Browsing by Subject "Zambia"

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    A day to bleed: exploring the effects of Zambia's Mother's Day policy on the representation of women in the financial sector
    (2025) Chirwa, Memory Bwalya; Daya, Preeya
    This study examined how Zambia's menstruation leave policy, locally referred to as Mother's Day, influences the recruitment and retention of women in the financial and insurance sectors. As the only African nation to formalise menstruation leave, Zambia provided a distinctive context to explore the operation of gender-specific workplace policies within postcolonial African organisational settings. The research drew on qualitative data from 32 interviews with employees and managers across four organisations, revealing several key findings. Firstly, organisational size significantly shaped implementation approaches, with large organisations employing bureaucratic processes, medium organisations adopting hybrid practices, and small organisations favouring Ubuntu-inspired community-oriented methods. Secondly, a leadership policy paradox emerged, where senior women often avoided using menstruation leave to safeguard their professional credibility, thereby perpetuating stigma around its use. Thirdly, varying levels of cultural integration were observed, ranging from surface-level adoption to deeply embedded practices that reflected local values. Women adopted different strategies to navigate the policy, balancing health needs with career aspirations. These strategies highlighted the complicated interplay between professional identity, organisational context, and cultural dynamics. While the policy aimed to support women's workplace participation, its impact on recruitment and retention was nuanced, particularly when compounded by other types of leave such as maternity, sick, and study leave. Implementation challenges were shaped by implicit biases, practical difficulties, and societal stigma. This research contributes to the nascent discourse on menstruation leave policies in the Global South by extending Acker's (1990, 2006) theory of gendered organisations to postcolonial African contexts and applying the social ecological model to workplace policy implementation. It offers practical recommendations for organisations, including the development of size appropriate implementation guidelines. The findings underscore the need for gender-specific policies to move beyond symbolic compliance, fostering genuine workplace equity.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    Factors influencing cheetah (Acinonyx jubatus) distribution in Kafue National Park, Zambia
    (2025) Mulenga, Choolwe; O'riain, Mannus; Woodgate, Zoe; Overton, Kim-Young; Durant, Sarah
    Globally, effective management of large carnivores, particularly threatened and endangered species like cheetah (Acinonyx jubatus), hinges upon a comprehensive understanding of their spatial distribution and conservation status. Despite being among the most threatened species within the Felid family, cheetah are data deficient throughout much of their known range, including within protected areas of Zambia, a potential stronghold for the species. In this study, existing camera trap data collected between 2018 and 2023, were used to assess cheetah occupancy estimates within Kafue National Park. These camera trap surveys were designed and run by the NGO Panthera Wildcat Conservation, in collaboration with Department of National Parks and Wildlife (DNPW) to estimate leopard density across the north, central, and southern regions of the park. To adapt this survey for use in cheetah occupancy analyses, I overlaid a 6 x 6 km grid cell onto the surveyed area (KNP), where each grid subsumed multiple camera traps stations, and was treated as an independent site. All subsequent analyses were conducted at this site level. Due to low detection of cheetah, I used a stacked occupancy model to analyse cheetah spatial distribution in relation to landscape/site covariates within KNP, interpreting the results as probability of site use rather than the true occupancy. Data on cheetah detection histories (presence and absence) were analysed against nine covariates, including closed versus open habitat types (namely open forest, closed forest and grassland), the relative abundance of both prey and other large predators (lion [Panthera leo] and spotted hyena [Crocuta Crocuta]), distance to water, anti–poaching patrol effort and distance to legal camps (lodges, NGO and DNPW bases). The results confirmed the presence of cheetah in KNP with 170 cheetah detections, 110 of which were independent. The detection probability for cheetah increased significantly with the sampling effort (total number of days cameras were active in a site) but the addition of other detection variables decreased the predictive performance of the models. The naïve occupancy varied from 28% in the south to 50% in the northern region. Similarly, cheetah detections were highest in the north and lowest in the south. Among the nine site covariates analysed, only prey RAI (β = 2.08), and proportion of open forest (β = –3.55) had a significant influence on cheetah probability of site use. Using cheetah by–catch data from a leopard survey provided a first estimate of cheetah occupancy in a Zambian National Park. These estimates could be improved through the addition of more sites and a longer survey duration (range: 80 –100 days) to improve estimates for this important carnivore species.
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    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.
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    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.
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    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.
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    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.
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    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).
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    Implications of customary land conversions on the authority of traditional leaders: a case of Mungule Chiefdom, Chibombo District in Central Province of Zambia
    (2025) Nsama, Priscillah; Chitonge, Horman
    This thesis examines the intricate dynamics surrounding the implications of customary land conversions on the authority of traditional leaders, with a specific focus on Mungule Chiefdom in Chibombo District, Zambia. The study investigates the multifaceted interactions between land administration and indigenous rights preservation in various political regimes. It underscores the central role of traditional leaders in managing customary land and the challenges they face, particularly the erosion of their authority resulting from land conversions. The study employs the theory of traditional leaders' authority to elucidate key concepts and their connections to customary land conversions. Using a case study approach, the research methodology involved purposive sampling and semi-structured interviews. The participants include headmen and headwomen, local members of the Mungule community, key informants from the Ministry of Chiefs and Traditional Affairs, Ministry of Lands, House of Chiefs, academicians, historians, and representatives from the private sector. The empirical evidence analysed in this study reveals the complex dynamics and adverse implications of land conversions on traditional leadership's authority. They include conflicts with cultural beliefs, economic challenges, and the blurring of legal boundaries. Customary land conversions fragment loyalty within culturally diverse communities, as individuals align themselves with leaders who resonate with their specific identities and interests. This fragmentation is exacerbated by land conversions that shift land from communal to individual ownership under statutory tenure, thus transforming land into an economic commodity. The study also highlights the challenges posed by newcomers and external forces that challenge traditional norms and practices, further weakening traditional leadership's authority and disrupting community cohesion. The economic consequences of losing control over valuable resources compound the struggles of traditional leaders. These consequences underscore the erosion of their authority resulting from converting customary land to leasehold tenure systems, the disruption caused by the influx of newcomers, and the complexity of land exchanges negotiated financially. This study offers significant insights into the impacts of customary land conversions on traditional leadership and local communities. It reveals that the shift from customary to leasehold tenure weakens traditional leaders' authority, challenging existing understandings of land governance. Additionally, the research explores nuanced dynamics like the detachment of newcomers from cultural practices and the fragmentation of loyalty within culturally diverse communities. It underscores the importance of inclusive approaches in land governance to address challenges while preserving cultural heritage and promoting equitable development.
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    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.
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    Innovative financing of public infrastructure in Zambia: instruments and critical success factors
    (2025) Kamiji, Kafula; Alhassan, Abdul Latif
    This dissertation investigates innovative financing mechanisms for financing public infrastructure in Zambia, juxtaposing current practices with their future potential. It aims to identify the key success factors that enhance the effectiveness of these innovative financial instruments. The research underscores the critical role of private sector participation in leveraging public resources for infrastructure financing in Zambia. The study employed a qualitative research approach by focusing on the perspectives and experiences of key stakeholders involved in public infrastructure financing. A multiple-case study design, encompassing diverse sectors and institutions, is utilised to provide a comprehensive understanding of the subject matter. The findings identify several potential innovative finance instruments suitable for the Zambian context, including debt instruments, risk management instruments, equity-based and partnership financing, and integrated and hybrid instruments. Additionally, the dissertation explores a broad spectrum of key success factors essential for the effective implementation of these innovative financial instruments. These factors include the availability of private capital, the necessity for investment-grade credit ratings, local currency financing, the bankability of projects, stable economic conditions, pension sector growth, financial incentives, proper deal structuring, and effective collaboration between the public and private sectors. The study concludes with recommendations for enhancing innovative financing mechanisms tailored to Zambia's specific context. It advocates for strategic policy changes to attract and sustain private sector investment, addressing the unique challenges and opportunities within Zambia's public infrastructure sector. This research aims to provide valuable insights for policymakers, practitioners, and researchers, contributing to the broader discourse on development finance and sustainable infrastructure development in developing and emerging economies.
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    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.
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    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.
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    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.
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    Participation in decision-making within prison settings as a tool for enhancing the enjoyment of the right to health: The case of women inmates in Zambia
    (2025) Nkhata, Chipo Mushota; Amien, Waheeda; Moult, Kelley
    The number of women inmates is growing exponentially globally, with sub-Saharan Africa experiencing an annual growth rate in the prison population of 22%. Many correctional facilities and prisons were not designed or built with women in mind. This has seen women excluded in many aspects of correctional and penal systems including in correctional health systems. The situation is no different for Zambian women inmates who have limited access to health facilities, goods, services, and programmes. Women inmates in Zambia have one of the lowest citizenship status' in the country owing to the multiple levels of discrimination that they experience including discrimination based on their gender and their legal status as inmates. For many years, women inmates were rendered invisible in the Zambian correctional and penal system and in the general population and treated as non-existent. The growing recognition of women's rights, the paradigm shifts from punitive to a hybrid of a punitive and correctional system, and the growing involvement of citizens in governance in Zambia, present an opportunity to re-evaluate the situation of women inmates and put in place measures that effectively integrate them as full members of the Zambian society, entitled to enjoy fundamental rights and freedoms such as health and citizenship. This thesis sets out to establish whether participation in health-related decision-making and programmes by women inmates would enhance their enjoyment of the right to health. Existing literature shows that citizenship participation is an appropriate vehicle for fostering citizens' effective participation in governance for the attainment of their rights and interests. While most interventions focus on citizenship participation as a political tool, I leverage the argument that citizenship participation is equally useful in advancing social rights and interests such as health. I use a qualitative research methodology to engage key stakeholders such as women inmates, their representative institutions, and governmental and quasi-governmental institutions to ascertain the desirability and feasibility of using the citizenship participation model to enhance women inmates' health rights. This methodology is also used to ascertain the role of the Zambian regulatory framework in realising such participation. Many study respondents in this study stated that women inmates' participation in health related decision-making and programmes is cardinal to the realisation of their right to health as envisaged under international and human rights frameworks. However, for women inmates to participate effectively in health governance, I argue that it is necessary to employ a model to citizenship participation that ensures their effective integration in health governance systems of the Zambia Correctional Service. Through the study respondents' views, I establish that traditional approaches to governance, including the rights-based and feminist approaches offer an entry point for women inmates' participation in health governance but are not entirely suitable for responding to their health needs and experiences. To address this gap, I propose a model that I term “a woman-centred citizenship participation model” for health. Through this model, the State should seek to solicit women inmates' effective and active participation in health governance in their correctional centres in Zambia.