Non-typhoidal Salmonella infection in Zambian infants

In the University Teaching Hospital, Lusaka, Zambia, 45 strains of various non-typhoidal Salmonella species were isolated from 2990 samples of stools, blood and C.S.F. About 93% of the 45 strains were isolated from infants less than two years old. S. heidelberg was the most common species isolated from stools and revealed a multi-drug resistant character. Only S. typhimurium and S. bovis-morbificans were isolated from blood and C.S.F.     

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

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

Molecular epidemiology of pathogenic Leptospira spp. in the straw-colored fruit bat (Eidolon helvum) migrating to Zambia from the Democratic Republic of Congo

The role played by bats as a potential source of transmission of Leptospira spp. to humans is poorly understood, despite various pathogenic Leptospira spp. being identified in these mammals. Here, we investigated the prevalence and diversity of pathogenic Leptospira spp. that infect the straw-colored fruit bat (Eidolon helvum). We captured this bat species, which is widely distributed in Africa, in Zambia during 2008–2013. We detected the flagellin B gene (flaB) from pathogenic Leptospira spp. in kidney samples from 79 of 529 E. helvum (14.9%) bats. Phylogenetic analysis of 70 flaB fragments amplified from E. helvum samples and previously reported sequences, revealed that 12 of the fragments grouped with Leptospira borgpetersenii and Leptospira kirschneri; however, the remaining 58 flaB fragments appeared not to be associated with any reported species. Additionally, the 16S ribosomal RNA gene (rrs) amplified from 27 randomly chosen flaB-positive samples was compared with previously reported sequences, including bat-derived Leptospira spp. All 27 rrs fragments clustered into a pathogenic group. Eight fragments were located in unique branches, the other 19 fragments were closely related to Leptospira spp. detected in bats. These results show that rrs sequences in bats are genetically related to each other without regional variation, suggesting that Leptospira are evolutionarily well-adapted to bats and have uniquely evolved in the bat population. Our study indicates that pathogenic Leptospira spp. in E. helvum in Zambia have unique genotypes.     

Performance of Xpert® MTB/RIF and Determine™ TB-LAM Ag in HIV-infected adults in peri-urban sites in Zambia

Setting:Peri-urban health facilities providing HIV and TB care in Zambia.Objective:To evaluate 1) the impact of Xpert^® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy (ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays.Design:Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5–10 km in Kafue District. TB was confirmed using mycobacterial culture.Results:Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from TB evaluation to diagnosis (P = 0.018), and from evaluation to treatment initiation (P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at CD4 < 50 cells/mm³ vs. 31.7% overall.Conclusion:Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care to PLHIV, particularly with advanced HIV disease.     

Income Transfers and Maternal Health: Evidence from a National Randomized Social Cash Transfer Program in Zambia

There is promising recent evidence that poverty‐targeted social cash transfers have potential to improve maternal health outcomes; however, questions remain surrounding design features responsible for impacts. In addition, virtually no evidence exists from the African region. This study explores the impact of Zambia's Child Grant Program on a range of maternal health utilization outcomes using a randomized design and difference‐in‐differences multivariate regression from data collected over 24 months from 2010 to 2012. Results indicate that while there are no measurable program impacts among the main sample, there are heterogeneous impacts on skilled attendance at birth among a sample of women residing in households having better access to maternal health services. The latter result is particularly interesting because of the overall low level of health care availability in program areas suggesting that dedicated program design or matching supply‐side interventions may be necessary to leverage unconditional cash transfers in similar settings to impact maternal health. Copyright © 2015 John Wiley & Sons, Ltd.     

Novel arenavirus, Zambia

To investigate arenavirus in Zambia, we characterized virus from the kidneys of 5 arenavirus RNA-positive rodents (Mastomys natalensis) among 263 captured. Full-genome sequences of the viruses suggested that they were new strains similar to Lassa virus-related arenaviruses. Analyzing samples from additional rodents and other species can elucidate epizootiologic aspects of arenaviruses.     

Child fosterage among Zambian families

African continent is characterized by a high prevalence of child fostering than that in the rest of the world. Very few studies have focused on the issue of social services for child fostering families in Zambia. The purpose of this article is to examine the characteristics of Zambian families that foster children and to identify the social services needs of the fostering families based on the empirical findings of this study. The data were collected from 156 households, and nearly one-third of our sample, 52 out of the 156, were fostering households. Results of this study suggest that child fostering in Zambia is not contributing to increases in the educational levels of fostered children. Child fostering appears to be an aspect of family-building strategies. There is a positive relationship between woman’s education and the likelihood of child fostering in Zambia.     

Education among Zambian children: linking head of household characteristics to school attendance

This study examined the impact of head of household characteristics on school attendance among Zambian children. The study used nationally representative cross-sectional survey data with a sample of 24,165 school-aged children between the ages of 6 and 14. Findings showed that approximately 23% of the children were not in school, 14% were orphans, and 42% of children in the sample were from poor households. Heads of household in the sample showed low levels of education attainment; about 45% had a primary level education. Male heads of household had significantly higher levels of education compared to females (p < .001). Logistic regression model results showed that children living with a female head of household were more likely to attend school compared to those living with a male head of household (OR = 1.339, p < .001). In addition, findings showed greater likelihood for children’s school attendance the more educated the head of household was (p < .001). Increase in the age of the head of household, and the further removed the child was in biological relatedness to the head of household were associated with lesser odds of school attendance. Children that were older, female, non-orphan and from wealthier households had greater odds of school attendance. Findings highlight important head of household socioeconomic factors that policy and research should take into consideration when looking at children’s school attendance in Zambia.     

Assessing care-givers’ satisfaction with child immunisation services in Zambia: Evidence from a national survey

AimThe main aim of this study was to assess care-giver satisfaction with vaccination services in public health facilities in Zambia, and examine its determinants.MethodsThis study used data from a recent population-based household survey, conducted from May to August 2015. Respondent satisfaction with vaccination services received during the last visit was measured on a five point Likert scale ranging from 1 to 5. We used an ordered logistic regression model to analyse the significance of perceived quality of vaccination services, immunisation delivery mode and a range of individual characteristics in predicting care-giver satisfaction.ResultsFindings show that one in five care givers were unsatisfied with the vaccination services that they had received, with rural populations showing a significantly higher level of satisfaction. Poor quality of care, defined by long waiting times, poor quality of communication between health staff and care givers, long distance to vaccination sites, mode of delivery, and personal characteristics were among major factors driving care-giver satisfaction ratings. We also find that receiving a vaccination at outreach mode of delivery was associated with higher odds of greater satisfaction compared to on-facility vaccination services. The odds of satisfaction were lower for respondents living further away from a health facility, which emphasizes the importance of access in seeking vaccination services.ConclusionThese findings suggest that major improvements in quality of vaccination and service organisation will be needed to increase client satisfaction and service utilisation.     

Circumstances and motivations for fostering children in Zambia

Abstract

This short report explores motivations and circumstances of fostering children at six sites in Zambia. Cross-sectional community household surveys using multistage random sampling (totalling 1503 households, reporting on 5009 children) and participatory qualitative research (focus groups and in-depth interviews) with adult and youth community members were conducted as part of baseline research for the US-funded RAPIDS (Reaching HIV/AIDS Affected People with Integrated Development and Support) programme. Interviews and discussions with community members revealed the complexity of fostering patterns and decision-making, considered from the dual perspectives of fostering household and fostered child. Programme implementers need to recognize the complexity of fostering in intervention design, including the possibility of introducing perverse incentives.     

Changes in tuberculosis notifications and treatment delay in Zambia when introducing a digital X-ray service

Setting:

In August 2009, a digital chest X-ray (CXR) machine was installed at a busy urban health centre in Lusaka, Zambia.

Objective:

To describe the changes in tuberculosis (TB) notifications and treatment delay ≥7 days in Zambia after introducing a digital X-ray service.

Design:

Operational retrospective research of TB notification, laboratory and CXR data for Q4 2008 (prior to digital CXR) compared to Q4 2009.

Results:

Notifications for sputum smear-negative TB increased by 8.1%, from 370/527 (70.2%) in Q4 2008 to 425/544 (78.1%) in Q4 2009, despite a 6.7% decrease in sputum smear positivity in Q4 2009. TB treatment delay decreased from 75/412 (18.2%) in Q4 2008 to 52/394 (13.2%) in Q4 2009 (P = 0.05).

Conclusion:

In Q4 2009, sputum smear-negative TB notifications increased and treatment delay decreased. However, accurate diagnosis of TB is challenging in this setting, and misdiagnosis and overtreatment may occur. Moreover, other factors in addition to the introduction of the digital X-ray service could have contributed to these findings. Nonetheless, we found that the digital X-ray service had many advantages and that it may aid in more efficient TB diagnosis.     

Family demography in a remote rural community in Zambia

A community survey was conducted in a remote rural area of Zambia by The Kasanka Trust whose aims in running a National Park are to include aid to the community living around its borders. Selected results have been extracted from a general report by the Kasanka Trust, including awareness of HIV infection and tuberculosis. The remarkable population dynamics found in this apparently impoverished, poorly served community is highlighted.     

The Efficacy of Fish as an Early Complementary Food on the Linear Growth of Infants Aged 6–7 Months: A Randomised Controlled Trial

Fish is a good animal-source protein for growth and development. The main objective of the study was to assess the efficacy of fish during the early complementary feeding period on infants’ linear growth in the Samfya district of the Luapula Province of Zambia in 6 months randomised controlled trial. The study was conducted from April 2019 to January 2020. Infants aged 6–7 months (N = 238) were assigned to either the intervention (treatment) group or control (placebo) group to receive fish powder or sorghum powder, respectively. Participants were followed on a weekly basis to distribute the powder and record compliance/usage and any morbidities. Anthropometric measurements were taken monthly. A linear mixed-effects model showed that fish powder improved linear growth among infants over all the 6 months of the intervention period. The fish powder increased length-for-age z scores by 1.26 (95% CI: 0.94–1.57) and weight-for-age z score by 0.95 (95% CI 0.6–1.23). The addition of fish powder to the infant’s usual food during the early complementary feeding improves the infant’s linear growth outcome.     

How effective and fair is user fee removal? Evidence from Zambia using a pooled synthetic control

Despite its high political interest, the impact of removing user charges for health care in low‐income settings remains a debatable issue. We try to clear up this contentious issue by estimating the short‐term effects of a policy change that occurred in 2006 in Zambia, when 54 of 72 districts removed fees. We use a pooled synthetic control method in order to estimate the causal impact of the policy on health care use, the provider chosen, and out‐of‐pocket medical expenses. We find no evidence that user fee removal increased health care utilisation, even among the poorest group. However, we find that the policy is likely to have led to a substitution away from the private sector for those using care and that it virtually eliminated medical expenditures, thereby providing financial protection to service users. We estimate that the policy was equivalent to a transfer of US$3.2 per health visit for the 50% richest but of only US$1.1 for the 50% poorest.     

Women at risk: Gender inequality and maternal health

Gender inequality has been documented as a key driver of negative health outcomes, especially among women. However, studies have not clearly examined the role of gender inequality in maternal health in an African setting. Therefore, the authors of this study examined the role of gender inequality, indicated by lack of female autonomy, in exposing women to maternal health risk. Data were obtained from the 2007 Zambia Demographic and Health Survey on a weighted sample of 3,906 married or partnered women aged 15–49 years. Multivariable analyses revealed that low autonomy in household decision power was associated with maternal health risk (Odds Ratio (OR) = 1.52, p < .001). Autonomy interacted with household wealth showed that respondents who were in the wealthier households and had low autonomy in household decision power (OR = 2.03, p < .05) were more likely to be exposed to maternal health risk than their counterparts who had more autonomy. Efforts to lower women’s exposure to maternal mortality and morbidity in Zambia should involve interventions to alter prevailing gender norms that limit women’s active participation in decisions about their own health during pregnancy and delivery.     

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

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

Developing a Framework Strategy for Supporting Radiographers in the Clinical Supervision of Radiography Students in Zambia: A Mixed Methods Study

BackgroundClinical supervisors of radiography students play a key role in the facilitation of practice-based learning. However, there is a scarcity of evidence-based strategies to support clinical supervisors. This study aimed at exploring the level of support required by radiographers in order to develop a framework strategy for supporting clinical supervisors of radiography students in Zambia.MethodsThis study used an exploratory sequential mixedmethods approach. The qualitative phase was conducted first, and the findings were used to develop the questionnaire for the quantitative phase. The study population was radiographers working in the Lusaka and Copperbelt provinces of Zambia. For the first phase, data were collected from a purposive sample of 10 clinical supervisors of radiography students. For the survey, data were collected from 120 radiographers using a questionnaire. In the third phase, a group of experts validated the proposed framework using an online questionnaire. Qualitative data were analysed thematically and quantitative data using statistics.ResultsFour support areas were identified: training and education in clinical supervision, clinical training resources, human resources and relationships, and quality assurance programmes related to clinical supervision. These findings informed the development of a support framework strategy for clinical supervisors.ConclusionThis study has revealed that clinical supervision of radiography students requires coordinated support from stakeholders: schools of radiography, professional body, and radiology and hospital management. It is anticipated that the developed framework, when implemented, will enhance the experiences of clinical supervisors and improve the quality of clinical education.     

Desire for fertility among HIV-seroconcordant and -discordant couples in Lusaka,Zambia

Pregnancy rates and the desire to conceive are increasing among women living with HIV in Africa. However, attempts to conceive may increase the risk of HIV transmission or reinfection. A better understanding of factors influencing fertility desires would significantly contribute to programmes to meet the reproductive needs of women living with HIV. Using a couples-based approach, this paper explored fertility desires among HIV-seroconcordant and -discordant couples in Lusaka, Zambia. Participants were 208 heterosexual couples recruited from community health clinics and their respective catchment areas. Couples completed assessments on demographics, condom use, relationship quality and communication. Desire for children was often shared among couple members, and the strongest predictor of participants' desire for children was having a partner who wanted children. Additionally, the number of children participants had, their own reports of positive communication, and their partner's HIV serostatus influenced reproductive desires. Results support the involvement of both couple members in pre-conception counselling and pregnancy planning interventions. The inclusion of both partners may be a more effective strategy to respond to the reproductive needs of couples affected by HIV, enabling them to safeguard the health of both partners and infants.