closing the gender gap in HIV testing, and has benefits for both genders and potentially for prevention of HIV transmission. The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach. The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was crucial to fully understand the intervention and its consequences. PMID:23972555
J�rgensen, Marte; Sand�y, Ingvild F; Michelo, Charles; Fylkesnes, Knut; Mwangala, Sheila; Blystad, Astrid
Rapid diagnostic tests for malaria and health workers' adherence to test results at health facilities in Zambia
Background In Zambia, there has been a large scaling up of interventions to control malaria in recent years including the deployment of rapid diagnostic tests (RDTs) to improve malaria surveillance data as well as guide malaria treatment in health facilities. The practical challenge is the impact of RDT results on subsequent management of patients. This study explored the role of RDTs in malaria diagnosis and the health workers� adherence to test results. Methods An observational prospective study was carried out at health centres in four districts, namely Chibombo, Chingola, Chipata, and Choma. Children under the age of five years with history of fever were recruited and the clinicians� use of RDT results was observed to establish whether prescriptions were issued prior to the availability of parasitological results or after, and whether RDT results influenced their prescriptions. Results Of the 2, 393 recruited children, 2, 264 had both RDT and microscopic results. Two in three (68.6%) children were treated with anti-malarials despite negative RDT results and almost half (46.2%) of these were prescribed Coartem�. Only 465 (19.4%) of the 2,393 children were prescribed drugs before receiving laboratory results. A total of 76.5% children were prescribed drugs after laboratory results. Children with RDT positive results were 2.66 (95% CI (2.00, 3.55)) times more likely to be prescribed anti-malarial drugs. Children who presented with fever at admission (although history of fever or presence of fever at admission was an entry criterion) were 42% less likely to be prescribed an anti-malarial drug compared to children who had no fever (AOR?=?0.58; 95% CI (0.52, 0.65)). It was noted that proportions of children who were RDT- and microscopy-positive significantly declined over the years from 2005 to 2008. Conclusions RDTs may contribute to treatment of febrile illness by confirming malaria cases from non-malaria cases in children under the age of five. However, the adherence of the health workers to prescribing anti-malarials to only RDT-positive cases at health facility level will still require to be explored further as their role is crucial in more precise reporting of malaria cases in this era towards malaria elimination as the target.
Pre-amplification methods for tracking low-grade Plasmodium falciparum populations during scaled-up interventions in Southern Zambia
Background Malaria is receding in many endemic countries with intervention scale -up against the disease. However, this resilient scourge may persist in low-grade submicroscopic infections among semi-immune members of the population, and be poised for possible resurgence, creating challenges for detection and assessment of intervention impact. Parasite genotyping methods, such as the molecular barcode, can identify specific malaria parasite types being transmitted and allow tracking and evaluation of parasite population structure changes as interventions are applied. This current study demonstrates application of pre-amplification methods for successful detection and genotyping of residual Plasmodium falciparum infections during a dramatic malarial decline. Methods The study was a prospective cross-sectional design and based on a 2,000�sq km vicinity of Macha Mission Hospital in southern Zambia. Willing and predominantly asymptomatic residents of all ages were screened for malaria by microscopy during the 2005 and 2008 transmission seasons, with simultaneous collection of dried blood spots (DBS) on filter paper, and extraction of Plasmodium falciparum DNA was performed. Plasmodium falciparum infections were genotyped using a 24 SNP-based molecular barcode assay using real-time PCR. Submicroscopic parasitaemia samples were subjected to pre-amplification using TaqMan PreAmp Master Mix following the manufacturer�s instructions before SNP barcode analysis. Results There was a dramatic decline of malaria between 2005 and 2008, and the geometric mean parasite density (95% CI) fell from 704/?L (390�1,271) in 2005 to 39/?L (23�68) in 2008, culminating in a large proportion of submicroscopic infections of which 90% failed to yield ample DNA for standard molecular characterization among 2008 samples. Pre-amplification enabled successful detection and genotyping of 74% of these low-grade reservoir infections, overall, compared to 54% that were detectable before pre-amplification (p <0.0005, n = 84). Furthermore, nine samples negative for parasites by microscopy and standard quantitative PCR amplification were positive after pre-amplification. Conclusions Pre-amplification allows analysis of an otherwise undetectable parasite population and may be instrumental for parasites identification, tracking and assessing the impact of interventions on parasite populations during malaria control and elimination programmes when parasitaemia is expected to decline to submicroscopic levels.
A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia
Objective To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. Methods This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. Results Out of 4?891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2?247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices. Conclusions Malaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.
Chanda-Kapata, Pascalina; Chanda, Emmanuel; Masaninga, Freddie; Habluetzel, Annette; Masiye, Felix; Fall, Ibrahima Soce
Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia123
Background: The effect of breastfeeding on growth in HIV-exposed infants is not well described. Objective: The objective was to evaluate the effect of early breastfeeding cessation on growth. Design: In a trial conducted in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 mo followed by rapid weaning to replacement foods or exclusive breastfeeding for 6 mo followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for-length z score (WLZ) and the self-reported breastfeeding practices of 593 HIV-uninfected singletons were analyzed. Generalized estimating equations were used to adjust for confounders. Results: WAZ scores declined precipitously between 4.5 and 15 mo. The decline was slower in the breastfed infants. At 9, 12, and 15 mo, mean WAZs were, respectively, ?0.74, ?0.92, and ?1.06 in infants who were reportedly breastfed and were ?1.07, ?1.20, and ?1.31 in the weaned infants (P = 0.003, 0.007, and 0.02, respectively). No differences were observed past 15 mo. Breastfeeding practice was not associated with LAZ, which declined from ?0.98 to ?2.24 from 1 to 24 mo. After adjustment for birth weight, maternal viral load, body mass index, education, season, and marital and socioeconomic status, not breastfeeding was associated with a 0.28 decline in WAZ between 4.5 and 15 mo (P < 0.0001). During the rainy season, not breastfeeding was associated with a larger WAZ decline (0.33) than during the dry season (0.22; P for interaction = 0.02). Conclusions: Early growth is compromised in uninfected children born to HIV-infected Zambian mothers. Continued breastfeeding partially mitigates this effect through 15 mo. Nutritional interventions to complement breastfeeding after 6 mo are urgently needed. This trial was registered at clinicaltrials.gov as NCT00310726.
Fawzy, Ashraf; Aldrovandi, Grace M; Kankasa, Chipepo; Sinkala, Moses; Mwiya, Mwiya; Thea, Donald M; Kuhn, Louise
Decline in HIV Prevalence among Young Women in Zambia: National-Level Estimates of Trends Mask Geographical and Socio-Demographic Differences
Background A decline in HIV incidence has been reported in Zambia and a number of other sub-Saharan countries. The trend of HIV prevalence among young people is a good marker of HIV incidence. In this study, different data sources are used to examine geographical and sub-population group differentials in HIV prevalence trends among men and women aged 15�24 years in Zambia. Design and Methods We analysed ANC data for women aged 15�24 years from 22 sentinel sites consistently covered in the period 1994�2008, and HIV data for young men and women aged 15�24 years from the ZDHS 2001/2 and 2007. In addition, we systematically reviewed peer-reviewed articles that have reported findings on HIV prevalence and incidence among young people. Findings Overall trends of the ANC surveillance data indicated a substantial HIV prevalence decline among young women in both urban and rural areas. However, provincial declines differed substantially, i.e. between 10% and 68% among urban women, and from stability to 86% among rural women. Prevalence declines were steeper among those with the highest educational attainments than among the least educated. The ZDHS data indicated a significant reduction in prevalence between the two survey rounds among young women only. Provincial-level ZDHS changes were difficult to assess because the sample sizes were small. ANC-based trend patterns were consistent with those observed in PMTCT-based data (2002�2006), whereas population-based surveys in a selected urban community (1995�2003) suggested that the ANC-based data underestimated the prevalence declines in the general populations of both young both men and women. Conclusion The overall HIV prevalence declined substantially among young women in Zambia and this is interpreted as indicating a decline in HIV incidence. It is noteworthy that overall national trends masked substantial differences by place and by educational attainment, demonstrating critical limitations in the current focus on overall country-level trends in epidemiological reports.
Kayeyi, Nkomba; Fylkesnes, Knut; Michelo, Charles; Makasa, Mpundu; Sand?y, Ingvild
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
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 communities seemed to lack the capacity to hold health workers accountable for the drugs and services. Conclusion The study has shown that building block specific weaknesses had cross cutting effect in other health system building blocks. These linkages emphasised the need to use system wide approaches in assessing the performance of health system strengthening interventions.
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
Background Zambia�s fertility rate and unmet need for family planning are still high. This is in spite of the progress reported from 1992 to 2007 of the increase in contraceptive prevalence rate from 15% to 41% and use of modern methods of family planning from 9% to 33%. However, partner disapproval of family planning has been cited by many women in many countries including Zambia. Given the effectiveness of long-acting and permanent methods of family planning (ILAPMs) in fertility regulation, this paper sought to examine the relationship between contraceptive decision-making and use of ILAPMs among married women in Zambia. Methods This paper uses data from the 2007 Zambia Demographic and Health Survey. The analysis is based on married women (15�49) who reported using a method of family planning at the time of the survey. Out of the 7,146 women interviewed, only 1,630 women were valid for this analysis. Cross-tabulations and binary logistic regressions with Chi-square were used to analyse associations and the predictors of use of ILAPMs of contraception, respectively. A confidence interval of .95 was used in determining relationships between independent and dependent variables. Results Two thirds of women made joint decisions regarding contraception and 29% of the women were using ILAPMs. Women who made joint contraceptive decisions are significantly more likely to use ILAPMs than women who did not involve their husband in contraceptive decisions. However, the most significant predictor is the wealth index. Women from rich households are more likely to use ILAPMs than women from medium rich and poor households. Results also show that women of North Western ethnicities and those from Region 3 had higher odds of using ILAPMs than Tonga women and women from Region 2, respectively. Conclusion Joint contraceptive decision-making between spouses is key to use of ILAPMs in Zambia. Our findings have also shown that the wealth index is actually the strongest factor determining use of these methods. As such, family planning programmes directed at increasing use of LAPMs ought to not only encourage spousal communication but should also consider rolling out interventions that incorporate economic empowerment.
Diagnosis of Schistosoma mansoni without the Stool: Comparison of Three Diagnostic Tests to Detect Schiostosoma mansoni Infection from Filtered Urine in Zambia
Diagnosis for intestinal Schistosoma mansoni lacks sensitivity and is arduous to conduct. The standard diagnostic tests, Kato-Katz (KK) and circulating cathodic antigen (CCA) both lack sensitivity and with KK, require obtaining, transporting, and examining fresh stool. We compared diagnostic efficacy of KK, CCA, and polymerase chain reaction (PCR) to detect S. mansoni infection (species-specific DNA) from 89 filtered urine samples collected in Zambia. The PCR was the strongest indicator of positive cases with sensitivity and specificity of 100% in comparison to CCA (67% and 60%) and KK (50% and 100%). High positive and negative predictive values (100%) were also indicative of robustness of PCR. The same pattern was observed when stratified for sex and age group-specific analysis. Diagnosis of S. mansoni from filtered urine samples by PCR is an effective means to detect low intensity infection and would enhance the effectiveness of surveillance and control programs of schistosomiasis.
Lodh, Nilanjan; Mwansa, James C. L.; Mutengo, Mable M.; Shiff, Clive J.
Using a discrete choice experiment to elicit the demand for a nutritious food: willingness-to-pay for orange maize in rural Zambia.
Using a discrete choice experiment, this paper estimates the willingness to pay for biofortified orange maize in rural Zambia. The study design has five treatment arms, which enable an analysis of the impact of nutrition information, comparing the use of simulated radio versus community leaders in transmitting the nutrition message, on willingness to pay, and to account for possible novelty effects in the magnitude of premiums or discounts. The estimation strategy also takes into account lexicographic preferences of a subset of our respondents. The results suggest that (a) orange maize is not confused with yellow maize, and has the potential to compete with white maize in the absence of a nutrition campaign, (b) there is a premium for orange maize with nutrition information, and (c) different modes of nutritional message dissemination have the same impact on consumer acceptance. PMID:22317960
Meenakshi, J V; Banerji, A; Manyong, Victor; Tomlins, Keith; Mittal, Nitya; Hamukwala, Priscilla
Diagnosis of Schistosoma mansoni without the stool: comparison of three diagnostic tests to detect Schistosoma [corrected] mansoni infection from filtered urine in Zambia.
Diagnosis for intestinal Schistosoma mansoni lacks sensitivity and is arduous to conduct. The standard diagnostic tests, Kato-Katz (KK) and circulating cathodic antigen (CCA) both lack sensitivity and with KK, require obtaining, transporting, and examining fresh stool. We compared diagnostic efficacy of KK, CCA, and polymerase chain reaction (PCR) to detect S. mansoni infection (species-specific DNA) from 89 filtered urine samples collected in Zambia. The PCR was the strongest indicator of positive cases with sensitivity and specificity of 100% in comparison to CCA (67% and 60%) and KK (50% and 100%). High positive and negative predictive values (100%) were also indicative of robustness of PCR. The same pattern was observed when stratified for sex and age group-specific analysis. Diagnosis of S. mansoni from filtered urine samples by PCR is an effective means to detect low intensity infection and would enhance the effectiveness of surveillance and control programs of schistosomiasis. PMID:23716406
Lodh, Nilanjan; Mwansa, James C L; Mutengo, Mable M; Shiff, Clive J
Hospitalizations and costs incurred at the facility level after scale-up of malaria control: pre-post comparisons from two hospitals in Zambia.
There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with < 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions. PMID:24218409
Comfort, Alison B; van Dijk, Janneke H; Mharakurwa, Sungano; Stillman, Kathryn; Gabert, Rose; Korde, Sonali; Nachbar, Nancy; Derriennic, Yann; Musau, Stephen; Hamazakaza, Petan; Zyambo, Khozya D; Zyongwe, Nancy M; Hamainza, Busiku; Thuma, Philip E
Control of aquatic weeds through pollutant reduction and weed utilization: a weed management approach in the lower Kafue River of Zambia
NASA Astrophysics Data System (ADS)
The aquatic weed situation in the Kafue River in Zambia continues to be a major challenge to the sustainable utilization of the water resources of the river. The general methods for managing the weeds, especially the water hyacinth, include use of bio-agents, chemicals, mechanical and physical approaches. These have had very little impact. This paper reports on a project that is investigating weed management strategies which involve use of cleaner production (CP) approach and the utilization of the weed for economic purposes. In addition, the ecological implications of these methods are being assessed. Effluent assessments indicated that apart from nitrates and phosphates, other effluent parameters met the Environmental Council of Zambia standards. Results further show that all the 24 areas surveyed for CP have uncontrolled socio-economic activities which generate both point and non-point sources of pollution that enter the water bodies. To minimize pollution, efforts include devising policy and technical strategies with the involvement of the affected riparian community. Production of mushroom by the communities using the water hyacinth substrate has been demonstrated. Up to 2.1 kg of mushroom was harvested from a single flush over a period of 4-5 weeks. Vegetables grown on soils treated with water hyacinth manure performed better than those grown using commercial fertiliser. The economics of the production are however, yet to be confirmed. If weed usage is proven economically and ecologically viable, the riverine community is envisaged to play a big role in aquatic weed management. High numbers of invertebrates known to be sensitive to pollution have been recorded in the weed-infested Kafue River implying that the water is of �good� quality for these aquatic invertebrates. This observed quality of water may be due to water hyacinth playing a role by sieving pollutants from the river.
Sinkala, Thomson; Mwase, Enala T.; Mwala, Mick
Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia
Background It is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of antenatal (ANC) and post-natal care (PNC) and post-partum modern contraceptives. Methods Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008�09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman�s adoption of modern contraceptives after a recent live birth. Results Tests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice. Conclusions While the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice.
The (Mis)Reporting of Male Circumcision Status among Men and Women in Zambia and Swaziland: A Randomized Evaluation of Interview Methods
Background To date, male circumcision prevalence has been estimated using surveys of men self-reporting their circumcision status. HIV prevention trials and observational studies involving female participants also collect data on partners' circumcision status as a risk factor for HIV/STIs. A number of studies indicate that reports of circumcision status may be inaccurate. This study assessed different methods for improving self- and partner reporting of circumcision status. Methods/Findings The study was conducted in urban and rural Zambia and urban Swaziland. Men (N?=?1264) aged 18�50 and their female partners (N?=?1264), and boys (N?=?840) aged 13�17 were enrolled. Participants were recruited from HIV counseling and testing sites, health centers, and surrounding communities. The study experimentally assessed methods for improving the reporting of circumcision status, including: a) a simple description of circumcision, b) a detailed description of circumcision, c) an illustration of a circumcised and uncircumcised penis, and d) computerized self-interviewing. Self-reports were compared to visual examination. For men, the error in reporting was largely unidirectional: uncircumcised men more often reported they were circumcised (2�7%), depending on setting. Fewer circumcised men misrepresented their status (0.05�5%). Misreporting by women was significantly higher (11�15%), with the error in both directions. A sizable number of women reported that they did not know their partner's circumcision status (3�8%). Computerized interviewing did not improve accuracy. Providing an illustration, particularly for illiterate participants, significantly improved reporting of circumcision status, decreasing misreporting among illiterate participants from 13% to 10%, although misreporting was not eliminated. Conclusions Study results suggest that the prevalence of circumcision may be overestimated in Zambia and Swaziland; the error in reporting is higher among women than among men. Improved reporting when a description or illustration is provided suggests that the source of the error is a lack of understanding of male circumcision.
Hewett, Paul C.; Haberland, Nicole; Apicella, Lou; Mensch, Barbara S.
Adherence Support Workers: A Way to Address Human Resource Constraints in Antiretroviral Treatment Programs in the Public Health Setting in Zambia
Background In order to address staff shortages and improve adherence counseling for people on antiretroviral therapy (ART), the Zambia Prevention, Care and Treatment Partnership (ZPCT) developed an innovative strategy of training community volunteers to provide adherence support at the health facility and community levels. The objective of this study was to assess the effectiveness of these �adherence support workers� (ASWs) in adherence counseling, treatment retention and addressing inadequate human resources at health facilities. Methodology/Principal Findings The study used quantitative and qualitative research techniques at five selected ART sites in four provinces in Zambia. Five hundred patients on ART were interviewed using a structured questionnaire to compare the quality of adherence counseling before and after the ASW scheme was introduced at the selected sites and between ASWs and HCWs after the introduction of ASWs. In addition, 3,903 and 4,972 electronic records of all new patients accessing antiretroviral therapy for the time period of 12 months before and 12 months after the introduction of ASWs respectively, were analyzed to assess loss to follow-up rates. Two focus group discussions with ASWs and health care workers (HCWs) were conducted in each clinic. Key informant interviews in the ART clinics were also conducted. There was a marked shift of workload from HCWs to ASWs without any compromise in the quality of counseling. Quality of adherence counseling by ASWs was comparable to HCWs after their introduction. The findings suggest that the deployment of ASWs helped reduce waiting times for adherence counseling. Loss to follow-up rates of new clients declined from 15% to 0% after the deployment of ASWs. Conclusion Adherence counseling tasks can be shifted to lay cadres like ASWs without compromising the quality of counseling. Follow-up of clients by ASWs within the community is necessary to improve retention of clients on ART.
Torpey, Kwasi E.; Kabaso, Mushota E.; Mutale, Liya N.; Kamanga, Mpuma K.; Mwango, Albert J.; Simpungwe, James; Suzuki, Chiho; Mukadi, Ya Diul
The impact of natural infestations of ticks in Zambia on the productivity of cattle and implications for tick control strategies in central Africa.
Studies were carried out in Zambia using a farming systems approach to quantify the effects of tick control on traditionally managed Sanga cattle. In the first trial to investigate the effect of tick control, significant improvements in liveweight gain (LWG) occurred only in periods of medium to high challenge with adult Amblyomma variegatum. However, during the first 18 months of the study when animals were young, the acaricide used caused a suppression in weight gains. A supplementary experimental study indicated that the adverse effects of ticks on weight gain may be delayed when animals are on a low plane of nutrition. In both studies on the effects of ticks on LWG, estimates of weight loss per female A. variegatum were in the range of 46 to 69 g. In the second long term trial to measure the impact of tick control on overall heard productivity, outputs of milk and weaner calf per livestock unit carrying capacity were about 25% higher in a tick-free herd. The annual cost of control in 1988 at ZK286.26/livestock unit was greater than the increase in value of the products at ZK175.48/livestock unit carrying capacity. It is concluded from these studies that intensive tick control in the multipurpose livestock system in Zambia is not justified in the absence of serious tick-borne disease. However, strategic seasonal tick control of adult ticks from November to April would probably be economically viable. Calves should not be treated until they are 3 months of age. PMID:2126618
Pegram, R G; Chizyuka, H G
Does knowledge about antiretroviral therapy and mother-to-child transmission affect the relationships between hiv status and fertility preferences and contraceptive use? New evidence from Nigeria and zambia.
Summary The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media. PMID:24331375
Bankole, Akinrinola; Biddlecom, Ann E; Dzekedzeke, Kumbutso; Akinyemi, Joshua O; Awolude, Olutosin; Adewole, Isaac F
National policy development for cotrimoxazole prophylaxis in Malawi, Uganda and Zambia: the relationship between Context, Evidence and Links
Background Several frameworks have been constructed to analyse the factors which influence and shape the uptake of evidence into policy processes in resource poor settings, yet empirical analyses of health policy making in these settings are relatively rare. National policy making for cotrimoxazole (trimethoprim-sulfamethoxazole) preventive therapy in developing countries offers a pertinent case for the application of a policy analysis lens. The provision of cotrimoxazole as a prophylaxis is an inexpensive and highly efficacious preventative intervention in HIV infected individuals, reducing both morbidity and mortality among adults and children with HIV/AIDS, yet evidence suggests that it has not been quickly or evenly scaled-up in resource poor settings. Methods Comparative analysis was conducted in Malawi, Uganda and Zambia, using the case study approach. We applied the �RAPID� framework developed by the Overseas Development Institute (ODI), and conducted a total of 47 in-depth interviews across the three countries to examine the influence of context (including the influence of donor agencies), evidence (both local and international), and the links between researcher, policy makers and those seeking to influence the policy process. Results Each area of analysis was found to have an influence on the creation of national policy on cotrimoxazole preventive therapy (CPT) in all three countries. In relation to context, the following were found to be influential: government structures and their focus, donor interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, we found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Further, local operational research results seem to have been taken up more quickly, while randomised controlled trials (the gold standard of clinical research) was not necessarily translated into policy so swiftly. Finally the links between different research and policy actors were of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get cotrimoxazole preventive therapy onto the policy agenda. Conclusions This analysis underscores the importance of considering national level variables in the explanation of the uptake of evidence into national policy settings, and recognising how local policy makers interpret international evidence. Local priorities, the ways in which evidence was interpreted, and the nature of the links between policy makers and researchers could either drive or stall the policy process. Developing the understanding of these processes enables the explanation of the use (or non-use) of evidence in policy making, and potentially may help to shape future strategies to bridge the research-policy gaps and ultimately improve the uptake of evidence in decision making.
Solar Irradiation over Zambia.
National Technical Information Service (NTIS)
Angstroem-Page linear regression equation between global irradiation and sunshine duration is fitted for five Zambian locations for which the direct measured values of the global irradiation exist. Excellent correlation is found to exist for all the five ...
P. C. Jain
Taking ART to Scale: Determinants of the Cost and Cost-Effectiveness of Antiretroviral Therapy in 45 Clinical Sites in Zambia
Background We estimated the unit costs and cost-effectiveness of a government ART program in 45 sites in Zambia supported by the Centre for Infectious Disease Research Zambia (CIDRZ). Methods We estimated per person-year costs at the facility level, and support costs incurred above the facility level and used multiple regression to estimate variation in these costs. To estimate ART effectiveness, we compared mortality in this Zambian population to that of a cohort of rural Ugandan HIV patients receiving co-trimoxazole (CTX) prophylaxis. We used micro-costing techniques to estimate incremental unit costs, and calculated cost-effectiveness ratios with a computer model which projected results to 10 years. Results The program cost $69.7 million for 125,436 person-years of ART, or $556 per ART-year. Compared to CTX prophylaxis alone, the program averted 33.3 deaths or 244.5 disability adjusted life-years (DALYs) per 100 person-years of ART. In the base-case analysis, the net cost per DALY averted was $833 compared to CTX alone. More than two-thirds of the variation in average incremental total and on-site cost per patient-year of treatment is explained by eight determinants, including the complexity of the patient-case load, the degree of adherence among the patients, and institutional characteristics including, experience, scale, scope, setting and sector. Conclusions and Significance The 45 sites exhibited substantial variation in unit costs and cost-effectiveness and are in the mid-range of cost-effectiveness when compared to other ART programs studied in southern Africa. Early treatment initiation, large scale, and hospital setting, are associated with statistically significantly lower costs, while others (rural location, private sector) are associated with shifting cost from on- to off-site. This study shows that ART programs can be significantly less costly or more cost-effective when they exploit economies of scale and scope, and initiate patients at higher CD4 counts.
Marseille, Elliot; Giganti, Mark J.; Mwango, Albert; Chisembele-Taylor, Angela; Mulenga, Lloyd; Over, Mead; Kahn, James G.; Stringer, Jeffrey S. A.
Co-operation in veterinary education between sub-Saharan Africa and the developed countries: experience of the University of Zambia.
As is the case with many other veterinary schools in sub-Saharan Africa, the development of the University of Zambia (UNZA) Veterinary School has been supported largely by aid from the developed countries in the form of general expenditure grants, staff training scholarships and technical assistance. The three major pillars of the policies which have governed interactions between UNZA and donors have been bilateralism, "projectisation" (the supplying of aid within the framework of specific projects) and donor management of aid. These have been blended according to the resources endowed by the donors and the negotiating position of UNZA. The authors discuss the effect of the consequent diverse policies on the development of the UNZA school. It is recognised that high dependence on donors by veterinary schools in sub-Saharan Africa will continue in the future. However, the emerging political and economic integration in the sub-region and in the developed countries, as well as the trend towards early specialisation in the veterinary profession in the developed countries at a time when countries in sub-Saharan Africa still require generalists, will mean that co-operation within a bilateral framework will become less desirable. It is therefore recommended that veterinary schools in sub-Saharan Africa evolve mechanisms for collective aid negotiations and utilisation of aid. Conversely, co-operation between donors in multi-donor supported schools will be essential to minimise rigidity in projects, which tends to undermine the cohesion of multi-donor funded schools. PMID:8219325
Kisauzi, D N; Tsutsumi, Y; Mlangwa, J E
Antimicrobial resistance in human and animal pathogens in Zambia, Democratic Republic of Congo, Mozambique and Tanzania: an urgent need of a sustainable surveillance system
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.
Nutritional status of breastfed infants in rural Zambia: comparison of the National Center for Health Statistics growth reference versus the WHO 12-month breastfed pooled data set.
Cross-sectional data for breastfed infants in rural Zambia were used to evaluate the effect of applying two different data sets as a reference, i.e. the WHO 12-month breastfed pooled data set and the National Center for Health Statistics (NCHS) growth reference in terms of prevalence of malnutrition (stunting, underweight, and wasting). A total of 518 infants who were attending mother-and-child health clinics were included. Age, weight and length were recorded. Anthropometric Z-scores were calculated in two ways: by applying the NCHS growth reference and by using the WHO breastfed data set. Anthropometric Z-scores calculated using the breastfed data set were lower during the first 6-7 months of life compared with those calculated by applying the NCHS growth reference. This resulted in a higher proportion of children aged 0-6 months being classified as stunted and underweight using the breastfed data set versus the NCHS growth reference. After the age of 7 months, similar prevalences of stunting or underweight were observed. Relatively few infants were classified as wasted. In order to adequately assess the prevalence of stunting and underweight in breastfed infants, it is recommended that a new growth reference be developed, as has been initiated by WHO.
Hautvast, J. L.; Pandor, A.; Burema, J.; Tolboom, J. J.; Chishimba, N.; Monnens, L. A.; van Staveren, W. A.
Risk factors associated with bovine tuberculosis in traditional cattle of the livestock/wildlife interface areas in the Kafue basin of Zambia.
We conducted a cross-sectional study from August 2003 to February 2004 to identify risk factors for bovine tuberculosis (BTB) in the Kafue basin of Zambia. We investigated a total of 106 herds of cattle for presence of BTB using the comparative intradermal tuberculin test (CITT) while an interviewer-administered questionnaire was used to gather epidemiological data on herd structure, management and grazing strategies. BTB prevalence at herd level was estimated and possible risk factors were investigated using the multiple logistic regression model. The true herd level prevalence of BTB was estimated at 49.8% (95% CI: 37.9, 61.7%). The logistic regression model showed that cattle herd BTB status was highly associated with area and husbandry practices. When compared to Kazungula, cattle herds in Blue Lagoon were more likely to test positive for BTB when other factors such as management practices were controlled (OR=10.5). In terms of grazing strategies, transhumant herds (TH) had higher odds (OR=3.0) of being positive compared to sedentary herds (OR=1.0). The results in this study provide preliminary information about potential risk factors that were found to be associated with BTB status in cattle. PMID:18455816
Munyeme, M; Muma, J B; Skjerve, E; Nambota, A M; Phiri, I G K; Samui, K L; Dorny, P; Tryland, M
Prevalence of bovine tuberculosis and animal level risk factors for indigenous cattle under different grazing strategies in the livestock/wildlife interface areas of Zambia.
A cross-sectional study was conducted to investigate the prevalence and animal level risk factors for bovine tuberculosis (BTB) in indigenous cattle of the livestock/wildlife interface areas in Zambia. A total of 944 cattle from 111 herds were investigated. The comparative intradermal tuberculin test (CIDT) was used to identify reactor animals for BTB. Animal level data on sex, age, parity and body condition score were registered. The overall animal prevalence of BTB as determined by the CIDT was 6.8% (95% CI: 4.2, 9.5%). In Lochinvar and Blue Lagoon areas, animal level prevalence were observed at 5.2% (95% CI: 2.2, 8.2%) and 9.6% (95% CI: 6.1, 13.2%), respectively. Kazungula, an area outside the livestock/wildlife interface, had a prevalence of only 0.8% (95% CI: 0.0, 2.3%). The age of the animal, its body condition score and the type of management system, were predictive of its BTB status. The study revealed that BTB was relatively high in the livestock/wildlife interface areas of Lochinvar and Blue Lagoon compared to Kazungula. These findings should raise a serious public health concern considering the extent to which the communities of the study areas are in contact with their animals and the levels at which they use untreated milk. PMID:18536998
Munyeme, M; Muma, J B; Samui, K L; Skjerve, E; Nambota, A M; Phiri, I G K; Rigouts, L; Tryland, M
Metal and metalloid levels and bio-accumulation characteristics in soil, sediment, land plants and hippopotami (Hippopotamus amphibius L) from the South Luangwa National Park, Zambia.
Hippopotami (Hippopotamus amphibius L) are large semi-aquatic mammals that can be exposed to metals and metalloid from both terrestrial and aquatic environments. Therefore, knowledge of metal and metalloid accumulation characteristics in hippopotami living in the national park is important from ecotoxicological point of view. Levels of toxic metals (Cd, Pb and Hg) and metalloid (As) in hippopotami liver from the South Luangwa National Park in Zambia were far lower compared to the established values of toxic levels in cattle. No temporal variations of metal levels in hippopotami were observed, probably because of good management condition and the lack of anthropogenic activities around the national park. However, hippopotami liver accumulated significantly higher concentrations of Hg compared to soil, sediment and their food (plants), most likely due to a process of biomagnification throughout a trophic chain. Moreover, hippopotami liver and land plants showed significantly higher Cd levels than those of soil. These results strongly suggest that hippopotami liver accumulate higher levels of these metals if surrounding environment is contaminated. Levels of Cr and Ni in hippopotami liver were higher compared to other toxic metals. Since this is the first report to show the Cr and Ni levels and bio-accumulation characteristics of Hg and Cd in hippopotami, we concluded that continuous monitoring and evaluation of toxic effects of these metals on hippopotami should be conducted. PMID:22521811
Nakayama, Shouta M M; Ikenaka, Yoshinori; Muzandu, Kaampwe; Choongo, Kennedy; M'kandawire, Ethel; Yasuda, Jun; Ishizuka, Mayumi
Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV positive couples in Lusaka, Zambia
Objectives To evaluate the impact of family planning promotion on incident pregnancy in a combined effort to address Prongs 1 and 2 of Prevention of Mother-to-Child Transmission of HIV. Design We conducted a factorial randomized controlled trial of two video-based interventions. Methods �Methods-focused� and �Motivational� messages promoted long-term contraceptive use among 1060 couples with HIV in Lusaka, Zambia. Results Among couples not using contraception prior to randomization (N=782), the video interventions had no impact on incident pregnancy. Among baseline contraceptive users, viewing the �Methods� video which focused on the IUD and contraceptive implant was associated with a significantly lower pregnancy incidence (HR=0.38; 95%CI:0.19�0.75) relative to those viewing control and/or motivational videos. The effect was strongest in concordant positive couples (HR=0.22; 95%CI:0.08�0.58) and couples with HIV+ women (HR=0.23; 95%CI:0.09�0.55). Conclusions The �Methods video� intervention was previously shown to increase uptake of longer-acting contraception and to prompt a shift from daily oral contraceptives to quarterly injectables and long-acting methods such as the IUD and implant. Follow-up confirms sustained intervention impact on pregnancy incidence among baseline contraceptive users, in particular couples with HIV positive women. Further work is needed to identify effective interventions to promote long-acting contraception among couples who have not yet adopted modern methods.
Wall, Kristin M; Vwalika, Bellington; Haddad, Lisa; Htee Khu, Naw; Vwalika, Cheswa; Kilembe, William; Chomba, Elwyn; Stephenson, Rob; Kleinbaum, David; Nizam, Azhar; Brill, Ilene; Tichacek, Amanda; Allen, Susan
Drinking Water Quality, Feeding Practices, and Diarrhea among Children under 2 Years of HIV-Positive Mothers in Peri-Urban Zambia
In low-income settings, human immunodeficiency virus (HIV)-positive mothers must choose between breastfeeding their infants and risking transmission of HIV or replacement feeding their infants and risking diarrheal disease from contaminated water. We conducted a cross-sectional study of children < 2 years of age of 254 HIV-positive mothers in peri-urban Zambia to assess their exposure to waterborne fecal contamination. Fecal indicators were found in 70% of household drinking water samples. In a multivariable analysis, factors associated with diarrhea prevalence in children < 2 years were mother having diarrhea (adjusted odds ratio [aOR] = 5.18, 95% confidence interval [CI] = 1.65�16.28), child given water in the past 2 days (aOR = 4.08, 95% CI = 1.07�15.52), child never being breastfed (aOR = 2.67, 95% CI = 1.06�6.72), and rainy (versus dry) season (aOR = 4.60, 95% CI = 1.29�16.42). Children born to HIV-positive mothers were exposed to contaminated water through direct intake of drinking water, indicating the need for interventions to ensure microbiological water quality.
Peletz, Rachel; Simuyandi, Michelo; Sarenje, Kelvin; Baisley, Kathy; Kelly, Paul; Filteau, Suzanne; Clasen, Thomas
Moving beyond the "male perpetrator, female victim" discourse in addressing sex and relationships for HIV prevention: peer research in Eastern Zambia.
Despite the resources put into HIV education programmes with young people in sub-Saharan Africa in the past two decades, there is little clear evidence of impact. Many programmes continue to be oriented towards individual behaviour change (and in reality, often sexual abstinence) with insufficient focus on understanding how societies constrain or enable individual agency in sexual decision-making and how this is affected by social norms. If education programmes do address gender they often reinforce a "male perpetrator, female victim" discourse, where girls and women are held responsible for boys' and men's sexuality as well as their own. This paper discusses the discourses around gender, sexuality and HIV constructed by young women and men (aged 16-29) in a rural Eastern Zambia village. Data on young women's and men's narratives were gathered using a participatory peer approach. Research uncovered numerous and sometimes conflicting discourses (cultural, moral, economic, and sexual) influencing young women's and men's thinking about sexuality and sexual behaviour, in particular the limited possibilities for safe consensual sex, and thus their vulnerability to HIV. The research suggests that the realities young people face are much more complex than HIV prevention strategies address. We recommend a more nuanced approach, tailored to the community contexts involved. PMID:23684205
Heslop, Jo; Banda, Rabecca
The Nexus between Bovine Tuberculosis and Fasciolosis Infections in Cattle of the Kafue Basin Ecosystem in Zambia: Implications on Abattoir Surveillance.
Bovine tuberculosis (bTB) and fasciolosis are important but neglected diseases that result in chronic infections in cattle. However, in Zambia, these diseases are mainly diagnosed at abattoirs during routine meat inspection. Albeit the coinfection status, these diseases have been reported as nothing more than normal separate findings without an explanatory phenomena. Forthwith, we formulated this study to assess the possible association of the two diseases in a known high prevalence area on the Kafue basin ecosystem. Of the 1,680 animals screened, 600 (35.7%; 95% CI 33.4%-38%) and 124 (7.4%; 95% CI 6.1%-8.6%) had fasciolosis and tuberculous lesions; respectively, whilst 72 had both fasciola and tuberculous lesions representing 12% (95% CI 9.4%-14.6%) and 58.1% (95% CI; 49.3%-66.7%) of the total positives for fasciola and tuberculosis, respectively. Jaundice was seen in 304 animals, 18.1% (95% CI; 16.3%-19.9%) and was significantly correlated to fasciolosis (r = 0.59, P < 0.0001). A significant association (?(2) = 76.2, df = 1, and P < 0.0001) was found between fasciolosis and tuberculous lesions. Simple logistic regression intimated fasciolosis as a strong predictor for tuberculous lesions with animals that had fasciola being five times more likely to have tuberculous lesions (odds ratio = 4.8, 95% CI: 3.3-7.0). This study indicates that transmission and spatial risk factors of communicable and noncommunicable diseases such as bTB and fasciolosis can be correlated in an ecosystem such as the Kafue flats. PMID:23213629
Munyeme, Musso; Munang'andu, Hetron Mweemba; Nambota, Andrew; Muma, John Bwalya; Phiri, Andrew Malata; Nalubamba, King Shimumbo
Human exposure to anopheline mosquitoes occurs primarily indoors, even for users of insecticide-treated nets in Luangwa Valley, South-east Zambia
Background Current front line malaria vector control methods such as indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs), rely upon the preference of many primary vectors to feed and/or rest inside human habitations where they can be targeted with domestically-applied insecticidal products. We studied the human biting behaviour of the malaria vector Anopheles funestus Giles and the potential malaria vector Anopheles quadriannulatus Theobald in Luangwa valley, south-east Zambia. Methods Mosquitoes were collected by human landing catch in blocks of houses with either combined use of deltamethrin-based IRS and LLINs or LLINs alone. Human behaviour data were collected to estimate how much exposure to mosquito bites indoors and outdoors occurred at various times of the night for LLIN users and non-users. Results Anopheles funestus and An. quadriannulatus did not show preference to bite either indoors or outdoors: the proportions [95% confidence interval] caught indoors were 0.586 [0.303, 0.821] and 0.624 [0.324, 0.852], respectively. However, the overwhelming majority of both species were caught at times when most people are indoors. The proportion of mosquitoes caught at a time when most people are indoors were 0.981 [0.881, 0.997] and 0.897 [0.731, 0.965], respectively, so the proportion of human exposure to both species occuring indoors was high for individuals lacking LLINs (An. funestus: 0.983 and An. quadriannulatus: 0.970, respectively). While LLIN users were better protected, more than half of their exposure was nevertheless estimated to occur indoors (An. funestus: 0.570 and An. quadriannulatus: 0.584). Conclusions The proportion of human exposure to both An. funestus and An. quadriannulatus occuring indoors was high in the area and hence both species might be responsive to further peri-domestic measures if these mosquitoes are susceptible to insecticidal products.
Association between early childhood exposure to malaria and children's pre-school development: evidence from the Zambia early childhood development project
Background Despite major progress made over the past 10?years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development. Methods The objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures. Results No statistically significant associations were found between parasite exposure and children�s height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference ?1.11, 95% CI ?2.43�0.20), as well as decreased overall socio-emotional development as assessed by parents (z-score difference ?1.55, 95% CI ?3.13�0.02). No associations were found between malaria exposure and receptive vocabulary or fine-motor skills. Conclusions The results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.
Can combination prevention strategies reduce HIV transmission in generalized epidemic settings in Africa? The HPTN 071 (PopART) study plan in South Africa and Zambia.
The HIV Prevention Trials Network (HPTN) is conducting the HPTN 071 (PopART) study in 21 communities in Zambia and South Africa with support from a consortium of funders. HPTN 071 (PopART) is a community-randomized trial of a combination prevention strategy to reduce HIV incidence in the context of the generalized epidemic of southern Africa. The full PopART intervention strategy is anchored in home-based HIV testing and facilitated linkage of HIV-infected persons to care through community health workers and universal antiretroviral therapy for seropositive persons regardless of CD4+ cell count or HIV viral load. To further reduce the risk of HIV acquisition among uninfected individuals, the study aims to expand voluntary medical male circumcision, diagnosis and treatment of sexually transmitted infections, behavioral counseling, and condom distribution. The full PopART intervention strategy also incorporates promotion of other interventions designed to reduce HIV and tuberculosis transmission, including optimization of the prevention of mother-to-child HIV transmission and enhanced individual and public health tuberculosis services. Success for the PopART strategy depends on the ability to increase coverage for the study interventions whose uptake is a necessary antecedent to a prevention effect. Processes will be measured to assess the degree of penetration of the interventions into the communities. A randomly sampled population cohort from each community will be used to measure the impact of the PopART strategy on HIV incidence over 3 years. We describe the strategy being tested and progress to date in the HPTN 071 (PopART) study. PMID:23764639
Vermund, Sten H; Fidler, Sarah J; Ayles, Helen; Beyers, Nulda; Hayes, Richard J
Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia
Background There has been limited research to date on the effects of food assistance provided to HIV-infected adults in resource-constrained settings with a high prevalence of malnutrition and chronic food insecurity. We compare antiretroviral therapy (ART) adherence, weight gain, and CD4+ lymphocyte count change among HIV-infected adults enrolled in a clinic-based food assistance program in Lusaka, Zambia versus a control group of non-recipients. Methods We conducted a cohort study incorporating interviewer-administered surveys and retrospective clinical data to compare ART patients receiving food assistance with a control group of non-recipients. Medication adherence was assessed using pharmacy dispensation records. We use propensity score matching to assess the effect of food assistance on outcome measures. Results After 6 months, food assistance recipients (n=145) had higher ART adherence compared to non-recipients (n=147, 98.3% versus 88.8%, respectively; p<0.01), but no significant effects were observed for weight or CD4+ lymphocyte count change. The improvement in adherence rates was greater for participants on ART for less than 230 days, and those with BMI<18.5 kg/m2, a higher HIV disease stage, or a CD4+ lymphocyte count ? 350 cells/?l. Conclusions Promoting optimal medication adherence among persons on ART is relevant to public health and the success of HIV control efforts. The provision of food assistance to HIV-infected adults on ART may have an incentivizing effect which can improve medication adherence, particularly among patients recently initiated on treatment and those with poor nutrition or advanced disease. The effects on body weight and immune reconstitution appear minimal.
Tirivayi, Nyasha; Koethe, John R; Groot, Wim
Efficiency of Household Reactive Case Detection for Malaria in Rural Southern Zambia: Simulations Based on Cross-Sectional Surveys from Two Epidemiological Settings
Background Case detection and treatment are critical to malaria control and elimination as infected individuals who do not seek medical care can serve as persistent reservoirs for transmission. Methods Household malaria surveys were conducted in two study areas within Southern Province, Zambia in 2007 and 2008. 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 a questionnaire and a blood sample was obtained for a rapid diagnostic test (RDT) for malaria. These data were used to estimate the proportions of individuals with malaria potentially identified through passive case detection at health care facilities and those potentially identified through reactive case finding. Simulations were performed to extrapolate data from sampled to non-sampled households. Radii of increasing size surrounding households with an index case were examined to determine the proportion of households with an infected individual that would be identified through reactive case detection. Results In the 2007 high transmission setting, with a parasite prevalence of 23%, screening neighboring households within 500 meters of an index case could have identified 89% of all households with an RDT positive resident and 90% of all RDT positive individuals. In the 2008 low transmission setting, with a parasite prevalence of 8%, screening neighboring households within 500 meters of a household with an index case could have identified 77% of all households with an RDT positive resident and 76% of all RDT positive individuals. Conclusions Testing and treating individuals residing within a defined radius from an index case has the potential to be an effective strategy to identify and treat a large proportion of infected individuals who do not seek medical care, although the efficiency of this strategy is likely to decrease with declining parasite prevalence.
Searle, Kelly M.; Shields, Timothy; Hamapumbu, Harry; Kobayashi, Tamaki; Mharakurwa, Sungano; Thuma, Philip E.; Smith, David L.; Glass, Gregory; Moss, William J.
Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia
Background High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. Methods We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (?95%), suboptimal (80�94%) and poor (<80%). Results Overall, 27 115 treatment-na�ve adults initiated and continued ART for ?12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9�1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4�2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/�l vs 217 cells/�l; P < 0.001), 24 months (213 cells/�l vs 246 cells/�l; P < 0.001), 30 months (226 cells/�l vs 261 cells/�l; P < 0.001) and 36 months (245 cells/�l vs 275 cells/�l; P < 0.01) when compared with those above this threshold. Conclusions MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings.
Chi, Benjamin H; Cantrell, Ronald A; Zulu, Isaac; Mulenga, Lloyd B; Levy, Jens W; Tambatamba, Bushimbwa C; Reid, Stewart; Mwango, Albert; Mwinga, Alwyn; Bulterys, Marc; Saag, Michael S; Stringer, Jeffrey SA
Rural health centres, communities and malaria case detection in Zambia using mobile telephones: a means to detect potential reservoirs of infection in unstable transmission conditions
Background Effective malaria control depends on timely acquisition of information on new cases, their location and their frequency so as to deploy supplies, plan interventions or focus attention on specific locations appropriately to intervene and prevent an upsurge in transmission. The process is known as active case detection, but because the information is time sensitive, it is difficult to carry out. In Zambia, the rural health services are operating effectively and for the most part are provided with adequate supplies of rapid diagnostic tests (RDT) as well as effective drugs for the diagnosis and treatment of malaria. The tests are administered to all prior to treatment and appropriate records are kept. Data are obtained in a timely manner and distribution of this information is important for the effective management of malaria control operations. The work reported here involves combining the process of positive diagnoses in rural health centres (passive case detection) to help detect potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to occur. Methods Twelve rural health centres in the Choma and Namwala Districts were recruited to send weekly information of rapid malaria tests used and number of positive diagnoses to the Malaria Institute at Macha using mobile telephone SMS. Data were entered in excel, expressed as number of cases per rural health centre and distributed weekly to interested parties. Results These data from each of the health centres which were mapped using geographical positioning system (GPS) coordinates were used in a time sensitive manner to plot the patterns of malaria case detection in the vicinity of each location. The data were passed on to the appropriate authorities. The seasonal pattern of malaria transmission associated with local ecological conditions can be seen in the distribution of cases diagnosed. Conclusions Adequate supplies of RDT are essential in health centres and the system can be expanded throughout the country to support strategic targeting of interventions by the National Malaria Control Programme. Participation by the health centre staff was excellent.
The Nexus between Bovine Tuberculosis and Fasciolosis Infections in Cattle of the Kafue Basin Ecosystem in Zambia: Implications on Abattoir Surveillance
Bovine tuberculosis (bTB) and fasciolosis are important but neglected diseases that result in chronic infections in cattle. However, in Zambia, these diseases are mainly diagnosed at abattoirs during routine meat inspection. Albeit the coinfection status, these diseases have been reported as nothing more than normal separate findings without an explanatory phenomena. Forthwith, we formulated this study to assess the possible association of the two diseases in a known high prevalence area on the Kafue basin ecosystem. Of the 1,680 animals screened, 600 (35.7%; 95% CI 33.4%�38%) and 124 (7.4%; 95% CI 6.1%�8.6%) had fasciolosis and tuberculous lesions; respectively, whilst 72 had both fasciola and tuberculous lesions representing 12% (95% CI 9.4%�14.6%) and 58.1% (95% CI; 49.3%�66.7%) of the total positives for fasciola and tuberculosis, respectively. Jaundice was seen in 304 animals, 18.1% (95% CI; 16.3%�19.9%) and was significantly correlated to fasciolosis (r = 0.59, P < 0.0001). A significant association (?2 = 76.2, df = 1, and P < 0.0001) was found between fasciolosis and tuberculous lesions. Simple logistic regression intimated fasciolosis as a strong predictor for tuberculous lesions with animals that had fasciola being five times more likely to have tuberculous lesions (odds ratio = 4.8, 95% CI: 3.3�7.0). This study indicates that transmission and spatial risk factors of communicable and noncommunicable diseases such as bTB and fasciolosis can be correlated in an ecosystem such as the Kafue flats.
Munyeme, Musso; Munang'andu, Hetron Mweemba; Nambota, Andrew; Muma, John Bwalya; Phiri, Andrew Malata; Nalubamba, King Shimumbo
Effects of home-based voluntary counselling and testing on HIV-related stigma: findings from a cluster-randomized trial in Zambia.
HIV-related stigma continues to be a prominent barrier to testing, treatment and care. However, few studies have investigated changes in stigma over time and the factors contributing to these changes, and there is no evidence of the impact of HIV testing and counselling on stigma. This study was nested within a pair-matched cluster-randomized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011, and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma. Data from a baseline survey (n�=�1500) and a follow-up survey (n�=�1107) were used to evaluate changes in stigma. There was an overall reduction of seven per cent in stigma from baseline to follow-up. This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma. The reduction did not differ between the trial arms (?�=�-0.22, p�=�0.423). Being tested for HIV was associated with a reduction in stigma (?�=�-0.57, p�=�0.030), and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches (?�=�-0.78, p�=�0.080 vs. ?�=�-0.37, p�=�0.551), possibly explained by a strong focus on counselling and the safe environment of the home. The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure, treatment access and adherence. Yet, the change in stigma may have been affected by social desirability bias, as extensive community mobilization was carried out in both arms. The study underscores the challenges in measuring and monitoring HIV-related stigma. Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma. PMID:23422056
J�rgensen, Marte; Sand�y, Ingvild Fossgard; Michelo, Charles; Fylkesnes, Knut
Can combination prevention strategies reduce HIV transmission in generalized epidemic settings in Africa? The HPTN 071 (PopART) study plan in South Africa and Zambia
The HIV Prevention Trials Network (HPTN) is conducting the HPTN 071(PopART) study in 21 communities in Zambia and South Africa with support from a consortium of funders. HPTN 071(PopART) is a community-randomized trial of a combination prevention strategy to reduce HIV incidence in the context of the generalized epidemic of southern Africa. The full PopART intervention strategy is anchored in home-based HIV testing and facilitated linkage of HIV-infected persons to care through community health workers, and universal antiretroviral therapy for seropositive persons regardless of CD4+ cell count or HIV viral load. In order to further reduce risk of HIV acquisition among uninfected individuals, the study aims to expand voluntary medical male circumcision, diagnosis and treatment of sexually transmitted infections, behavioral counseling, and condom distribution. The full PopART intervention strategy also incorporates promotion of other interventions designed to reduce HIV and tuberculosis transmission, including optimization of the prevention of mother to child HIV transmission and enhanced individual and public health tuberculosis services. Success for the PopART strategy depends upon the ability to increase coverage for the study interventions whose uptake is a necessary antecedent to a prevention effect. Processes will be measured to assess the degree of penetration of the interventions into the communities. A randomly sampled population cohort from each community will be used to measure the impact of the PopART strategy on HIV incidence over three years. We describe the strategy being tested and progress to date in the HPTN 071(PopART) study.
Vermund, Sten H.; Fidler, Sarah J.; Ayles, Helen; Beyers, Nulda; Hayes, Richard J.
Modeling the Impact of Integrating HIV and Outpatient Health Services on Patient Waiting Times in an Urban Health Clinic in Zambia
Background Rapid scale up of HIV treatment programs in sub-Saharan Africa has refueled the long-standing health policy debate regarding the merits and drawbacks of vertical and integrated system. Recent pilots of integrating outpatient and HIV services have shown an improvement in some patient outcomes but deterioration in waiting times, which can lead to worse health outcomes in the long run. Methods A pilot intervention involving integration of outpatient and HIV services in an urban primary care facility in Lusaka, Zambia was studied. Data on waiting time of patients during two seven-day periods before and six months after the integration were collected using a time and motion study. Statistical tests were conducted to investigate whether the two observation periods differed in operational details such as staffing, patient arrival rates, mix of patients etc. A discrete event simulation model was constructed to facilitate a fair comparison of waiting times before and after integration. The simulation model was also used to develop alternative configurations of integration and to estimate the resulting waiting times. Results Comparison of raw data showed that waiting times increased by 32% and 36% after integration for OPD and ART patients respectively (p<0.01). Using simulation modeling, we found that a large portion of this increase could be explained by changes in operational conditions before and after integration such as reduced staff availability (p<0.01) and longer breaks between consecutive patients (p<0.05). Controlling for these differences, integration of services, per se, would have resulted in a significant decrease in waiting times for OPD and a moderate decrease for HIV services. Conclusions Integrating health services has the potential of reducing waiting times due to more efficient use of resources. However, one needs to ensure that other operational factors such as staff availability are not adversely affected due to integration.
Deo, Sarang; Topp, Stephanie M.; Garcia, Ariel; Soldner, Mallory; Yagci Sokat, Kezban; Chipukuma, Julien; Wamulume, Chibesa S.; Reid, Stewart E.; Swann, Julie
Reduced Mortality Associated With Breast-Feeding-Acquired HIV Infection and Breast-Feeding Among HIV-Infected Children in Zambia
Objectives In developing countries, where mother-to-child transmission of HIV through breast-feeding is common, little is known about the impact of postpartum transmission on child survival. This study assessed whether children infected postpartum have longer survival from time of infection versus those infected during gestation or delivery. Design We used a prospective cohort study to analyze data from 213 HIV-infected children enrolled in a breast-feeding intervention trial in Lusaka, Zambia (2001 to 2004). Methods We compared mortality 1 year after HIV infection in children stratified by age of infection: 0 to 3 days (intrauterine [IU] group), 4 to 40 days (intrapartum/early postpartum [IP/EPP] group), and >40 days (postpartum [PP] group). Results A total of 61, 71, and 81 children were infected in the IU, IP/EPP, and PP groups, respectively. Children with intrauterine or intrapartum/early postpartum transmission had higher mortality over the first 12 months after infection than children with postpartum transmission (P = 0.001 and P = 0.006, respectively); no differences were detected between children with intrauterine and intrapartum/early postpartum transmission. Nearly 20% of the IU and IP/EPP groups died by 100 days after infection, whereas nearly 10% of the PP group had died by this time. After adjusting for birth weight, maternal CD4 cell count, breast-feeding, and maternal death, children infected postpartum had one quarter the mortality rate (hazard ratio [HR] = 0.27, 95% confidence interval [CI]: 0.15 to 0.50) of those infected in utero. Stopping breast-feeding increased mortality in infected children (HR = 3.1, 95% CI: 1.8 to 5.3). Conclusions This study demonstrates a survival benefit among children infected postpartum versus children infected during pregnancy or delivery and a benefit to increased breast-feeding duration among infected children. Testing children for HIV early may provide a means to allow for earlier intervention.
Fox, Matthew P.; Brooks, Daniel; Kuhn, Louise; Aldrovandi, Grace; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Horsburgh, Robert; Thea, Donald M.
Community-based follow-up for late patients enrolled in a district-wide programme for antiretroviral therapy in Lusaka, Zambia.
Timely adherence to clinical and pharmacy appointments is well correlated with favourable patient outcomes among HIV-infected individuals on antiretroviral therapy. To date, however, there is little work exploring reasons behind missed visits or evaluating programmatic strategies to recall patients. For this study we implemented community-based follow-up of late patients as part of a large-scale programme for HIV care and treatment in Lusaka, Zambia. Through a network of local home-based care organizations, we attempted home visits to recall patients using locator information provided at time of enrolment. Between May and September 2005, home-based caregivers were dispatched to trace 1,343 patients with missed appointments. Of these, 554 (41%) were untraceable because the provided address was invalid, the patient had moved or no one was at the home. Of the remaining 789, 359 (46%) were reported to have died. Only 430 (54% of those traced, 32% overall) were contacted directly and encouraged to return for care. The likelihood of patient return was higher among traced patients in crude analysis (relative risk [RR] = 2.5; 95%CI = 1.9-3.2) and in multivariable analysis controlling for baseline body mass index, sex and CD4 + count < or = 50/microL (adjusted RR = 2.3; 95%CI = 1.7-3.2). However, the process was inefficient: one late patient returned for every 18 home visits that were made. Reasons for missed visits were provided in 271 of 430 (63%) of the patients who were successfully traced. Common reasons included feeling too sick to come to the clinic, travelling away from home and being too busy. Despite the availability of free ART in Lusaka, patients face significant barriers to attending scheduled clinical visits. Cost-effective and feasible strategies are urgently needed to improve timely patient follow-up. PMID:18351478
Krebs, D W; Chi, B H; Mulenga, Y; Morris, M; Cantrell, R A; Mulenga, L; Levy, J; Sinkala, M; Stringer, J S A
Mortality and virologic outcomes following access to antiretroviral therapy among a cohort of HIV-infected women who received single-dose nevirapine in Lusaka, Zambia
Objectives Single-dose nevirapine (SDNVP) for prevention of mother-to-child HIV transmission selects mutations conferring resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. We investigated mortality and virologic and clinical outcomes following introduction of antiretroviral treatment (ART) among a cohort of women given SDNVP. Methods When ART programs were introduced in 2004 in Lusaka, Zambia, we were completing a trial of infant feeding which involved following HIV-infected women who received SDNVP between 2001 and 2005. Women still in follow-up or who could be contacted were evaluated for eligibility for ART (CD4 count <200 or <350 and WHO stage ? 3) and started on NNRTI-based therapy if eligible. We compared mortality in the cohort of women before and after ART access, and examined, among women initiating ART, whether virologic response was better allowing a longer time to elapse between SDNVP and treatment initiation. Results In the cohort of 872 women, mortality more than halved after ART became available (relative hazard [RH] = 0.46 95% CI: 0.23�0.91 p=0.03). Of 161 SDNVP-exposed women followed on NNRTI-based ART, 70.8% suppressed (viral load <400 copies/ml). Only 3/8 (37.5%) women SDNVP-exposed <6 months of starting therapy suppressed compared to 13/22 (59.1%) who started 6�12 months, 44/61 (72.1 %) 12�24 months, and 54/70 (77.1%) >24 months post-exposure (chi-square trend p=0.01). Conclusions Most SDNVP-exposed women respond well to NNRTI-based therapy but there was an attenuation of therapy efficacy that persisted to 12 months after exposure. Women should be screened for ART eligibility during pregnancy and started on effective regimens before delivery.
Kuhn, Louise; Semrau, Katherine; Ramachandran, Shobana; Sinkala, Moses; Scott, Nancy; Kasonde, Prisca; Mwiya, Mwiya; Kankasa, Chipepo; Decker, Don; Thea, Donald M.; Aldrovandi, Grace M.
Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia
Background Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual's perspective on the illness. Although individual variations are important in determining help-seeking and treatment behaviour patterns, the ability to cope with an illness and quality of life, the role of explanatory models in shaping treatment preferences is undervalued. The aim was to identify explanatory models employed by HIV-infected and uninfected individuals and to compare them with those employed by local health care providers. Furthermore, we aimed to build a theoretical model linking the perception of mental distress to treatment preferences and coping mechanisms. Methods Qualitative investigation nested in a cross-sectional validation study of 28 (male and female) attendees at four primary care clinics in Lusaka, Zambia, between December 2008 and May 2009. Consecutive clinic attendees were sampled on random days and conceptual models of mental distress were examined, using semi-structured interviews, in order to develop a taxonomic model in which each category was associated with a unique pattern of symptoms, treatment preferences and coping strategies. Results Mental distress was expressed primarily as somatic complaints including headaches, perturbed sleep and autonomic symptoms. Economic difficulties and interpersonal relationship problems were the most common causal models among uninfected individuals. Newly diagnosed HIV patients presented with a high degree of hopelessness and did not value seeking help for their symptoms. Patients not receiving anti-retroviral drugs (ARV) questioned their effectiveness and were equivocal about seeking help. Individuals receiving ARV were best adjusted to their status, expressed hope and valued counseling and support groups. Health care providers reported that 40% of mental distress cases were due to HIV infection. Conclusions Patient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. Mental health interventions should be further researched and prioritized for HIV-infected individuals.
Utilization of Cervical Cancer Screening Services and Trends in Screening Positivity Rates in a 'Screen-And-Treat' Program Integrated with HIV/AIDS Care in Zambia
Background In the absence of stand-alone infrastructures for delivering cervical cancer screening services, efforts are underway in sub-Saharan Africa to dovetail screening with ongoing vertical health initiatives like HIV/AIDS care programs. Yet, evidence demonstrating the utilization of cervical cancer prevention services in such integrated programs by women of the general population is lacking. Methods We analyzed program operations data from the Cervical Cancer Prevention Program in Zambia (CCPPZ), the largest public sector programs of its kind in sub-Saharan Africa. We evaluated patterns of utilization of screening services by HIV serostatus, examined contemporaneous trends in screening outcomes, and used multivariable modeling to identify factors associated with screening test positivity. Results Between January 2006 and April 2011, CCPPZ services were utilized by 56,247 women who underwent cervical cancer screening with visual inspection with acetic acid (VIA), aided by digital cervicography. The proportion of women accessing these services who were HIV-seropositive declined from 54% to 23% between 2006�2010, which coincided with increasing proportions of HIV-seronegative women (from 22% to 38%) and women whose HIV serostatus was unknown (from 24% to 39%) (all p-for trend<0.001). The rates of VIA screening positivity declined from 47% to 17% during the same period (p-for trend <0.001), and this decline was consistent across all HIV serostatus categories. After adjusting for demographic and sexual/reproductive factors, HIV-seropositive women were more than twice as likely (Odds ratio 2.62, 95% CI 2.49, 2.76) to screen VIA-positive than HIV-seronegative women. Conclusions This is the first �real world� demonstration in a public sector implementation program in a sub-Saharan African setting that with successful program scale-up efforts, nurse-led cervical cancer screening programs targeting women with HIV can expand and serve all women, regardless of HIV serostatus. Screening program performance can improve with adequate emphasis on training, quality control, and telemedicine-support for nurse-providers in clinical decision making.
Kapambwe, Sharon; Shepherd, Bryan E.; Chibwesha, Carla; Pfaendler, Krista S.; Mkumba, Gracilia; Vwalika, Belington; Hicks, Michael L.; Vermund, Sten H.; Stringer, Jeffrey SA.; Parham, Groesbeck P.
Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities
Background The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. Methods Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities� infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. Results Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers� PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers� ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. Conclusions These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.
A cost-effective, community-based, mosquito-trapping scheme that captures spatial and temporal heterogeneities of malaria transmission in rural Zambia
Background Monitoring mosquito population dynamics is essential to guide selection and evaluation of malaria vector control interventions but is typically implemented by mobile, centrally-managed teams who can only visit a limited number of locations frequently enough to capture longitudinal trends. Community-based (CB) mosquito trapping schemes for parallel, continuous monitoring of multiple locations are therefore required that are practical, affordable, effective, and reliable. Methods A CB surveillance scheme, with a monthly sampling and reporting cycle for capturing malaria vectors, using Centers for Disease Control and Prevention light traps (LT) and Ifakara Tent Traps (ITT), were conducted by trained community health workers (CHW) in 14 clusters of households immediately surrounding health facilities in rural south-east Zambia. At the end of the study, a controlled quality assurance (QA) survey was conducted by a centrally supervised expert team using human landing catch (HLC), LT and ITT to evaluate accuracy of the CB trapping data. Active surveillance of malaria parasite infection rates amongst humans was conducted by CHWs in the same clusters to determine the epidemiological relevance of these CB entomological surveys. Results CB-LT and CB-ITT exhibited relative sampling efficiencies of 50 and 7%, respectively, compared with QA surveys using the same traps. However, cost per sampling night was lowest for CB-LT ($13.6), followed closely by CB-ITT ($18.0), both of which were far less expensive than any QA survey (HLC: $138, LT: $289, ITT: $269). Cost per specimen of Anopheles funestus captured was lowest for CB-LT ($5.3), followed by potentially hazardous QA-HLC ($10.5) and then CB-ITT ($28.0), all of which were far more cost-effective than QA-LT ($141) and QA-ITT ($168). Time-trends of malaria diagnostic positivity (DP) followed those of An. funestus density with a one-month lag and the wide range of mean DP across clusters was closely associated with mean densities of An. funestus caught by CB-LT (P?0.001). Conclusions CB trapping schemes appear to be far more affordable, epidemiologically relevant and cost-effective than centrally supervised trapping schemes and may well be applicable to enhance intervention trials and even enable routine programmatic monitoring of vector population dynamics on unprecedented national scales.
Risk Factors Associated with Positive QuantiFERON-TB Gold In-Tube and Tuberculin Skin Tests Results in Zambia and South Africa
Introduction The utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis. Objectives To determine risk factors associated with positive QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) results and the level of agreement between the tests; to explore the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST. Methods Adult household contacts of tuberculosis patients were invited to participate in a cross-sectional study across 24 communities in Zambia and South Africa. HIV, QFT-GIT and TST tests were done. A questionnaire was used to assess risk factors. Results A total of 2,220 contacts were seen. 1,803 individuals had interpretable results for both tests, 1,147 (63.6%) were QFT-GIT positive while 725 (40.2%) were TST positive. Agreement between the tests was low (kappa?=?0.24). QFT-GIT and TST results were associated with increasing age (adjusted OR [aOR] for each 10 year increase for QFT-GIT 1.15; 95% CI: 1.06�1.25, and for TST aOR: 1.10; 95% CI 1.01�1.20). HIV positivity was less common among those with positive results on QFT-GIT (aOR: 0.51; 95% CI: 0.39�0.67) and TST (aOR: 0.61; 95% CI: 0.46�0.82). Smear positivity of the index case was associated with QFT-GIT (aOR: 1.25; 95% CI: 0.90�1.74) and TST (aOR: 1.39; 95% CI: 0.98�1.98) results. We found little evidence in our data to support our hypotheses. Conclusion QFT-GIT may not be more sensitive than the TST to detect risk factors associated with tuberculous infection. We found little evidence to support the hypotheses that positivity in QFT-GIT is more related to recent infection and less affected by HIV than the TST.
Shanaube, Kwame; Hargreaves, James; Fielding, Katherine; Schaap, Ab; Lawrence, Katherine-Anne; Hensen, Bernadette; Sismanidis, Charalambos; Menezes, Angela; Beyers, Nulda; Ayles, Helen; Godfrey-Faussett, Peter
Assessing Water Filtration and Safe Storage in Households with Young Children of HIV-Positive Mothers: A Randomized, Controlled Trial in Zambia
Background Unsafe drinking water presents a particular threat to people living with HIV/AIDS (PLHIV) due to the increased risk of opportunistic infections, diarrhea-associated malabsorption of essential nutrients, and increased exposure to untreated water for children of HIV-positive mothers who use replacement feeding to reduce the risk of HIV transmission. This population may particularly benefit from an intervention to improve water quality in the home. Methods and Findings We conducted a 12-month randomized, controlled field trial in Zambia among 120 households with children <2 years (100 with HIV-positive mothers and 20 with HIV-negative mothers to reduce stigma of participation) to assess a high-performance water filter and jerry cans for safe storage. Households were followed up monthly to assess use, drinking water quality (thermotolerant coliforms (TTC), an indicator of fecal contamination) and reported diarrhea (7-day recall) among children <2 years and all members of the household. Because previous attempts to blind the filter have been unsuccessful, we also assessed weight-for-age Z-scores (WAZ) as an objective measure of diarrhea impact. Filter use was high, with 96% (596/620) of household visits meeting the criteria for users. The quality of water stored in intervention households was significantly better than in control households (3 vs. 181 TTC/100 mL, respectively, p<0.001). The intervention was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among children <2 years (LPR?=?0.47, 95% CI: 0.30�0.73, p?=?0.001) and 54% among all household members (LPR?=?0.46, 95% CI: 0.30�0.70, p<0.001). While reduced WAZ was associated with reported diarrhea (?0.26; 95% CI: ?0.37 to ?0.14, p<0.001), there was no difference in WAZ between intervention and control groups. Conclusion In this population living with HIV/AIDS, a water filter combined with safe storage was used correctly and consistently, was highly effective in improving drinking water quality, and was protective against diarrhea. Trial Registration Clinicaltrials.gov NCT01116908
Peletz, Rachel; Simunyama, Martin; Sarenje, Kelvin; Baisley, Kathy; Filteau, Suzanne; Kelly, Paul; Clasen, Thomas
Couple experiences of provider-initiated couple HIV testing in an antenatal clinic in Lusaka, Zambia: lessons for policy and practice
Background Couple HIV testing has been recognized as critical to increase uptake of HIV testing, facilitate disclosure of HIV status to marital partner, improve access to treatment, care and support, and promote safe sex. The Zambia national protocol on integrated prevention of mother-to-child transmission of HIV (PMTCT) allows for the provision of couple testing in antenatal clinics. This paper examines couple experiences of provider-initiated couple HIV testing at a public antenatal clinic and discusses policy and practical lessons. Methods Using a narrative approach, open-ended in-depth interviews were held with couples (n?=?10) who underwent couple HIV testing; women (n?=?5) and men (n?=?2) who had undergone couple HIV testing but were later abandoned by their spouses; and key informant interviews with lay counsellors (n?=?5) and nurses (n?=?2). On-site observations were also conducted at the antenatal clinic and HIV support group meetings. Data collection was conducted between March 2010 and September 2011. Data was organised and managed using Atlas ti, and analysed and interpreted thematically using content analysis approach. Results Health workers sometimes used coercive and subtle strategies to enlist women�s spouses for couple HIV testing resulting in some men feeling �trapped� or �forced� to test as part of their paternal responsibility. Couple testing had some positive outcomes, notably disclosure of HIV status to marital partner, renewed commitment to marital relationship, uptake of and adherence to treatment and formation of new social networks. However, there were also negative repercussions including abandonment, verbal abuse and cessation of sexual relations. Its promotion also did not always lead to safe sex as this was undermined by gendered power relationships and the desires for procreation and sexual intimacy. Conclusions Couple HIV testing provides enormous bio-medical and social benefits and should be encouraged. However, testing strategies need to be non-coercive. Providers of couple HIV testing also need to be mindful of the intimate context of partner relationships including couples� childbearing aspirations and lived experiences. There is also need to make antenatal clinics more male-friendly and responsive to men�s health needs, as well as being attentive and responsive to gender inequality during couselling sessions.
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.
The Cervical Cancer Prevention Program in Zambia (CCPPZ) has increasingly used community-level structures to increase the uptake and ensure the sustainability of the program. Traditional marriage counselors, the alangizi, who have existed in the Zambian society for many years, are one of the structures used by the program to impart cervical cancer knowledge and increase access to screening and care using an existing community structure. Several steps were followed in developing this intervention: (a) ensuring the alangizi understood the process of screening by encouraging them to go through the screening process; (b) workshops were arranged for the alangizi to meet and share experiences during which lessons were given on cervical cancer by health workers as well; and (c) eight alangizi were chosen to help document the lessons as part of ensuring that cervical cancer information is accurate and passed in a consistent manner. Over 70 alangizi, who had undergone cervical cancer screening, were trained by CCPPZ. A 'Cervical Cancer Training Manual for Marriage Counsellors' was developed to help the alangizi integrate cervical cancer lessons in their routine teachings. An evaluation was conducted during the training of the alangizi that forms the basis for this paper. The results show that although the alangizi face key challenges in their work (e.g. changing social contexts), they are still considered relevant by most communities in Zambia and are potentially an important avenue for cervical cancer and other health information. This paper shows that it is possible to integrate sexual and reproductive health messages into existing structures in the community. However, it is important to design culturally specific and sensitive healthcare strategies that embrace locally accepted good practices. PMID:24722743
Kapambwe, Sharon; Parham, Groesbeck; Mwanahamuntu, Mulindi; Chirwa, Susan; Mwanza, Jacob; Amuyunzu-Nyamongo, Mary
New constraints on the Pan-African tectonics and the role of the Mwembeshi Zone in Central Zambia: Deformation style and timing of two orthogonal shortening events
NASA Astrophysics Data System (ADS)
In Central Zambia the Mwembeshi Zone (MwZ) separates two branches of the Late Neoproterozoic - Cambrian Pan-African Orogen: the NE-convex Lufilian Arc and the E-W trending Zambezi Belt whose distinct features emphasize the role of the zone as a regional structural and metamorphic boundary. North of the MwZ, the Hook Batholith was emplaced within the low metamorphic grade Neoproterozoic metasedimentary rocks, and represents the largest Pan-African intrusion in Southern Africa. The granitoids and their host-rocks were affected by two deformation events. During the D1 deformation of E-W shortening, two high-strained zones developed in the batholith. To the NE, the Nalusanga Zone (NZ) is a ~3 km wide NW-striking subvertical sinistral strike-slip shear zone. To the SW, a ~2.5 km wide N-S trending subvertical pure-shear Itezhi-Tezhi Zone (ITZ) formed. In both structures, the granitoids show a smooth transition from weakly deformed rocks to porphyroclastic mylonites. Microstructural analysis defined them as medium metamorphic grade zones, deforming the granitoids at temperatures between 500 and 550�C. The lower greenschist facies metamorphism in the country rocks indicates that the deformation occurred during the cooling of the granitoids. D1 in the metasedimentary rocks east of the Hook batholith formed tight, upright folds with subvertical axial-planar cleavage and NNW-SSE trending axis consistent with the E-W shortening. U-Pb zircon geochronology and cross-cutting relationships between granites bracket D1 deformation between 549 � 2 Ma and 541 � 3 Ma in the NZ and in the SE part of the batholith. In the ITZ, the 533 � 3 Ma age on a deformed granite indicates prolonged E-W shortening during granite emplacement and cooling history. D2 represents a stage of N-S shortening. Airborne geophysical data revealed bending of the N-S trending ITZ and rotation to the east. The D1 structures in the granitoids are cut by D2 north-vergent thrusts and subvertical NW trending dextral strike-slip zones. East of the granite, D2 resulted in E-W trending open folds that refolded the D1 structures. This folding becomes more intense and the folds are tighter when approaching the MwZ to the south. Along the MwZ, the molasse rocks, deposited after D1 (post ~528 Ma, based on new detrital-zircon ages), recorded high-strain greenschist facies coaxial deformation and the formation of E-W trending isoclinal folds with a steep south-dipping axial planar cleavage. This study shows that the area north of the MwZ is characterised by two orthogonal contraction events. The newly described D1 event of E-W shortening in the Hook area cannot be correlated with any of the published Pan-African tectonic models for the Lufilian Arc and Zambezi Belt. The D2 event of N-S shortening affected the region in response to the final docking between the Lufilian Arc and the Zambezi Belt. The strongest effect of this event was observed along the MwZ, which, during this stage, was a zone of intense coaxial deformation.
Naydenov, Kalin; Lehmann, Jeremie; Saalmann, Kerstin; Milani, Lorenzo; Kinnaird, Judith; Charlesworth, Guy; Rankin, William; Frei, Dirk
Descriptive models, grade-tonnage relations, and databases for the assessment of sediment-hosted copper deposits--with emphasis on deposits in the Central Africa Copperbelt, Democratic Republic of the Congo and Zambia
The Central African Copperbelt (CACB) is one of the most important copper-producing regions of the world. The majority of copper produced in Africa comes from this region defined by the Neoproterozoic Katanga sedimentary basin of the southern Democratic Republic of the Congo (DRC) and northern Zambia. Copper in the CACB is mined from sediment-hosted stratabound copper deposits associated with red beds and includes the giant deposits in the Kolwezi and Tenge-Fungurume districts in the DRC and the Konkola-Musoshi and Nchanga-Chingola districts in Zambia. In recent years, sediment-hosted structurally controlled replacement and vein (SCRV) copper deposits, such as the giant Kansanshi deposit in Zambia have become important exploration targets in the CACB region. In 2011, the CACB accounted for 7.2 percent of the estimated global mine production of copper. Global production of copper is principally derived from porphyry and sediment-hosted copper deposits (57 and 23 percent, respectively). Almost 50 percent of the copper known to exist in sediment-hosted deposits (past production plus identified resources) is contained in the CACB, 25 percent is contained in the Zechstein Basin of northern Europe, and the remainder is contained in an additional 29 sedimentary basins distributed around the globe. The U.S. Geological Survey (USGS) led an assessment of undiscovered copper resources in the CACB as part of a global mineral resource assessment for undiscovered resources of potash, copper, and platinum-group elements in selected mineral deposit types. As part of the assessment process, available data for the CACB were compiled and evaluated. This report describes the results of that work, including new descriptive mineral-deposit and grade and tonnage models and spatial databases for deposits and occurrences, ore bodies and open pits. Chapter 1 of this report summarizes a descriptive model of sediment-hosted stratabound copper deposits. General characteristics and subtypes of sediment-hosted stratabound copper deposits are described based upon worldwide examples. Chapter 2 provides a global database of 170 sediment-hosted copper deposits, along with a statistical evaluation of grade and tonnage data for stratabound deposits, a comparison of stratabound deposits in the CACB with those found elsewhere, a discussion of the distinctive characteristics of the subtypes of sediment-hosted copper deposits that occur within the CACB, and guidelines for using grade and tonnage distributions for assessment of undiscovered resources in sediment-hosted stratabound deposits in the CACB. Chapter 3 presents a new descriptive model of sediment-hosted structurally controlled replacement and vein (SCRV) copper deposits with descriptions of individual deposits of this type in the CACB and elsewhere. Appendix A describes a relational database of tonnage, grade, and other information for more than 100 sediment-hosted copper deposits in the CACB. These data are used to calculate the pre-mining mineral endowment for individual deposits in the CACB and serve as the basis for the grade and tonnage models presented in chapter 2. Appendix B describes three spatial databases (Esri shapefiles) for (1) point locations of more than 500 sediment-hosted copper deposits and prospects, (2) projected surface extent of 86 selected copper ore bodies, and (3) areal extent of 77 open pits, all within the CACB.
Taylor, Cliff D.; Causey, J. Douglas; Denning, Paul D.; Hammarstrom, Jane M.; Hayes, Timothy S.; Horton, John D.; Kirschbaum, Michael J.; Parks, Heather L.; Wilson, Anna B.; Wintzer, Niki E.; Zientek, Michael L.
North-South Corridor Demonstration Project: Ethical and Logistical Challenges in the Design of a Demonstration Study of Early Antiretroviral Treatment for Long Distance Truck Drivers along a Transport Corridor through South Africa, Zimbabwe, and Zambia.
Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350?cells/ ? L) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate "real world" programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes. PMID:23606977
Gomez, G B; Venter, W D F; Lange, J M A; Rees, H; Hankins, C
North-South Corridor Demonstration Project: Ethical and Logistical Challenges in the Design of a Demonstration Study of Early Antiretroviral Treatment for Long Distance Truck Drivers along a Transport Corridor through South Africa, Zimbabwe, and Zambia
Background. Long-distance truck drivers are at risk of acquiring and transmitting HIV and have suboptimal access to care. New HIV prevention strategies using antiretroviral drugs to reduce transmission risk (early antiretroviral therapy (ART) at CD4 count >350?cells/?L) have shown efficacy in clinical trials. Demonstration projects are needed to evaluate �real world� programme effectiveness. We present the protocol for a demonstration study to evaluate the feasibility, acceptability, and cost of an early ART intervention for HIV-positive truck drivers along a transport corridor across South Africa, Zimbabwe, and Zambia, as part of an enhanced strategy to improve treatment adherence and retention in care. Methods and Analysis. This demonstration study would follow an observational cohort of truck drivers receiving early treatment. Our mixed methods approach includes quantitative, qualitative, and economic analyses. Key ethical and logistical issues are discussed (i.e., choice of drug regimen, recruitment of participants, and monitoring of adherence, behavioural changes, and adverse events). Conclusion. Questions specific to the design of tailored early ART programmes are amenable to operational research approaches but present substantial ethical and logistical challenges. Addressing these in demonstration projects can inform policy decisions regarding strategies to reduce health inequalities in access to HIV prevention and treatment programmes.
Gomez, G. B.; Venter, W. D. F.; Lange, J. M. A.; Rees, H.; Hankins, C.
Use of the Xpert(R) MTB/RIF assay for diagnosing pulmonary tuberculosis comorbidity and multidrug-resistant TB in obstetrics and gynaecology inpatient wards at the University Teaching Hospital, Lusaka, Zambia
OBJECTIVES In high-tuberculosis (TB)-endemic countries, comorbidity of pulmonary TB in hospitalised patients with non-communicable diseases is well documented. In this study, we evaluated the use of the Xpert� MTB/RIF assay for the detection of concomitant pulmonary TB in patients admitted to the University Teaching Hospital, Lusaka, Zambia, with a primary obstetric or gynaecological condition. METHODS The Study population were inpatients admitted with a primary obstetric or gynaecological problem who had a concomitant cough and were able to expectorate a sputum sample. Sputum samples from 94 patients were analysed for the presence of Mycobacterium tuberculosis (M.tb) by standard smear microscopy, MGIT culture, MGIT drug-susceptibility testing (DST) and the Xpert� MTB/RIF assay. The sensitivity and specificity of the Xpert� MTB/RIF assay were evaluated against the culture gold standard. RESULTS Twenty-six of 94 (27.7%) patients had culture-confirmed pulmonary TB. The Xpert� MTB/RIF assay had a sensitivity of 80.8% [95% CI: 60.0�92.7%]) compared against MGIT culture. The Xpert� MTB/RIF assay was more sensitive than sputum smear microscopy (21/26 (80.8%) vs. 13/26 (50.0%), P�=�0.02) and detected an additional eight culture-confirmed cases. Culture DST analysis identified two monoresistant M.tb strains: one resistant to rifampicin (rifampicin sensitive by the Xpert� MTB/RIF assay) and one to ethambutol. HIV infection was linked with a 3-fold increase in risk of TB, accounting for 87.5% (21/24) of TB cases. 50% of cases presented as comorbidities with other communicable diseases (CDs) and non-communicable diseases (NCDs). CONCLUSIONS As an alternative to sputum microscopy, the Xpert� MTB/RIF assay provides a sensitive, specific and rapid method for the diagnosis of pulmonary TB in obstetric or gynaecological inpatients. Pulmonary TB is an important cause of concomitant comorbidity to the obstetric or gynaecological condition necessitating admission. TB and HIV comorbidities with other communicable and non-communicable diseases were also common. More proactive screening for TB comorbidity is required in obstetric and gynaecological wards.
Bates, Matthew; Ahmed, Yusuf; Chilukutu, Lophina; Tembo, John; Cheelo, Busiku; Sinyangwe, Sylvester; Kapata, Nathan; Maeurer, Markus; O'Grady, Justin; Mwaba, Peter; Zumla, Alimuddin
Conference on Afican Health Initiatives: Lusaka, Zambia.
National Technical Information Service (NTIS)
Todays White House Office of Faith-Based and Community Initiatives Conference is offered as part of the continued expansion of President Bushs vision for compassion in action around the world. Its objective is to highlight, honor, and expand the work of w...
Women's Experiences Living with Epilepsy in Zambia
Epilepsy-associated stigma is a well-recognized phenomenon that adversely impacts the lives of people with epilepsy (PWE). The burden of stigma follows power differentials, with socially and economically disenfranchised groups being particularly susceptible. To guide instrument development for quantitative studies, we conducted a series of focus group discussions among PWE and found that women with epilepsy experienced especially adverse social and economic problems because of epilepsy-associated stigma. The social burden of the disease largely outweighed the medical burden. Women revealed seizure worries related to accidental and intentional injury and the risk of breaking taboos as well as limitations in role fulfillment and extremes of social rejection by family and community. Our findings have implications for access to care and care delivery for vulnerable populations with epilepsy.
Birbeck, Gretchen L.; Chomba, Elwyn; Atadzhanov, Masharip; Mbewe, Edward; Haworth, Alan
Wood fuel transportation and distribution in Zambia.
National Technical Information Service (NTIS)
This paper discusses Zambian charcoal markets using data from interviews undertaken in three cities. These data show that there are large numbers of agents engaged actively in the production, transport and distribution stages of the industry. As a result,...
S. H. Hibajene
Educational Alternatives to Schooling in Zambia.
ERIC Educational Resources Information Center
This paper contrasts two perspectives for evaluating educational programs: (1) a growth curve model of personal development in the sociocultural context; and (2) a narrowing staircase model of educational success. According to the first perspective, development occurs along personal, social, and cognitive dimensions, and arises from the�
Serpell, Robert
A manual for local government financial management in Zambia
This manual, supported by the School of the Built Environment at\\u000aCopperbelt University and the Institute for Housing and Urban\\u000aDevelopment Studies, The Netherlands, aims to bring together various\\u000aaspects of Public Finance covered in the various workshops and\\u000aseminars conducted by SINPA. It is intended that the Copperbelt\\u000aUniversity will use the manual as part of the requisite training
Chitembo A
An Overview of the Malaria Control Programme in Zambia
The Zambian national malaria control programme has made great progress in the fight against Malaria. The country has solid, consistent, and coordinated policies, strategies, and guidelines for malaria control, with government prioritizing malaria in both the National Health Strategic Plan and the National Development Plan. This has translated into high coverage of proven and effective key preventive, curative, and supportive interventions with concomitant marked reduction in both malaria cases and deaths. The achievements attained can be attributed to increased advocacy, communication and behaviour changes, efficient partnership coordination including strong community engagement, increased financial resources, and evidence-based deployment of key technical interventions in accordance with the national malaria control programme policy and strategic direction. The three-ones strategy has been key for increased and successful public-private sector partner coordination, strengthening, and mobilization. However, maintaining the momentum and the gains is critical as the programme strives to achieve universal coverage of evidence-based and proven interventions. The malaria control programme's focus is to maintain the accomplishments, by mobilizing more resources and partners, increasing the government funding towards malaria control, scaling up and directing interventions based on epidemiological evidence, and strengthen active malaria surveillance and response to reduce transmission and to begin considering elimination.
Chanda, Emmanuel; Kamuliwo, Mulakwa; Steketee, Richard W.; Macdonald, Michael B.; Babaniyi, Olusegun; Mukonka, Victor M.
Use of Space Technology in Flood Mitigation (Western Province, Zambia)
Disasters, by definition are events that appear suddenly and with little warning. They are usually short lived, with extreme events bringing death, injury and destruction of buildings and communications. Their aftermath can be as damaging as their physical effects through destruction of sanitation and water supplies, destruction of housing and breakdown of transport for food, temporary shelter and emergency services.
A. Mulando
Antimicrobial sensitivity in enterobacteria from AIDS patients, Zambia.
Mycoplasma contamination of the licensed anthrax vaccine administered to military personnel has been suggested as a possible cause of Persian Gulf illness. Vaccine samples tested by nonmilitary laboratories were negative for viable mycoplasma and mycoplasma DNA and did not support its survival. Mycoplasma contamination of anthrax vaccine should not be considered a possible cause of illness. PMID:11749759
Mwansa, James; Mutela, Kabanga; Zulu, Isaac; Amadi, Beatrice; Kelly, Paul
Zambia: Long-Term Generation Expansion Study-Executive Summary.
National Technical Information Service (NTIS)
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 ...
G. Conzelmann T. Veseika V. Konitarov W. Buehring
Battling AIDS through home care in Uganda and Zambia.
Innovative home care programs, providing a variety of services to persons with HIV infection and their families and reflecting different health, political, cultural, social, and philosophical concepts, have been developed in Africa, starting in 1987. In 1989 the World Health Organization (WHO) Global Programme on AIDS conducted a descriptive study of some of these programs. It is hoped that these experiences will assist planners and health care providers in their decision making and thereby benefit persons with HIV infection and their families. The lessons learned about the context, backgrounds, structure, process, and outcome of the six selected home care programs can be used and adapted by policymakers and program planners in their own settings when deciding on "their" model of home care. PMID:10121240
Assessing Sector Institutions: Lessons of Experience from Zambia's Education Sector.
National Technical Information Service (NTIS)
This study presents the methodological customization of Institutional Environment Assessments (IEAs) introduced in Discussion Paper No. 252 into Sector Institutional Assessments (SIAs) and discusses the first experience with its operationalization. It des...
R. F. Pinto A. J. Mrope
Peace Corps/Zambia PST 1995 Special Lessons: Bemba.
ERIC Educational Resources Information Center
This manual is designed for the Bemba language training of Peace Corps volunteers and focuses on daily communication needs in that context. They consist of: a list of useful "survival" phrases and vocabulary; a noun and affix chart; the national anthem; a section on verb tenses and negation, with extensive grammar and usage notes; notes on�
Peace Corps (Zambia).
Benefits of HIV screening of blood transfusions in Zambia
Blood transfusion continues to be an important route of transmission of HIV in developing countries, especially for young children following the perinatal period. Testing for HIV is costly and reliable donor support for the purchase of test kits is often essential, yet difficult to secure. The costs of screening of transfusions for HIV and the financial benefits in terms of
S Foster; A Buv�
Health and human rights of women imprisoned in Zambia
Background��The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely studied and poorly understood.\\u000a \\u000a \\u000a \\u000a Methods��A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners and 21 prison officers in\\u000a four Zambian prisons to assess the health and human rights concerns of female detainees. Key informant interviews with 46\\u000a officials from government and
Katherine W Todrys; Joseph J Amon
Political economy studies: are they actionable ? some lessons from Zambia
In recent years, the number of studies looking at the effect of politics on economic outcomes has flourished. For developing economies, these studies are useful to better understand why long overdue reforms are not implemented. The studies analyze the overall context within which reforms are being implemented and the underlying incentive framework. However, it seems difficult to make such studies
Monica Beuran; Gael Raballand; Kapil Kapoor
Pupils' Projects from Zambia. Third World Science. A Collection of Third Form Science Projects from Lubushi Seminary, Kasama, Zambia as Written and Drawn by the Pupils Themselves.
ERIC Educational Resources Information Center
The Third World Science Project (TWSP) is designed to add a multicultural element to existing science syllabi (for students aged 11-16) in the United Kingdom. The project seeks to develop an appreciation of the: boundless facination of the natural world; knowledge, skills, and expertise possessed by men/women everywhere; application of knowledge�
University Coll. of North Wales, Bangor (United Kingdom). School of Education.
Preservation and Conservation of Information Resources in the University of Zambia Library
ERIC Educational Resources Information Center
Preservation and conservation of library materials is an important aspect of library and information management. Their importance and necessity are more paramount in countries where resources are limited and libraries need to balance them with the needs of an ever increasing number of students hoping to use them. This article reports on the�
Kanyengo, Christine Wamunyima
Task sharing in Zambia: HIV service scale-up compounds the human resource crisis
BACKGROUND: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV\\/AIDS control scale-up. This study analyses and reports
Aisling Walsh; Phillimon Ndubani; Joseph Simbaya; Patrick Dicker; Ruair� Brugha
Understanding local water conflict and cooperation: The case of Namwala District, Zambia
Understanding the nature of water conflict and cooperation is a crucial element in water governance within Integrated Water Resources Management (IWRM). Much of the recent attention to the issue has however focused on transboundary aspects, while we know rather less about the nature and dynamics of local water conflict and cooperation. Drawing on the work of the collaborative Competing for
Mikkel Funder; Carol Mweemba; Imasiku Nyambe; Barbara van Koppen; Helle Munk Ravnborg
Poverty Reduction in Zambia: A Conceptual Analysis of the Zambian Poverty Reduction Strategy Paper
ERIC Educational Resources Information Center
Poverty reduction strategy papers (PRSPs) present a recipient country's program of intent for the utilization of World Bank loans and grants to alleviate debt under the bank's programs of action for poverty reduction in highly indebted poor countries (HIPCs). This article argues that structural transformation is a prerequisite for poverty�
Imboela, Bruce Lubinda
'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa
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
Patricia Kingori; Maureen Muchimba; Bornwell Sikateyo; Beatrice Amadi; Paul Kelly
Acceptability of male circumcision for prevention of HIV infection in Zambia
Numerous observational studies and three clinical trials have shown male circumcision (MC) to be partially protective against HIV acquisition in heterosexual men. This has led to consideration of introducing circumcision as an HIV prevention strategy in parts of sub-Saharan Africa. This study assesses the acceptability of male circumcision as an intervention to improve male genital hygiene and reduce sexually transmitted
M. D. Lukobo; R. C. Bailey
Using a Geographical-Information-System-Based Decision Support to Enhance Malaria Vector Control in Zambia
Geographic information systems (GISs) with emerging technologies are being harnessed for studying spatial patterns in vector-borne diseases to reduce transmission. To implement effective vector control, increased knowledge on interactions of epidemiological and entomological malaria transmission determinants in the assessment of impact of interventions is critical. This requires availability of relevant spatial and attribute data to support malaria surveillance, monitoring, and evaluation. Monitoring the impact of vector control through a GIS-based decision support (DSS) has revealed spatial relative change in prevalence of infection and vector susceptibility to insecticides and has enabled measurement of spatial heterogeneity of trend or impact. The revealed trends and interrelationships have allowed the identification of areas with reduced parasitaemia and increased insecticide resistance thus demonstrating the impact of resistance on vector control. The GIS-based DSS provides opportunity for rational policy formulation and cost-effective utilization of limited resources for enhanced malaria vector control.
Chanda, Emmanuel; Mukonka, Victor Munyongwe; Mthembu, David; Kamuliwo, Mulakwa; Coetzer, Sarel; Shinondo, Cecilia Jill
Health effects of charcoal and wood fuel use in low-income households in Lusaka, Zambia.
National Technical Information Service (NTIS)
The results of this investigation provide no confirmation that the health status of charcoal users is different from that of electricity users. In wood users the subjective symptom description was similar to that of charcoal and electricity users. Wood us...
A. Ellegaard H. Egneus
Ecology and productivity of an African wetland system: The Kafue, Zambia
This book discusses the main ecological processes in African floodplain grasslands. It researches the structure of the various types of grasslands, and their correlation with the environmental factors operating in the floodplain ecosystem. From detailed measurements of structure and biomass it estimates primary production in various habitats. It also surveys the impact of disturbing factors like grazing and fires and discusses the year to year variation in the ecosystems.
Ellenbroek, G.A.
Does climate change really explain changes in the fisheries productivity of Lake Kariba (Zambia-Zimbabwe)?
This paper examines the notion that the fish stocks in Lake Kariba may now be suffering from the effects of climate change as air temperatures there have increased by about 2 �C since 1960. The ecosystem of Lake Kariba has changed dramatically since it was created in 1958, and the nutrients released by the collapse of the floating water-fern Salvinia
B. E. Marshall
Elephants, people, parks and development: the case of the Luangwa Valley, Zambia
New ideas about conserving wildlife are emerging to compete with conventional national park policies. But methods of analyzing wildlife conservation problems in Africa are inadequate for the analysis of complex issues of policy. Much of the analysis of conservation policy attempts to be �apolitical� on issues charged with social conflict. Analyses are too often ahistorical when history can say a
Nick Abel; Piers Blaikie
Gender-based violence against female pupils at a high school in northern Zambia
SummaryGender-based violence was commonly directed against female pupils by teachers and male pupils using non-consensual sex, corporal punishment and abusive language. The victims didn't report the matter for fear of reprisals.ResultsThe pupils were aged between 10 and 21 years (with majority between 16 and 20 years old) and equal gender representation. 29 (58%) pupils reported being sexually abused by teachers,
R E Mtonga
VILLAGE--A Minimum Structure Simulation Game Developed for Agricultural Extension Training in Central Africa (Zambia).
ERIC Educational Resources Information Center
Discusses training needs of agricultural students and the process, activities, and resources utilized by a simulation game designed to encourage development of appropriate conflict resolution and communications skills and to create awareness of agricultural extension needs. Summarizes results of field test evaluation of VILLAGE and deficiencies in�
Dall, Frank
The Participatory Research Approach in Non-Western Countries: Practical Experiences from Central Asia and Zambia
ERIC Educational Resources Information Center
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�
Katsui, Hisayo; Koistinen, Mari
Working Together to Improve the Lives of People Affected by Epilepsy in Zambia
ERIC Educational Resources Information Center
Epilepsy is a neurologic disorder that results in recurrent, unprovoked seizures. The biomedical burden of epilepsy can be substantial, but for many the social consequences may be just as extreme, with epilepsy victims suffering from social abandonment as well as economic and physical vulnerabilities. Since its founding in 2000, the Chikankata�
Birbeck, Gretchen L.
Mortality among HIV-1- and Human Herpesvirus Type 8-Affected Mother-Infant Pairs in Zambia
Objective To determine the respective trends in mortality of Zambian mother-infant pairs based on maternal infection with HIV-1 and human herpesvirus type 8 (HHV-8). Methods A prospective cohort study was done on Zambian mother-infant pairs, stratified by maternal serologic status and followed from 6 weeks postdelivery for 48 months. Statistical analysis of the differences in the calculated mortality rates among the four groups was done using Stata 7.0. Kaplan-Meier analysis and Cox proportional hazard models were used to measure subject survival time. Results Between September 1998 and March 2002, a total of 1,425 mother-infant pairs were enrolled. The crude mortality rate among children born to dually infected mothers was ~9 times higher (245.90 deaths per 1,000 live births) when compared with the death ratio of children born to seronegative mothers (24.63 deaths per 1,000 live births). The incidence rate for death was 0.34/1,000 in infants of co-infected mothers in comparison with 0.32/1,000 among HIV-1�infected mothers, 0.0336/1,000 among uninfected mothers, and 0.0403/1,000 among HHV-8�infected mothers (?2 = 154.56; P < 0.01). Infants of co-infected mothers had a comparable risk of death in comparison with infants infected with HIV-1 alone {hazard ratio, 9.91 [95% confidence interval (95% CI), 5.08�19.37] for co-infected versus 9.26 [95% CI, 4.75�18.07] for HIV-1�infected alone}. Infants of mothers infected only with HHV-8 also had comparable survival in comparison with uninfected infants (hazard ratio, 1.21; 95% CI, 0.56�2.61). Conclusion Infants born to mothers dually infected with both HIV-1 and HHV-8 have comparable survival with infants exposed to HIV-1 alone. Infants born to mothers infected only with HHV-8 have comparable survival with uninfected infants.
Wojcicki, Janet; Mwanahamuntu, Mulindi; Minhas, Veenu; Djokic, Boris; Kankasa, Chipepo; Klaskala, Winslow; Brayfield, Brad; Phiri, Saul; Wood, Charles; Mitchell, Charles D.
Successes and Challenges of Food Market Reform: Experiences from Kenya, Mozambique, Zambia, and Zimbabwe
This paper describes the different food policy courses pursued in recent years by four countries in Eastern and Southern Africa, and documents their differential effects on farmer and consumer behavior. Results are based primarily on a survey and synthesis of recent analysis. The paper highlights lessons learned from the different policy paths pursued in each country, and thus provides insights
David L. Tschirley; Mulinge Mukumbu; Michael T. Weber; Ballard Zulu; Robert C. Johansson; Paula Mota Santos; David Soroko
The carbonate-hosted willemite prospects of the Zambezi Metamorphic Belt (Zambia)
Zambian willemite (Zn2SiO4) deposits occur in the metasedimentary carbonate rocks of the Proterozoic Katangan Supergroup. The most important orebodies\\u000a are located around Kabwe and contain both sulphides and willemite in dolomites of low metamorphic grade. The Star Zinc and\\u000a Excelsior prospects (Lusaka area), discovered in the early 1920s, occur in the metamorphic lithotypes of the late Proterozoic\\u000a Zambezi Supracrustal sequence,
Maria Boni; Rosario Terracciano; Giuseppina Balassone; Sarah A. Gleeson; Alexander Matthews
Correlates of Syphilis Seroreactivity Among Pregnant Women: The HIVNET 024 Trial in Malawi, Tanzania, and Zambia
Objective The objectives of this cross-sectional study were to determine correlates of syphilis seroprevalence among HIV-infected and -uninfected antenatal attendees in an African multisite clinical trial, and to improve strategies for maternal syphilis prevention. Results A total of 2270 (86%) women were HIV-infected and 366 (14%) were HIV-uninfected. One hundred seventy-five (6.6%) were syphilis-seropositive (7.3% among HIV-infected and 2.6% HIV-uninfected women). Statistically significant correlates included geographic site (odds ratio [OR] = 4.5, Blantyre; OR = 3.2, Lilongwe; OR = 9.0, Lusaka vs. Dar es Salaam referent); HIV infection (OR = 3.3); age 20 to 24 years (OR = 2.5); being divorced, widowed, or separated (OR = 2.9); genital ulcer treatment in the last year (OR = 2.9); history of stillbirth (OR = 2.8, one stillbirth; OR = 4.3, 2�5 stillbirths); and history of preterm delivery (OR = 2.7, one preterm delivery). Conclusion Many women without identified risk factors were syphilis-seropositive. Younger HIV-infected women were at highest risk. Universal integrated antenatal HIV and syphilis screening and treatment is essential in sub-Saharan African settings.
Potter, Dara; Goldenberg, Robert L.; Read, Jennifer S.; Wang, Jing; Hoffman, Irving F.; Saathoff, Elmar; Kafulafula, George; Aboud, Said; Martinson, Francis E. A.; Dahab, Maysoon; Vermund, Sten H.
Management of the invasive Mimosa pigra L. in Lochinvar National Park, Zambia
Mimosa pigra L. is a tropical\\/sub-tropical spiny shrub that is becoming invasive in several parts of Asia, Australia and Africa. It is spreading on several floodplains where it can form thick, impenetrable, one-species stands that exclude other plants and most animals - both terrestrial and aquatic. M. pigra has invaded the floodplain of the Kafue River - a significant tributary
Griffin K. Shanungu
Architecture Beyond Architecture Experimental Institutional Design Projects: Ethiopia, Sri Lanka, Tanzania, Zambia.
National Technical Information Service (NTIS)
The report is a documentation of the experimental study program introduced to the participants of the Master Program majoring in architectural design, in order to see beyond the western concepts and conventional design process and to meet the challenge ca...
A. Nevanlinna V. Kokuleraj
SADCC-Petroleum Acts from 6 SADCC Countries: Angola, Botswana, Malawi, Mozambique, Tanzania, Zambia.
National Technical Information Service (NTIS)
The document reprints the petroleum exploration and production laws of 6 member countries of the Southern African Development Coordination Conference (SADCC). Those countries included in the document are Angola, Botswana, Malawi, Mozambique, Tanzania, and...
P a g e | 1 ZAMBIA HUMAN RESOURCES FOR TREATING NEW CANCER CASES IN ZAMBIA Executive Summary The purpose of this report is to describe the human resources needed in Zambia to treat new cancer patients. The population of Zambia is approximately
Inappropriately low aldosterone concentrations in adults with AIDS-related diarrhoea in Zambia: a study of response to fluid challenge
Background Chronic diarrhoea is one of the most debilitating consequences of HIV infection in sub-Saharan Africa and it carries a high mortality rate. We report unexpectedly low concentrations of circulating aldosterone in 12 patients (6 men, 6 women) in the University Teaching Hospital, Lusaka, who all had diarrhoea for over one month. Changes in serum electrolytes, blood pressure, Karnofsky score and serum aldosterone concentration were being monitored during a short study of responses to saline infusion (3 litres/24 h) over 72 hours. Findings At baseline, 9/12 (75%) of the patients were hyponatraemic, 10/11 (91%) were hypokalaemic, and 6/12 (50%) had undetectable aldosterone concentrations. Blood pressure and Karnofsky score rose and creatinine concentration fell in response to the infusion. Conclusion Circulating aldosterone concentrations were inappropriately low and complicate the profound electrolyte deficiencies resulting from chronic diarrhoea. Management of these deficiencies needs to be more aggressive than is currently practised and consideration should be given to a formal clinical trial of mineralocorticoid replacement in these severely ill patients. If the inappropriately low aldosterone reflects a general adrenal failure, it may explain a considerable proportion of the high mortality seen both before and after initiation of anti-retroviral therapy.
Kaile, Trevor; Zulu, Isaac; Lumayi, Ruth; Ashman, Neil; Kelly, Paul
Sediment accumulation and carbon, nitrogen, and phosphorus deposition in the large tropical reservoir Lake Kariba (Zambia/Zimbabwe)
NASA Astrophysics Data System (ADS)
Large dams affect the aquatic continuum from land to ocean by accumulating particles and nutrients in their reservoirs. We examined sediment cores to quantify sediment, organic carbon (OC), nitrogen (N), and phosphorous (P) accumulation, and to examine historic changes and spatial variability in the sedimentation pattern in Lake Kariba, the largest hydropower reservoir in the Zambezi River Basin (ZRB). Sediment characteristics (concentrations of OC, N, P; ?13C and ?15N; wet bulk density) showed large variability both with sediment depth and between cores. While organic matter (OM) in river deltas was primarily allochthonous in origin, OM characteristics (?13C, C:N) in lacustrine sediments suggest that autochthonous sources account for >45% of the OM that accumulates over large areas of the lake. At the same time, the relative contribution of allochthonous material within individual layers of lacustrine cores varied considerably with depth due to discrete flood deposits. The overall sediment accumulation rate in Lake Kariba is on the order of 4 � 106 t yr-1, and the estimated OC accumulation of 120 � 103 t C yr-1 accounts for �1� of globally buried OC in reservoirs. In addition, mass balance calculations revealed that approximately 70% and 90% of incoming total N and P, respectively, are eliminated from the water column by sedimentation (N, P) and denitrification (N). Since Lake Kariba attenuates flow from �50% of the ZRB, these OC, N, and P removals represent a drastic reduction in nutrient loadings to downstream riparian ecosystems and to the coastal Indian Ocean.
Kunz, Manuel J.; Anselmetti, Flavio S.; W�est, Alfred; Wehrli, Bernhard; Vollenweider, Adrian; Th�ring, Silvan; Senn, David B.
Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.
The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. PMID:24786142
Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Fa�ndes, Anibal
'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa. | accrualnet.cancer.gov
Rumors as to the purpose and outcome of research are a common feature of medical research conducted in developing countries. This paper presents a case study of how deep-seated suspicions among trial participants and family members can challenge medical research and public health interventions. The �rumors� are commentaries on social relations, involving and extending beyond scientific medical research. Consequently, rumors are best understood as metaphors representing local concerns and should be considered within this context.
Detection of Salmonella invA by isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) in Zambia
The isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) is a new isothermal DNA amplification method composed of exo Bca DNA polymerase, RNaseH and DNA�RNA chimeric primers. We detected invA of Salmonella from chicken carcasses, egg yolk and cattle fecal samples. Fifty-three of 59 isolates were invA-positive in ICAN-chromatostrip detection. The result was consistent with those obtained by standard
Emiko Isogai; Chitwambi Makungu; John Yabe; Patson Sinkala; Andrew Nambota; Hiroshi Isogai; Hideto Fukushi; Manda Silungwe; Charles Mubita; Michelo Syakalima; Bernard Mudenda Hang'ombe; Shunji Kozaki; Jun Yasuda
An Assessment of Cost, Quality and Outcomes for Five HIV Prevention Youth Peer Education Programs in Zambia
ERIC Educational Resources Information Center
Youth peer education (YPE) programs are a popular strategy for HIV prevention in sub-Saharan Africa. However, research on the effectiveness of YPE programs is scarce and the wide variation in programs makes it difficult to generalize research findings. Measuring quality and comparing program effectiveness require the use of standardized�
Burke, H. M.; Pedersen, K. F.; Williamson, N. E.
USAID/ZAMBIA Bender Assessment and Education Strategy Workshop Proceedings. Held on May 23-27, 2005.
National Technical Information Service (NTIS)
The objectives of the workshop were to: Form a collective understanding of gender integration and gender equality and its implications for effective basic education; Increase knowledge and skills in gender assessment including using some basic assessment ...
Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model
BACKGROUND: Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. METHOD: This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health
Max O Bachmann
A Primary Healthcare Screening Tool to Identify Depression and Anxiety Disorders among People with Epilepsy in Zambia
Among the 50 million people with epilepsy (PWE) worldwide, ~15 to 60% also likely suffer from depression and/or anxiety disorders and 80% reside in low-income regions where these comorbidities are often under-recognised and undertreated. We developed a 10-item screening tool for the detection of depression and anxiety disorders for use in Zambian primary care clinics where the baseline detection rate of depression and/or anxiety disorders among PWE is ~1%. Consenting adults (n=595) completed the screening tool and 53.7% screened positive. The screen was validated by a Psychiatric Clinical Officer using DMS-IV criteria. Cronbach�s Alpha was 0.77 overall, and 0.67 and 0.57 for the depression and anxiety components, respectively. Other test characteristics included sensitivity 56.63%, specificity 68.05%, positive predictive value 67.3%, and negative predictive value 57.5%. Interrater reliability (kappa) was 0.85. The psychometric qualities of the tool are inadequate. Development of further, better quality instruments is needed though this will likely require a longer tool which the healthcare workers delivering epilepsy care services have previously deemed non-feasible for routine use. As we work toward development and acceptability of a more optimal instrument, use of this initial screening tool which healthcare workers are willing to use may increase the identification of comorbid depression and anxiety in the low resource setting described in the study.
Mbewe, Edward K; Uys, Leana R; Nkwanyana, Ntombifikile M; Birbeck, Gretchen L
Strengthening Health Systems at Facility-Level: Feasibility of Integrating Antiretroviral Therapy into Primary Health Care Services in Lusaka, Zambia
IntroductionHIV care and treatment services are primarily delivered in vertical antiretroviral (ART) clinics in sub-Saharan Africa but there have been concerns over the impact on existing primary health care services. This paper presents results from a feasibility study of a fully integrated model of HIV and non-HIV outpatient services in two urban Lusaka clinics.MethodsIntegration involved three key modifications: i) amalgamation
Stephanie M. Topp; Julien M. Chipukuma; Mark Giganti; Linah K. Mwango; Like M. Chiko; Bushimbwa Tambatamba-Chapula; Chibesa S. Wamulume; Stewart Reid; Landon Myer
Education for All in the North and the South: Teachers' Attitudes towards Inclusive Education in Finland and Zambia
ERIC Educational Resources Information Center
A survey assessed attitudes of 1636 Zambian and Finnish teachers towards inclusive education and consequently the perceptions of appropriate educational environment for children with different disabilities. On the whole, attitudes varied but were quite critical. Structure of the attitudes was similar in both countries; factor analyses extracted�
Moberg, Sakari
A pilot study of food supplementation to improve adherence to antiretroviral therapy among food insecure adults in Lusaka, Zambia
Background: The provision of food supplementation to food insecure patients initiating antiretroviral therapy may improve adherence to medications. Methods: A home-based adherence support program at 8 government clinics assessed patients for food insecurity. 4 clinics provided food supplementation and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio [MPR]), CD4, and weight gain outcomes among food insecure patients enrolled at the food clinics to those of controls. Results: Between May 1, 2004 and March 31, 2005, 636 food insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. 258 of 366 (70%) of patients in the food group achieved an MPR of 95% or greater versus 79 of 166 (48%) among controls (relative risk, RR=1.5; 95%CI:1.2-1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline WHO stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response. Conclusions: This analysis suggests that providing food to food insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.
Cantrell, Ronald A.; Sinkala, Moses; Megazinni, Karen; Lawson-Marriott, Sibi; Washington, Sierra; Chi, Benjamin H.; Tambatamba-Chapula, Bushimbwa; Levy, Jens; Stringer, Elizabeth M.; Mulenga, Lloyd; Stringer, Jeffrey S. A.
The impact of project closure on HIV incidence and mortality in a cohort of couples in Lusaka, Zambia.
The objective of this study was to assess the impact of temporary closure of an HIV research clinic on the health of study participants. Primary data were collected quarterly from couples enrolled in research studies at an established HIV study site. There were 632 participating couples enrolled when the project closed, 475 of whom returned when it re-opened six months later. HIV sero-incidence, mortality rates and risk-taking behaviours were compared before and during the closure. Perceived impact of the closure was measured in returning participants. Demographic data collected at the last pre-closure study visit were used to look at the differences between returning and non-returning study participants. Serologic data from those who returned were compared pre- and post-closure to examine changes in HIV incidence. Mortality rates were estimated from reported deaths, and were compared pre- and during project closure. Perceptions of the impact of the closure among returning participants were examined through an interviewer administered questionnaire. It was found that couples who returned were not demographically different from couples who did not return. Most participants reported no problems with finding alternate sources of condoms and the incidence of HIV did not change significantly during the closure. Eighty-four percent respondents reported that the closure had a negative impact on them, 87% of whom rated loss of medical care as the main impact. The mortality rate among HIV-positive participants doubled from 6.7/100 person years to 12.4/100 person years during the closure (p=0.01). Results indicate that couples voluntary counselling and testing (CVCT) established durable risk-reduction behaviours that persisted during project closure. ThIn ae loss of healthcare was perceived as the most negative impact on participants, reflected in increased mortality rates. Research projects should make transition plans and budget for mechanisms to reduce the negative impact on participants of project closures. PMID:18576170
Stephenson, R; Shutes, E; McKenna, S; Allen, S; Brill, I; Kancheya, N; Zulu, I; Sinkala, M; Tichacek, A; Chomba, E
Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia
BACKGROUND: Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services,
Lumbwe Chola; Bjarne Robberstad
Hazardous Wastes in Zambian Households: A Pilot Study.
National Technical Information Service (NTIS)
In 1998, the Environmental Council of Zambia (ECZ), as part of its activities for the Basil Convention on Transborder Handling of Hazardous Wastes, asked the Wildlife and Environmental Conservation Society of Zambia (Wildlife Society) to begin thinking ab...
J. O. Nriagu
3 CFR - Emergency Fund Drawdown to Assist Zimbabwean Refugees in South Africa, Botswana, Mozambique, and...
Code of Federal Regulations, 2010 CFR
...Emergency Fund Drawdown to Assist Zimbabwean Refugees in South Africa, Botswana, Mozambique, and Zambia Presidential...Emergency Fund Drawdown to Assist Zimbabwean Refugees in South Africa, Botswana, Mozambique, and Zambia Memorandum...
An overview of industrial wastewater treatment and analysis as means of preventing pollution of surface and underground water bodies�the case of Nkana Mine in Zambia
NASA Astrophysics Data System (ADS)
The wastewaters coming from mining operations usually have low pH (acidic) values and high levels of metal pollutants depending on the type of metals being extracted. If unchecked, the acidity and metals will have an impact on the surface water. The organisms and plants can adversely be affected and this renders both surface and underground water unsuitable for use by the communities. The installation of a treatment plant that can handle the wastewaters so that pH and levels of pollutants are reduced to acceptable levels provides a solution to the prevention of polluting surface and underground waters and damage to ecosystems both in water and surrounding soils. The samples were collected at five points and analyzed for acidity, total suspended solids, and metals. It was found that the pH fluctuated between pH 2 when neutralization was forgotten and pH 11 when neutralization took place. The levels of metals that could cause impacts to the water ecosystem were found to be high when the pH was low. High levels of metals interfere with multiplication of microorganisms, which help in the natural purification of water in stream and river bodies. The fish and hyacinth placed in water at the two extremes of pH 2 and pH 11 could not survive indicating that wastewaters from mining areas should be adequately treated and neutralized to pH range 6-9 if life in natural waters is to be sustained.
Ntengwe, F. W.
Educational benefits from solar technology�Access to solar electric services and changes in children's study routines, experiences from eastern province Zambia
Solar technology is diffused in many parts of the world with the ambition to improve the situation in rural areas. One claimed benefit of solar power at household level is improved situation for studies. The aim of this article is to analyse the impacts that access to solar electric services can have on education in a rural setting. The results
Mathias Gustavsson
Efficacy of ACTELLIC 300 CS, pirimiphos methyl, for indoor residual spraying in areas of high vector resistance to pyrethroids and carbamates in Zambia.
The selection of insecticide resistance in malaria vectors has the potential to compromise any insecticide-based malaria vector control program. To ensure that transmission-interrupting tools remain effective, and their choice is evidence based, insecticide surveillance and monitoring is essential. This study assessed and compared the residual efficacy of an organophosphate insecticide pirimiphos methyl (ACTELLIC 300 CS, 0-2-diethylamino-6-methylpyrimidin-4-yl 0, 0-dimethylphosphorothioate) at 1 g/m2 and the pyrethroid deltamethrin (K-Othrine WG 250, (S)-alpha-cyano-3-phenoxybenzyl (1R, 3R)-3- (2,2-dibromovinyl)-2,2-dimethylcyclopropane carboxylate) at 20 mg/m2 for indoor residual spraying on cement and mud-rendered walls inside houses. Insecticide susceptibility profiles of local malaria vectors were also assessed using World Health Organization standard protocols. The residual efficacy of ACTELLIC 300 CS on cement and mud walls lasted for 5 mo on both surfaces, with complete mortality of Anopheles gambiae sensu stricto Giles (Kisumu strain) (Diptera: Culicidae) in cone assays. By 8 mo, the average residual effect of ACTELLIC 300 CS remained much better on cement walls than on mud walls but not significantly different from deltamethrin-treated cement walls. Anopheles funestus sensu stricto Giles was resistant to 0.05% deltamethrin and 0.01% bendiocarb but remained completely susceptible to 5% malathion and 4% dichlorodiphenyltrichloroethane. The duplicated P450 genes, CYP6P9a and CYP6P9b, were found to be highly overexpressed in deltamethrin-resistant An. funestus s.s as compared with bendiocarb-resistant individuals. Pirimiphos methyl CS is recommended for intra-domiciliary spraying for malaria control and could replace dichlorodiphenyltrichloroethane within the context of an insecticide resistance management strategy. PMID:24843932
Chanda, Emmanuel; Chanda, Javan; Kandyata, Alister; Phiri, Faustina N; Muzia, Lucy; Haque, Ubydul; Baboo, Kumar S
These Wetlands are lands with characteristics between aquatic and terrestrial ecosystems. They generally consist of grasslands, swamps, marshes, peat bogs, willows, mangroves, etc. Some wetlands are found in shallow slow flowing or percolating waters with hydric soils and hydrophytic vegetation. These characteristics ensure the biological diversity and uniqueness of wetland ecosystems. However, as population increases there is increased need to
Michael Aduah; Ben Maathuis; Yousif Ali Hussin
A method of active case detection to target reservoirs of asymptomatic malaria and gametocyte carriers in a rural area in Southern Province, Zambia
BACKGROUND: Asymptomatic reservoirs of malaria parasites are common yet are difficult to detect, posing a problem for malaria control. If control programmes focus on mosquito control and treatment of symptomatic individuals only, malaria can quickly resurge if interventions are scaled back. Foci of parasite populations must be identified and treated. Therefore, an active case detection system that facilitates detection of
Gillian H Stresman; Aniset Kamanga; Petros Moono; Harry Hamapumbu; Sungano Mharakurwa; Tamaki Kobayashi; William J Moss; Clive Shiff
Prevalence of antibodies to Brucella spp. and individual risk factors of infection in traditional cattle, goats and sheep reared in livestock-wildlife interface areas of Zambia.
A cross-sectional study was performed in the livestock-wildlife interface areas of Lochinvar and Blue Lagoon National Parks and the non-interface area of Kazungula to determine the prevalence of antibodies to Brucella spp. in domestic ruminants and identify individual animal risk factors of infection. A total of 1245 cattle from 124 herds and 280 goats and sheep from 29 flocks were tested sequentially for Brucella antibodies using the Rose Bengal test (RBT) and competitive ELISA. In cattle, individual seroprevalence ranged from 14.1% to 28.1%, while herd sero-prevalence ranged from 46.2% to 74.0% in the three study areas. No goat or sheep tested positive for Brucella antibodies. Three types of cattle grazing strategies were encountered: locally grazed herds (LGH), transhumantly grazed herds (TGH) and river flood plain grazed herds (FGH). Brucella seroprevalence was seen to vary according to area and grazing strategy: Lochinvar and transhumant grazed herds recorded the highest figures, respectively. Age, sex and history of abortion were found to have independent effects on individual seroprevalence. This study establishes that brucellosis is endemic in domestic animals in the livestock-wildlife interface areas of Blue Lagoon and Lochinvar national parks and the disease is also present in Kazungula. We observed that type of grazing strategy had significant impact on cattle Brucella seroprevalence and that transhumant herds were at high risk of being infected. PMID:16986767
Muma, J B; Samui, K L; Siamudaala, V M; Oloya, J; Matop, G; Omer, M K; Munyeme, M; Mubita, C; Skjerve, E
Putting the 2007\\/2008 global food crisis in longer-term perspective: Trends in staple food affordability in urban Zambia and Kenya
Staple food prices in cities in eastern and southern Africa rose sharply between late 2007 and early 2009, leading to estimates of massive increases in food insecurity and hunger. However, in assessing the impacts of soaring food prices on urban consumers� access to food it is important to consider food price changes relative to changes in per capita incomes. In
Nicole M. Mason; T. S. Jayne; Antony Chapoto; Cynthia Donovan
To Feed Ourselves. A Proceedings of the First Eastern, Central and Southern Africa Regional Maize Workshop Held at Lusaka, Zambia, March 10-17, 1985.
National Technical Information Service (NTIS)
Proceedings from a March 1985 workshop on maize research and production in the eastern, central, and southern Africa regions are presented. Eighteen country reports are provided by scientists from Angola, Burundi, Ethiopia, Kenya, Lesotho, Madagascar, Mal...
Risk Factors Associated with Positive QuantiFERON-TB Gold InTube and Tuberculin Skin Tests Results in Zambia and South Africa
IntroductionThe utility of T-cell based interferon-gamma release assays for the diagnosis of latent tuberculosis infection remains unclear in settings with a high burden of tuberculosis.ObjectivesTo determine risk factors associated with positive QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) results and the level of agreement between the tests; to explore the hypotheses that positivity in QFT-GIT is more related
Kwame Shanaube; James Hargreaves; Katherine Fielding; Ab Schaap; Katherine-Anne Lawrence; Bernadette Hensen; Charalambos Sismanidis; Angela Menezes; Nulda Beyers; Helen Ayles; Peter Godfrey-Faussett; Madhukar Pai
The Quality of Education: Some Policy Suggestions Based on a Survey of Schools--Zambia. An Interim Report. SACMEQ Policy Research Report.
ERIC Educational Resources Information Center
The Southern Africa Consortium for Monitoring Educational Quality (SACMEQ) is a consortium of ministries of education in southern Africa. This bound report--one of seven--presents the research results and policy suggestions that emerged from implementation of SACMEQ's initial educational policy research project. The report looks broadly at five�
Nkamba, Manasseh; Kanyika, Joe
Identification, modification, and implementation of an evidence-based psychotherapy for children in a low-income country: the use of TF-CBT in Zambia
Background The need to address the treatment gap in mental health services in low- and middle-income countries (LMIC) is well recognized and particularly neglected among children and adolescents. Recent literature with adult populations suggests that evidence-based mental health treatments are effective, feasible, and cross-culturally modifiable for use in LMIC. This paper addresses a gap in the literature documenting pre-trial processes. We describe the process of selecting an intervention to meet the needs of a particular population and the process of cross-cultural adaptation. Methods Community-based participatory research principles were implemented for intervention selection, including joint meetings with stakeholders, review of qualitative research, and review of the literature. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) was chosen as the evidence-based practice for modification and feasibility testing. The TF-CBT adaptation process, rooted within an apprenticeship model of training and supervision, is presented. Clinical case notes were reviewed to document modifications. Results Choosing an intervention can work as a collaborative process with community involvement. Results also show that modifications were focused primarily on implementation techniques rather than changes in TF-CBT core elements. Conclusions Studies documenting implementation processes are critical to understanding why intervention choices are made and how the adaptations are generated in global mental health. More articles are needed on how to implement evidence-based treatments in LMIC.
Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study
Background Single-dose nevirapine (SDNVP) for the prevention of mother-to-child HIV transmission (PMTCT) results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood. Methods We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders. Results Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0). Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19%) at both the first (unexposed) and second (exposed) delivery. The results were unchanged, if infant death was included as an outcome. Conclusion These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
Walter, Jan; Kuhn, Louise; Kankasa, Chipepo; Semrau, Katherine; Sinkala, Moses; Thea, Donald M; Aldrovandi, Grace M
Morbidity and Mortality Among a Cohort of Human Immunodeficiency Virus Type 1-Infected and Uninfected Pregnant Women and Their Infants From Malawi, Zambia, and Tanzania
Background: Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions. Methods: Data from mothers and their infants enrolled in a trial of antibiotics to reduce mother-to-child-transmission of HIV-1 at 4 sub-Saharan African sites were analyzed. Women were enrolled during pregnancy and follow-up continued until the infants reached 12 months of age. We describe maternal and infant morbidity and mortality in a cohort of HIV-1-infected and HIV-1-uninfected mothers. Maternal and infant factors associated with mortality risk in the infants were assessed using Cox proportional hazard modeling. Results: Among 2292 HIV-1-infected mothers, 166 (7.2%) had a serious adverse event (SAE) and 42 (1.8%) died, whereas no deaths occurred among the 331 HIV-1 uninfected mothers. Four hundred twenty-four (17.8%) of 2383 infants had an SAE and 349 (16.4%) died before the end of follow-up. Infants with early HIV-1 infection (birth to 4 � 6 weeks) had the highest mortality. Among infants born to HIV-1-infected women, maternal morbidity and mortality (P = 0.0001), baseline CD4 count (P = 0.0002), and baseline plasma HIV-1 RNA concentration (P < 0.0001) were significant predictors of infant mortality in multivariate analyses. Conclusions: The high mortality among infants with early HIV-1 infection supports access to HIV-1 diagnostics and appropriate early treatment for all infants of HIV-1-infected mothers. The significant association between stage of maternal HIV-1 infection and infant mortality supports routine CD4 counts at the time of prenatal HIV-1 testing.
Chilongozi, David; Wang, Lei; Brown, Lillian; Taha, Taha; Valentine, Megan; Emel, Lynda; Sinkala, Moses; Kafulafula, George; Noor, Ramadhani A.; Read, Jennifer S.; Brown, Elizabeth R.; Goldenberg, Robert L.; Hoffman, Irving