OpenUCT :: Browsing by Subject "Zambia"

Browsing by Subject "Zambia"

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Open Access
An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
(BioMed Central Ltd, 2011) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, Alan
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.
Open Access
Clinical and genetic analysis of spinocerebellar ataxia type 7 (SCA7) in Zambian families
(BioMed Central, 2017-11-29) Atadzhanov, Masharip; Smith, Danielle C; Mwaba, Mwila H; Siddiqi, Omar K; Bryer, Alan; Greenberg, L Jacquie
Background: To date, 43 types of Spinocerebellar Ataxias (SCAs) have been identified. A subset of the SCAs are caused by the pathogenic expansion of a CAG repeat tract within the corresponding gene. Ethnic and geographic differences are evident in the prevalence of the autosomal dominant SCAs. Few descriptions of the clinical phenotype and molecular genetics of the SCAs are available from the African continent. Established studies mostly concern the South African populations, where there is a high frequency of SCA1, SCA2 and SCA7. The SCA7 mutation in South Africa (SA) has been found almost exclusively in families of indigenous Black African ethnic origin. Objective: To present the results of the first clinical description of seven Zambian families presenting with autosomal dominant SCA, as well as the downstream molecular genetic analysis of a subset of these families. Methods: The study was undertaken at the University Teaching Hospital in Lusaka, Zambia. Ataxia was quantified with the Brief Ataxia Rating Scale derived from the modified international ataxia rating scale. Molecular genetic testing for 5 types of SCA (SCA1, SCA2, SCA3, SCA6 and SCA7) was performed at the National Health Laboratory Service at Groote Schuur Hospital and the Division of Human Genetics, University of Cape Town, SA. The clinical and radiological features were evaluated in seven families with autosomal dominant cerebellar ataxia. Molecular genetic analysis was completed on individuals representing three of the seven families. Results: All affected families were ethnic Zambians from various tribes, originating from three different regions of the country (Eastern, Western and Central province). Thirty-four individuals from four families had phenotypic features of SCA7. SCA7 was confirmed by molecular testing in 10 individuals from 3 of these families. The age of onset of the disease varied from 12 to 59 years. The most prominent phenotypic features in these families were gait and limb ataxia, dysarthria, visual loss, ptosis, ophthalmoparesis/ophthalmoplegia, pyramidal tract signs, and dementia. Affected members of the SCA7 families had progressive macular degeneration and cerebellar atrophy. All families displayed marked anticipation of age at onset and rate of symptom progression. The pathogenic SCA7 CAG repeat ranges varied from 47 to 56 repeats. Three additional families were found to have clinical phenotypes associated with autosomal dominant SCA, however, DNA was not available for molecular confirmation. The age of onset of the disease in these families varied from 19 to 53 years. The most common clinical picture in these families included a combination of cerebellar symptoms with slow saccadic eye movements, peripheral neuropathy, dementia and tremor. Conclusion: SCA is prevalent in ethnic Zambian families. The SCA7 families in this report had similar clinical presentations to families described in other African countries. In all families, the disease had an autosomal dominant pattern of inheritance across multiple generations. All families displayed anticipation of both age of onset and the rate of disease progression. Further clinical and molecular investigations of the inherited ataxias in a larger cohort of patients is important to understand the natural history and origin of SCAs in the Zambian population.
Open Access
Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia
(BioMed Central Ltd, 2009) Chanda, Pascalina; Castillo-Riquelme, Marianela; Masiye, Felix
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.
Open Access
Epidemiology of pharyngitis as reported by Zambian school children and their families: implications for demand-side interventions to prevent rheumatic heart disease
(BioMed Central, 2017-07-06) Musuku, John; Lungu, Joyce C; Machila, Elizabeth; Jones, Catherine; Colin, Laurence; Schwaninger, Sherri; Musonda, Patrick; Tadmor, Brigitta; Spector, Jonathan M; Engel, Mark E; Zühlke, Liesl J
Background: Prompt and appropriate treatment of streptococcal pharyngitis decreases the risk of acute rheumatic fever and rheumatic heart disease (RHD). Understanding public perceptions and behaviors related to sore throat is fundamental to inform health programs aimed at eliminating new cases of RHD in endemic regions. We sought to describe the epidemiology of pediatric pharyngitis and its treatment, as reported by children and their parents or guardians in Lusaka, Zambia. Methods: This was a cross-sectional investigation using interviews and written surveys, nested in a school-based RHD prevalence study. Students and their parents were asked to report number of sore throats in the previous 12 months, treatment received, and type and place of treatment. A focused history and physical examination to detect pharyngitis was conducted and children were referred for follow-up as indicated. Results: A total of 3462 students from 47 schools participated in the study, along with their parents or guardians. Six hundred and fifty eight (19%) parents/guardians reported their child had at least one sore throat in the previous year, and 835 (24%) of students reported at least one sore throat in the same time period. Girls were reported to have pharyngitis 50% more often than boys, and also made up two-thirds of the total students treated. Approximately two-thirds of children who had at least one episode of pharyngitis during the previous year were also reported to have received some form of treatment. The majority of treatments were received in government clinics (36.6%) and at home (26.3%). Half of treatments included an antibiotic. Nineteen students (0.5%) had clinically-apparent pharyngitis at screening. Conclusion: Pharyngitis is common among school-aged children and adolescents in Zambia, with females reporting significantly more sore throat episodes than males. Parents/guardians have variable knowledge about the frequency of sore throat in their children, and management of pharyngitis may be suboptimal for many children since more than a quarter were reported to have received treatment without skilled assessment. These results provide insight into current perceptions and practices related to sore throat in Zambia and will be used to design public awareness activities aimed at reducing RHD.
Open Access
Estimating loss to follow-up in HIV-infected patients on antiretroviral therapy: the effect of the competing risk of death in Zambia and Switzerland
(Public Library of Science, 2011) Schöni-Affolter, Franziska; Keiser, Olivia; Mwango, Albert; Stringer, Jeffrey; Ledergerber, Bruno; Mulenga, Lloyd; Bucher, Heiner C; Westfall, Andrew O; Calmy, Alexandra; Boulle, Andrew; Chintu, Namwinga; Egger, Matthias; Chi, Benjamin H
BACKGROUND: Loss to follow-up (LTFU) is common in antiretroviral therapy (ART) programmes. Mortality is a competing risk (CR) for LTFU; however, it is often overlooked in cohort analyses. We examined how the CR of death affected LTFU estimates in Zambia and Switzerland. Methods and FINDINGS: HIV-infected patients aged ≥18 years who started ART 2004-2008 in observational cohorts in Zambia and Switzerland were included. We compared standard Kaplan-Meier curves with CR cumulative incidence. We calculated hazard ratios for LTFU across CD4 cell count strata using cause-specific Cox models, or Fine and Gray subdistribution models, adjusting for age, gender, body mass index and clinical stage. 89,339 patients from Zambia and 1,860 patients from Switzerland were included. 12,237 patients (13.7%) in Zambia and 129 patients (6.9%) in Switzerland were LTFU and 8,498 (9.5%) and 29 patients (1.6%), respectively, died. In Zambia, the probability of LTFU was overestimated in Kaplan-Meier curves: estimates at 3.5 years were 29.3% for patients starting ART with CD4 cells <100 cells/µl and 15.4% among patients starting with ≥350 cells/µL. The estimates from CR cumulative incidence were 22.9% and 13.6%, respectively. Little difference was found between naïve and CR analyses in Switzerland since only few patients died. The results from Cox and Fine and Gray models were similar: in Zambia the risk of loss to follow-up and death increased with decreasing CD4 counts at the start of ART, whereas in Switzerland there was a trend in the opposite direction, with patients with higher CD4 cell counts more likely to be lost to follow-up. CONCLUSIONS: In ART programmes in low-income settings the competing risk of death can substantially bias standard analyses of LTFU. The CD4 cell count and other prognostic factors may be differentially associated with LTFU in low-income and high-income settings.
Open Access
Evaluating the impact of bilateral and multilateral official development assistance on economic growth in Zambia
(2020) Nsomi-Mukuka, Nonde; Alhassan, Abdul Latif
As a recipient of Official Development Assistance (ODA), the Republic of Zambia is considered one of the aid-dependent nations in Sub-Saharan Africa. Development assistance has been said to have had made absolutely no contribution to economic growth and development in the country on observation of the Gross Domestic Product (GDP) per capita figure over the years which indicates periods of stagnation in growth despite ODA receipts. Generally, this conclusion has in the past been drawn without consideration for, and appreciation of, the variations in the objectives and disbursement channels of ODA. Consequently, this study sought to investigate the separate impact of multilateral and bilateral ODA on GDP per capita which served as a proxy for economic growth and development in Zambia. Based on a modified neo-classical economic growth model that incorporates multilateral and bilateral ODA as determinants of economic growth, this study employed the ARDL model to investigate the long-run and short-run relationship between GDP per capita and ODA from 1975 to 2016. Two similar growth models were analysed substituting the net ODA variable with multilateral and bilateral ODA in order to assess the relationship. In addition to net ODA, the model included the variables investment, trade openness and the labour force as determinants of economic growth. Findings from the study show that multilateral ODA had a significant negative impact on GDP per capita, while the bilateral ODA model showed a statistically insignificant negative relationship. The findings of the study support the notion that different types of foreign aid cannot be expected to have a uniform impact on growth and development in terms of effectiveness. The recommendations point to the importance of re-evaluation of modalities by donors to ensure that development assistance is more effective in achieving sustainable development goals.
Open Access
Growth patterns of infants with in- utero HIV and ARV exposure in Cape Town, South Africa and Lusaka, Zambia
(2022-01-10) Nyemba, Dorothy C.; Kalk, Emma; Vinikoor, Michael J; Madlala, Hlengiwe P; Mubiana-Mbewe, Mwangelwa; Mzumara, Maureen; Moore, Carolyn B; Slogrove, Amy L; Boulle, Andrew; Davies, Mary-Ann; Myer, Landon; Powis, Kathleen
Background Infants born HIV-exposed yet remain uninfected (HEU) are at increased risk of poorer growth and health compared to infants born HIV-unexposed (HU). Whether maternal antiretroviral treatment (ART) in pregnancy ameliorates this risk of poorer growth is not well understood. Furthermore, whether risks are similar across high burden HIV settings has not been extensively explored. Methods We harmonized data from two prospective observational studies conducted in Cape Town, South Africa, and Lusaka, Zambia, to compare weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) Z-scores between infants who were HEU and HU, converting infant anthropometric measures using World Health Organisation Growth Standards adjusted for age and sex. Linear mixed effects models were fit to identify risk factors for differences in anthropometrics at 6–10 weeks and 6 months by infant HIV exposures status and by timing of exposure to maternal ART, either from conception or later in gestation. Results Overall 773 mother-infant pairs were included across two countries: women living with HIV (WLHIV), 51% (n = 395) with 65% on ART at conception and 35% initiating treatment in pregnancy. In linear mixed effects models, WAZ and WLZ at 6–10 weeks were lower among infants who were HEU vs HU [β = − 0.29 (95% CI: − 0.46, − 0.12) and [β = − 0.42 (95% CI: − 0.68, − 0.16)] respectively after adjusting for maternal characteristics and infant feeding with a random intercept for country. At 6 months, LAZ was lower [β = − 0.28 CI: − 0.50, − 0.06)] among infants who were HEU, adjusting for the same variables, with no differences in WAZ and WLZ. Within cohort evaluations identified different results with higher LAZ among infants who were HEU from Zambia at 6–10 weeks, [β = + 0.34 CI: + 0.01, + 0.68)] and lower LAZ among infants who were HEU from South Africa [β = − 0.30 CI: − 0.59, − 0.01)] at 6 months, without other anthropometric differences at either site. Conclusion Infant growth trajectories differed by country, highlighting the importance of studying contextual influences on outcomes of infants who were HEU.
Open Access
Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: the PEARL study
(Public Library of Science, 2012) Ekouevi, Didier K; Stringer, Elizabeth; Coetzee, David; Tih, Pius; Creek, Tracy; Stinson, Kathryn; Westfall, Andrew O; Welty, Thomas; Chintu, Namwinga; Chi, Benjamin H
BACKGROUND: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant. Conclusions/RESULTS: We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage.
Open Access
Hepatitis B infection, viral load and resistance in HIV-infected patients in Mozambique and Zambia
(Public Library of Science, 2016) Wandeler, Gilles; Musukuma, Kalo; Zürcher, Samuel; Vinikoor, Michael J; Llenas-García, Jara; Aly, Mussa M; Mulenga, Lloyd; Chi, Benjamin H; Ehmer, Jochen; Hobbins, Michael A; Bolton-Moore, Carolyn; Hoffmann, Christopher J; Egger, Matthias; IeDEA-Southern Africa
BACKGROUND: Few data on the virological determinants of hepatitis B virus (HBV) infection are available from southern Africa. METHODS: We enrolled consecutive HIV-infected adult patients initiating antiretroviral therapy (ART) at two urban clinics in Zambia and four rural clinics in Northern Mozambique between May 2013 and August 2014. HBsAg screening was performed using the Determine ® rapid test. Quantitative real-time PCR and HBV sequencing were performed in HBsAg-positive patients. Risk factors for HBV infection were evaluated using Chi-square and Mann-Whitney tests and associations between baseline characteristics and high level HBV replication explored in multivariable logistic regression. RESULTS: Seventy-eight of 1,032 participants in Mozambique (7.6%, 95% confidence interval [CI]: 6.1-9.3) and 90 of 797 in Zambia (11.3%, 95% CI: 9.3-13.4) were HBsAg-positive. HBsAg-positive individuals were less likely to be female compared to HBsAg-negative ones (52.3% vs. 66.1%, p<0.001). Among 156 (92.9%) HBsAg-positive patients with an available measurement, median HBV viral load was 13,645 IU/mL (interquartile range: 192-8,617,488 IU/mL) and 77 (49.4%) had high values (>20,000 UI/mL). HBsAg-positive individuals had higher levels of ALT and AST compared to HBsAg-negative ones (both p<0.001). In multivariable analyses, male sex (adjusted odds ratio: 2.59, 95% CI: 1.22-5.53) and CD4 cell count below 200/μl (2.58, 1.20-5.54) were associated with high HBV DNA. HBV genotypes A1 (58.8%) and E (38.2%) were most prevalent. Four patients had probable resistance to lamivudine and/or entecavir. CONCLUSION: One half of HBsAg-positive patients demonstrated high HBV viremia, supporting the early initiation of tenofovir-containing ART in HIV/HBV-coinfected adults.
Open Access
Impacts of mining on land use - A case (study) of Luanshya district, Zambia
(2018) Sakuwaha, Kabangu Grace; Broadhurst, Jennifer; Odendaal, Nancy
Copper mining is the main driver of Zambia’s economic growth and development and plays a significant role in the global supply of materials for electrical, plumbing, heating and transport equipment among other benefits. However, primary production and beneficiation of copper pose serious risks to the mining districts such as environmental pollution, landscape alterations, land degradation and social economic challenges to the host communities. This research looks at the landscape alterations in the mining district of Luanshya, and how these alterations are related to mining and other land uses. Using remote sensing and Geographic Information Systems (GIS), the landscape alterations were mapped and analysed to identify the processes causing these alterations and their impacts on land use. Secondly, stakeholder interviews were conducted to gain a deeper understanding of the mapped landscape alterations, what the approach has been to land use planning and the stakeholder roles in this planning. Analysis of the findings identifies that landscape alterations in the district have been caused by different inter-related mechanisms stemming from a number of causes. These causes include high dependency on copper mining; inadequate enforcement of environmental legislation; lack of state involvement in land use planning of mining districts; and also global factors such as commodity market conditions. As a result, boom and bust commodity cycles have had significant impacts on the wellbeing of both mining communities and the environment. These impacts are not limited to the mine sites alone but extend to entire districts. This research also identifies that while mining plays a vital role in the economic development of Zambia, adequate enforcement of environmental legislation and adoption of inclusive land use planning may stimulate sustainable development of mining districts and foster sustainable land use patterns. Furthermore, this study recommends that future land use planning must be dynamic in terms of adopting postmining restoration of landscapes and infrastructure while also taking the direct and indirect impacts of mining into account.
Open Access
Implementing large-scale health system strengthening interventions: experience from the better health outcomes through mentoring and assessments (BHOMA) project in Zambia
(BioMed Central, 2018-10-19) Mutale, Wilbroad; Cleary, Susan; Olivier, Jill; Chilengi, Roma; Gilson, Lucy
Background Under the Doris Duke Charitable Foundation’s African Health Initiative, five Population Health Implementation and Training partnerships were established as long-term health system strengthening projects in five Sub-Saharan Countries. In Zambia, the Centre for Infectious Disease Research in Zambia began to implement the Better Health Outcomes through Mentorship and Assessments (BHOMA) in 2009. This was a combined community and health systems project involving 42 public facilities and their catchment populations. The impact of this intervention is reported elsewhere, but less attention has been paid to evaluation approaches that generate an understanding of the forces shaping the intervention. This paper is focused on understanding the implementation practices of the BHOMA intervention in Zambia. Methods Qualitative approaches were employed to understand and explain health systems intervention implementation practices between 2014 and 2016. We purposively sampled six clinics out of the 42 that participated in the BHOMA project within three districts of Lusaka province in Zambia. At the facility-level we targeted health centre in-charges, health workers, and community health workers. In-depth interviews (n = 22), focus group discussions (n = 3) and observations were also collected and synthesised. Results The major health system challenges addressed by the BHOMA project included poor infrastructure, lack of human resources, poor service delivery, long distances to health centres and inadequate health information systems. In order to implement this in the districts it was necessary to engage with the Ministry of Health and district managers, however, these partners were not actively engaged in intervention design There was great variation in perceptions about the BHOMA interventions. The implementation team considered BHOMA as a ‘proof of concept pilot project’, running parallel to the public health system, while district health officials from the Ministry of health understood it as a ‘long term partner’ and were therefore resistant to the short-term nature of the intervention. Conclusions The Normalization Process Theory provided a useful framework to understand and explain implementation processes for the BHOMA intervention in Zambia. We clearly demonstrated the applicability of all the four main components of the NPT: coherence (or sense-making); cognitive participation (or engagement); collective action and reflexive monitoring. We demonstrated how complex and dynamic the intervention played out among different actors and how implementation was affected by difference in appreciation and interpretation of the goal of the intervention. Our findings support the growing demand for process evaluations to use theory based approaches to examine how context interact with local interventions to affect outcomes intended or not. Trial registration ClinicalTrials.gov Identifier: NCT01942278 . Registered: September 13, 2013 (Retrospectively registered).
Open Access
Inequalities in public health care delivery in Zambia
(BioMed Central, 2014-03-19) Phiri, Jane; Ataguba, John E
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.
Open Access
Integrating mental health into primary health care in Zambia: a care provider's perspective
(BioMed Central Ltd, 2010) Mwape, Lonia; Sikwese, Alice; Kapungwe, Augustus; Mwanza, Jason; Flisher, Alan; Lund, Crick; Cooper, Sara
BACKGROUND:Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services.AIMS:The aim of this paper was to explore health providers' views about mental health integration into primary health care. METHODS: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). RESULTS: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems.RECOMMENDATIONS:It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. CONCLUSION: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.
Open Access
Knowledge management practices and challenges in international networked NGOs: the case of one world international
(Academic Conferences Ltd., 2008) Smith, Gretchen J; Lumba, Patricia Mweene
This paper is based on the outcomes of a study that explored the knowledge management practices and challenges in an international NGO network. The investigation constituted comparative case studies of two centres (one in Zambia and the other in the Netherlands) belonging to a single international network. An empirically grounded framework of knowledge management practices based on the taxonomy proposed by Holsapple and Joshi was utilised as the reference framework for the study. The framework provided guidelines to characterize factors that influence organizational knowledge management; knowledge manipulation activities (processes) and organizational knowledge resources. The results of the empirical study confirm that a variety of factors affect knowledge management behaviours in an organization. These factors include managerial and internal controls such as management styles and incentives for knowledge creation and sharing; resource influences; and environmental influences relating to an organization's culture and the needs of partner organizations. The study highlights important variation in diversity, gaps and perceptions in managing knowledge between centres in the network that are based in Europe and Africa. This is despite significant communality in knowledge management processes and infrastructures. The results further show that institutionalization of knowledge management practices within a network seem to enable or constrain knowledge management at centre and network level. Recommendations are proposed to improve knowledge management practices at local and international level and include enhanced technical and advisory services at international level; capacity building; creating greater awareness of knowledge management; decentralization of knowledge management processes; implementation of a knowledge management strategy at network level and improving relationships between centres. The authors conclude that networked NGO's and specifically OWI could operate more efficiently and incrementally enhance service provision by leveraging their knowledge resources more effectively. It is in this light that knowledge management practices should be examined in NGOs and particularly networks with their complex structures and attendant reoccurring and unavoidable problems.
Open Access
Micro, small medium enterprise (MSMEs) and financial inclusion in Zambia
(2021) Masialeti, Nalumino; Alhassan, Abdul Latif
This study investigated Zambia's current financial inclusion state with specific reference to micro, small and medium enterprises (MSMEs). It also sought to determine the relationship between the age of the owner of MSME, size, literacy, gender, age, the period of operations, asymmetrical information, and financial inclusion in Zambia. The data collected from 70 respondents comprising MSMEs owners were analysed using multiple regression, correlation analysis and descriptive statistics. The research employed dependent variables, notably access, availability, and financial services, as the dependent variable. In contrast, independent variables included the size of MSME, literacy level, income level of the owner of MSME, the period of operations and asymmetrical information. On the one hand, the empirical findings indicate a positive relationship between usage and availability of financial services, and 'MSME's age of owner, size, literacy, gender, age, operation period, asymmetrical information in Zambia. On the other hand, findings, however, also show a negative relationship between gender and financial inclusion access. Whilst a positive relationship with the remaining independent variables. Accordingly, the study concluded that financial inclusion is evident in Zambia among MSMEs. However, the primary issue is that most MSMEs do not have access to formal funding from formal financial institutions. Therefore, the study calls for policies to be put in place to help MSMEs have access to formal financing. In addition, it also proposes formalising 'women's informal sector, financial literacy roadshows for women in the informal sector, training women in digital skills to enable them to have better access to financial services and giving financial institutions targets to onboard women-led MSMEs.
Open Access
Prevalence of rheumatic heart disease in Zambian school children
(BioMed Central, 2018-07-03) Schwaninger, Sherri; Musuku, John; Engel, Mark E; Musonda, Patrick; Lungu, Joyce C; Machila, Elizabeth; Mtaja, Agnes; Mulendele, Evans; Kavindele, Dorothy; Spector, Jonathan; Tadmor, Brigitta; Gutierrez, Marcelo M; Van Dam, Joris; Colin, Laurence; Long, Aidan; Fishman, Mark C; Mayosi, Bongani M; Zühlke, Liesl J
Background The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country’s capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. Methods Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. Results Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. Conclusion The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. Trial registration The study was registered on clinicaltrials.gov ( #NCT02661763 ).
Open Access
Private Equity Financing in Zambia: Determinants and Constraints
(2019) Lumbala, Malasa; Chelwa, Grieve
Growth and development of small and medium-sized enterprises (SMEs) are the key drivers of economic growth and development in Africa. While this has become a widely accepted idea, access to financing for growth remains a stumbling block for many enterprises in Zambia. Traditional lenders (i.e. banks) are risk averse because they may not understand the SME market and have been negatively impacted by information asymmetry that is often associated with these ventures. As a result, they tend to charge exorbitant interest rates that are unsustainable for long-term growth. The existing focus of many microfinance institutions in Zambia is typically directed towards salaried employees which crowds out lending to SMEs. Private equity financing, on the other hand, presents an alternative solution to the long-term financing dilemma faced by enterprises. The Zambian private equity market is itself in a nascent space but shows much potential. This dissertation seeks to determine what drives private equity financing in Zambia and what constrains it. The dissertation adopts a qualitative research approach relying on the interviews of various Fund Managers who are familiar with investing in Zambia. The paper finds that private equity investment in Zambia is determined and catalysed broadly by business attractiveness and the business environment. Business attractiveness is underpinned by management capacity, the business track record, exits and returns, impact potential and business scalability. The business environment is driven by political stability, GDP growth and population growth. The sector is however, constrained by a less developed private equity culture, limited opportunities to invest and currency risk.
Open Access
Regional differences in prevalence of HIV-1 discordance in Africa and enrollment of HIV-1 discordant couples into an HIV-1 prevention trial
(Public Library of Science, 2008) Lingappa, Jairam R; Lambdin, Barrot; Bukusi, Elizabeth Ann; Ngure, Kenneth; Kavuma, Linda; Inambao, Mubiana; Kanweka, William; Allen, Susan; Kiarie, James N; Makhema, Joseph
BACKGROUND: Most HIV-1 transmission in Africa occurs among HIV-1-discordant couples (one partner HIV-1 infected and one uninfected) who are unaware of their discordant HIV-1 serostatus. Given the high HIV-1 incidence among HIV-1 discordant couples and to assess efficacy of interventions for reducing HIV-1 transmission, HIV-1 discordant couples represent a critical target population for HIV-1 prevention interventions and prevention trials. Substantial regional differences exist in HIV-1 prevalence in Africa, but regional differences in HIV-1 discordance among African couples, has not previously been reported. METHODOLOGY/PRINCIPAL FINDINGS: The Partners in Prevention HSV-2/HIV-1 Transmission Trial ("Partners HSV-2 Study"), the first large HIV-1 prevention trial in Africa involving HIV-1 discordant couples, completed enrollment in May 2007. Partners HSV-2 Study recruitment data from 12 sites from East and Southern Africa were used to assess HIV-1 discordance among couples accessing couples HIV-1 counseling and testing, and to correlate with enrollment of HIV-1 discordant couples. HIV-1 discordance at Partners HSV-2 Study sites ranged from 8-31% of couples tested from the community. Across all study sites and, among all couples with one HIV-1 infected partner, almost half (49%) of couples were HIV-1 discordant. Site-specific monthly enrollment of HIV-1 discordant couples into the clinical trial was not directly associated with prevalence of HIV-1 discordance, but was modestly correlated with national HIV-1 counseling and testing rates and access to palliative care/basic health care (r = 0.74, p = 0.09). Conclusions/Significance HIV-1 discordant couples are a critical target for HIV-1 prevention in Africa. In addition to community prevalence of HIV-1 discordance, national infrastructure for HIV-1 testing and healthcare delivery and effective community outreach strategies impact recruitment of HIV-1 discordant couples into HIV-1 prevention trials.
Open Access
The potential of the agro-processing industry for industrialization in Zambia
(2020) Mapulanga, Willard; Black, Anthony
This study investigates how the development of the agro-food processing industry could support the structural transformation of the Zambian economy. This is set against a backdrop of improved food systems coupled with increased demand for processed foods domestically and regionally, as well as income growth, urbanization, and regional integration. Developing the agro-processing sector will involve the building of dynamic industrial capabilities along with product certification and standards, packaging, logistics, and access to formal markets. Using the value chain of soya beans, the study explains how the development of such a value chain could support structural transformation. Findings suggest that there are numerous opportunities, currently underexploited, for processing soya beans into diversified products. Insights from the study reveal further opportunities to accumulate productive capabilities, both downstream and upstream to stimulate value-addition and export-led growth. Harnessing these opportunities will require specific policy support for soya beans particularly aimed at growing smallholder entry, upgrading agricultural efficiency, engaging government and non-state actors to build capacity to improve processing technologies, food testing, packaging, meeting standards and certification schemes, as well as harmonisation of regional standards.
Open Access
The trophy hunting of African lions: scale, current management practices and factors undermining sustainability
(Public Library of Science, 2013) Lindsey, Peter Andrew; Balme, Guy Andrew; Funston, Paul; Henschel, Philipp; Hunter, Luke; Madzikanda, Hilary; Midlane, Neil; Nyirenda, Vincent
The trophy hunting of lions Panthera leo is contentious due to uncertainty concerning conservation impacts and because of highly polarised opinions about the practice. African lions are hunted across at least ∼558,000 km 2 , which comprises 27-32% of the lion range in countries where trophy hunting of the species is permitted. Consequently, trophy hunting has potential to impart significant positive or negative impacts on lions. Several studies have demonstrated that excessive trophy harvests have driven lion population declines. There have been several attempts by protectionist non-governmental organisations to reduce or preclude trophy hunting via restrictions on the import and export of lion trophies. We document the management of lion hunting in Africa and highlight challenges which need addressing to achieve sustainability. Problems include: unscientific bases for quota setting; excessive quotas and off-takes in some countries; fixed quotas which encourage over-harvest; and lack of restrictions on the age of lions that can be hunted. Key interventions needed to make lion hunting more sustainable, include implementation of: enforced age restrictions; improved trophy monitoring; adaptive management of quotas and a minimum length of lion hunts of at least 21 days. Some range states have made important steps towards implementing such improved management and off-takes have fallen steeply in recent years. For example age restrictions have been introduced in Tanzania and in Niassa in Mozambique, and are being considered for Benin and Zimbabwe, several states have reduced quotas, and Zimbabwe is implementing trophy monitoring. However, further reforms are needed to ensure sustainability and reduce conservation problems associated with the practice while allowing retention of associated financial incentives for conservation.