Selestine Nzala

Prevalence of hypertension and its correlates in Lusaka urban district of Zambia: a population based survey

Background Hypertension is a leading cause for ill-health, premature mortality and disability. The objective of the study was to determine the prevalence and associated factors for hypertension in Lusaka, Zambia. Methods A cross sectional study was conducted. Odds ratios and their 95% confidence intervals were calculated to assess relationships between hypertension and explanatory variables. Results A total of 1928 individuals participated in the survey, of which 33.0% were males. About a third of the respondents had attained secondary level education (35.8%), and 20.6% of males and 48.6% of females were overweight or obese. The prevalence for hypertension was 34.8% (38.0% of males and 33.3% of females). In multivariate analysis, factors independently associated with hypertension were: age, sex, body mass index, alcohol consumption, sedentary lifestyle, and fasting blood glucose level. Conclusions Health education and structural interventions to promote healthier lifestyles should be encouraged taking into account the observed associations of the modifiable risk factors.

Pilot-testing service-based planning for health care in rural Zambia

BackgroundHuman resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo.MethodsThe health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district’s health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies.ResultsThe primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient’s medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment.ConclusionsAlthough active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country’s ability to align the training, management, and deployment of its health workforce to meet the needs of its people.RésuméContexteEn Zambie, comme dans d’autres pays, la planification des ressources humaines en santé consiste souvent à comparer les données sur les ressources et le nombre de postes établis, sans égard aux besoins de la population en matière de santé. La planification fondée sur les services consiste à comparer le nombre et le type de services requis par les populations, en fonction de leurs besoins, et la capacité des ressources existantes à fournir ces services. L’étude avait pour but de mettre en oeuvre la planification des ressources humaines en santé fondée sur les services dans deux districts ruraux de la Zambie – Gwembe et Chibombo – afin d’en démontrer l’efficacité.MéthodesAu moyen des données administratives et de la consultation des comités de santé communautaire et des travailleurs de la santé, on a cerné les problèmes de santé qui causent le plus de mortalité et de morbidité dans chaque district. Le nombre et le type de services de santé requis pour traiter ces problèmes ont été estimés en fonction de la taille de la population, de l’incidence et de la prévalence de chaque problème et des niveaux de service souhaités. La capacité des travailleurs de la santé de chaque district à fournir ces services a été estimée grâce à une enquête menée auprès de ces travailleurs (n = 44), qui a évalué leurs compétences particulières.RésultatsLes principaux problèmes de santé relevés étaient le VIH/sida dans le district de Gwembe et le paludisme dans le district de Chibombo. Si les compétences des travailleurs de la santé de ces deux districts cadraient en grande partie avec ces problèmes, d’importants écarts ont été décelés entre les services fournis par ces travailleurs et les services dont ont besoin les populations qu’ils servent. Les écarts les plus importants qui ont été relevés dans les deux districts avaient trait aux éléments suivants : les tests en laboratoire et l’interprétation des résultats, l’imagerie diagnostique et l’interprétation des résultats, la vérification et l’interprétation des antécédents médicaux des patients, l’examen physique, le dépistage et le diagnostic de la maladie et l’évaluation de l’admissibilité au traitement antirétroviral.ConclusionsBien qu’ils soient actifs, productifs et compétents, les travailleurs de la santé de ces districts sont trop peu nombreux pour répondre aux principaux besoins de la population en matière de santé. Compte tenu des compétences particulières où les lacunes sont les plus grandes, offrir une formation en milieu de travail aux travailleurs de la santé actuels afin qu’ils acquièrent ces compétences pourrait être la meilleure approche pour réduire les écarts qui ont été relevés. L’utilisation continue de cette approche fondée sur les services en Zambie améliorera la capacité du pays à penser la formation, la gestion et le déploiement de ses travailleurs en santé en fonction des besoins de sa population.

Molecular identification of non-tuberculous mycobacteria isolated from clinical specimens in Zambia.

BackgroundThe emergence of Acquired Immunodeficiency Syndrome has highlighted the increased incidence and importance of the disease caused by Non-tuberculous Mycobacteria (NTM). While disease due to M. avium-intracellulare complex is apparently common throughout the world, other Non-tuberculous mycobacterial species have been isolated from both immunocompromised and immunocompetent individuals. The increasing number of infections caused by these organisms has made it clinically important to quickly identify mycobacterial species. The diagnosis of a pathogenic versus a non-pathogenic species not only has epidemiological implications but is also relevant to the demands of patient management. Since antibiotic treatment varies according to the species encountered, species identification would reduce the burden of some of these emerging opportunistic pathogens especially in immunocompromised patients and improve their quality of life.FindingsA total of 91 NTM suspected isolates from four regions of Zambia were included in the study. These isolates were identified using the sequence analysis of the 16S-23S rRNA intergenic transcribed spacer (ITS) region of Mycobacteria.Fifty-four of the 91 (59%) isolates were identified as NTM and these included M. intracellulare (27.8%), M. lentiflavum (16.7%), M. avium (14.8%), M. fortuitum (7.4%), M. gordonae (7.4%), M. kumamotonense (3.7%), M. indicus pranii (3.7%), M. peregrinum (3.7%), M. elephantis (1.85%), M. flavescens (1.85%), M. asiaticum (1.85%), M. bouchedurhonense (1.85%), M. chimaera (1.85%), M. europaeum (1.85%), M. neourum (1.85%), M. nonchromogenicum (1.5%).ConclusionThe study has shown that DNA sequencing of the ITS region may be useful in the preliminary identification of NTM species. All species identified in this study were potentially pathogenic.

Determination of the prevalence of African trypanosome species in indigenous dogs of Mambwe district, eastern Zambia, by loop-mediated isothermal amplification

BackgroundDogs have been implicated to serve as links for parasite exchange between livestock and humans and remain an important source of emerging and re-emerging diseases including trypanosome infections. Yet, canine African trypanosomosis (CAT), particularly in indigenous dogs (mongrel breed) remains under- reported in literature. This study evaluated the performance of loop-mediated isothermal amplification (LAMP) in detecting trypanosomes in blood from indigenous dogs of tsetse-infested Mambwe district in eastern Zambia.MethodsA cross sectional survey of CAT was conducted within 5 chiefdoms (Msoro, Kakumbi, Munkanya, Nsefu, Malama) of Mambwe district, eastern Zambia, during October 2012. Blood samples from 237 indigenous hunting dogs were collected and screened by microscopy and LAMP.ResultsOf the 237 dogs screened for CAT, 14 tested positive by microscopy (5.9%; 95% CI: 2.9 – 8.9%), all of which also tested positive by LAMP. In addition, LAMP detected 6 additional CAT cases, bringing the total cases detected by LAMP to 20 (8.4%; 95% CI: 4.9 – 12.0%). Irrespective of the detection method used, CAT was only recorded from 3 chiefdoms (Munkanya, Nsefu, Malama) out of the 5. According to LAMP, these infections were caused by Trypanosoma congolense, Trypanosoma brucei brucei and the zoonotic Trypanosoma brucei rhodesiense. Although these CAT cases generally did not manifest clinical illness, an association was observed between infection with Trypanosoma brucei subspecies and occurrence of corneal opacity.ConclusionsThis communication reports for the first time the occurrence of CAT in indigenous Zambian dogs. Our study indicates that LAMP is a potential diagnostic tool for trypanosome detection in animals. LAMP was more sensitive than microscopy and was further capable of distinguishing the closely related T. b. brucei and T. b. rhodesiense. In view of the sporadic cases of re-emerging HAT being reported within the Luangwa valley, detection of the human serum resistant associated (SRA) gene in trypanosomes from mongrels is intriguing and indicative of the risk of contracting HAT by local communities and tourists in Mambwe district. Consequently, there is a need for continuous trypanosome surveillances in animals, humans and tsetse flies using sensitive and specific tests such as LAMP.

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

BackgroundIn response to Zambia’s critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia.MethodsUsing a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers’ self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district.ResultsNineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers’ job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions.ConclusionsAlthough somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.RésuméContexteEn réponse aux problèmes de pénuries des ressources humaines dans le domaine de la santé en Zambie, un certain nombre de stratégies ont été mises en oeuvre pour recruter et maintenir en poste les travailleurs de la santé dans les régions rurales et éloignées. Avant cette étude, l’efficacité de ces stratégies n’avait pas été étudiée. L’objectif de cette étude était donc de déterminer l’incidence de différentes stratégies de maintien en poste de différents corps de métiers de la santé dans deux districts ruraux de la Zambie.MéthodesAu moyen d’une cartographie des incidences modifiée, des données transversales qualitatives et quantitatives ont été recueillies auprès des travailleurs de la santé et d’autres intervenants grâce à des groupes de discussion et des questionnaires individuels auxquels ont été intégrés des données administratives. Les principaux thèmes ont été dégagés des données qualitatives grâce à la transcription des discussions au moyen de l’analyse thématique. Les données quantitatives ont été analysées de façon descriptive ainsi qu’à l’aide d’un modèle de régression. Pour ce dernier, le degré de variation de la satisfaction par rapport à l’emploi, de la probabilité de quitter l’emploi et de la fréquence à laquelle les travailleurs pensaient à quitter leur emploi a été modelé en fonction de leur participation à chacune des différentes stratégies de maintien en poste, tout en considérant des données sur l’âge, le sexe, la profession et le district.RésultatsPas moins de 19 stratégies de recrutement et de maintien en poste ont été dénombrées auprès des 45 travailleurs de la santé interviewés dans les deux districts. La participation à chacune des stratégies variait de 0 à 80 % selon les participants à l’étude. Bien que les suppléments de rémunération pour les travailleurs de la santé dans les régions rurales constituent les mesures incitatives les plus efficaces, presque aucune stratégie de recrutement et de maintien en poste n’était un bon indicateur de la satisfaction face à l’emploi, de la probabilité de le quitter et de la fréquence à laquelle les travailleurs pensaient à quitter leur emploi. Ces facteurs étaient, dans une large part, expliqués par les caractéristiques des travailleurs comme l’âge, le sexe et la profession. Ces résultats quantitatifs étaient conformes aux données qualitatives, qui indiquaient que les stratégies de recrutement et de maintien en poste ne permettaient pas de régler les principaux problèmes déterminés par les travailleurs de la santé de ces districts, notamment des conditions de vie et de travail difficiles.ConclusionsMalgré la taille de l’échantillon limitée et la nature transversale des données primaires disponibles, les résultats montrent néanmoins que les nombreuses stratégies de recrutement et de maintien en poste mises en oeuvre en Zambie rurale n’ont que peu ou pas du tout d’incidence sur le maintien en poste des travailleurs de la santé dans les régions rurales et mettent en lumière des problèmes de recrutement et de maintien en poste clés.

A scoping review of training and deployment policies for human resources for health for maternal, newborn, and child health in rural Africa

BackgroundMost African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries’ abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa.MethodsFourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official languages. Non-peer reviewed literature and policy documents were also identified through systematic searches of selected international organizations and government websites. Documents were included based on pre-determined criteria.ResultsThere was an overall paucity of information on training and deployment policies for HRH for MNCH in rural Africa; 37 articles met the inclusion criteria. Of these, the majority of primary research studies employed a variety of qualitative and quantitative methods. Doctors, nurses, and midwives were equally represented in the selected policy literature. Policies focusing exclusively on training or deployment were limited; most documents focused on both training and deployment or were broader with embedded implications for the management of HRH or MNCH. Relevant government websites varied in functionality and in the availability of policy documents.ConclusionsThe lack of available documentation and an apparent bias towards HRH research in developed areas suggest a need for strengthened capacity for HRH policy research in Africa. This will result in enhanced potential for evidence uptake into policy. Enhanced alignment between policy-makers’ information needs and the independent research agenda could further assist knowledge development and uptake. The results of this scoping review informed an in-depth analysis of relevant policies in a sub-set of African countries.

Banning traditional birth attendants from conducting deliveries: experiences and effects of the ban in a rural district of Kazungula in Zambia

BackgroundIn 2010 the government of the republic of Zambia stopped training traditional birth attendants and forbade them from conducting home deliveries as they were viewed as contributing to maternal mortality. This study explored positive and negative maternal health related experiences and effects of the ban in a rural district of Kazungula.MethodsThis was a phenomenological study and data were collected through focus group discussions as well as in-depth interviews with trained traditional birth attendants (tTBAs) and key informant interviews with six female traditional leaders that were selected one from each of the six zones. All 22 trained tTBAs from three clinic catchment areas were included in the study. Content analysis was used to analyse the data after coding it using NVIVO 8 software.ResultsHome deliveries have continued despite the community and tTBAs being aware of the ban. The ban has had both negative and positive effects on the community. Positive effects include early detection and management of pregnancy complications, enhanced HIV/AIDS prevention and better management of post-natal conditions, reduced criticisms of tTBAs from the community in case of birth complications, and quick response at health facilities in case of an emergency. Negatives effects of the ban include increased work load on the part of health workers, high cost for lodging at health facilities and traveling to health facilities, as well as tTBAs feeling neglected, loss of respect and recognition by the community.ConclusionCountries should design their approach to banning tTBAs differently depending on contextual factors. Further, it is important to consider adopting a step wise approach when implementing the ban as the process of banning tTBAs may trigger several negative effects.

A study on usefulness of a set of known risk factors in predicting maternal syphilis infections in three districts of Western Province, Zambia

Introduction Despite roll-out of cost-effective point-of-care tests, less than half antenatal attendees in rural western Zambia are screened for syphilis. This study formulated a clinical, risk-based assessment criteria and evaluated its usefulness as a non-biomedical alternative for identifying high-risk prenatal cases. Methods We conducted a cross-sectional survey of antenatal clinic attendees in Kaoma, Luampa and Nkeyema districts to collect data on exposure to nine pre-selected syphilis risk factors. These factors were classified into major and minor factors based on their observed pre-study association strengths to maternal syphilis. Clinical disease was defined as exposure to either two major factors, one major with two minor factors or three minor factors. Sensitivity, specificity and predictive values of the clinical protocol were then calculated in comparison to rapid plasmin reagin results. Results The observed syphilis prevalence was 9.3% (95% CI: 7.4 - 11.6%) and the overall sensitivity of the study criteria was 62.3% with positive predictive value of 72.9%. Sensitivities of individual case-defining categories were even lower; from 17.4% to 33.3%. Results confirmed that abortion history, still birth, multiple sexual partners, previous maternal syphilis infection, partner history of sexually transmitted infection and maternal co-morbid conditions of HIV and genital ulcer disease were significantly associated to maternal syphilis in study population as well. Conclusion The criteria was not as effective as biomedical tests in identifying maternal syphilis. However, it could be a useful adjunct/alternative in antenatal clinics when biomedical tests are either inadequate or unavailable.

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

Zambia is facing a crisis in its human resources for health, with deficits in the number and skill mix of health workers. The University of Zambia School of Medicine (UNZA SOM) was the only medical school in the country for decades, but recently it was joined by three new medical schools—two private and one public. In addition to expanding medical education, the government has also approved several allied health programs, including pharmacy, physiotherapy, biomedical sciences, and environmental health. This expansion has been constrained by insufficient numbers of faculty. Through a grant from the Medical Education Partnership Initiative (MEPI), UNZA SOM has been investing in ways to address faculty recruitment, training, and retention. The MEPI-funded strategy involves directly sponsoring a cohort of faculty at UNZA SOM during the five-year grant, as well as establishing more than a dozen new master’s programs, with the goal that all sponsored faculty are locally trained and retained. Because the issue of limited basic science faculty plagues medical schools throughout Sub-Saharan Africa, this strategy of using seed funding to build sustainable local capacity to recruit, train, and retain faculty could be a model for the region.

Evaluation of oral hygiene services in selected public health facilities in Lusaka district of Zambia

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. This study was conducted in the public health centers and first level hospitals with dental units (DUs) in Lusaka district. Adequacy of dental equipment, instruments and materials required for scaling and polishing (S&P) and oral hygiene instructions (OHI) was evaluated. Challenges faced by the dental therapists (DTs) in the entire DUs were also evaluated. This was a mixed method study; quantitative data was collected using a structured questionnaire which contained a standard facility assessment check list. Qualitative data was collected by conducting in-depth interviews. The study results showed that the oral hygiene services offered by the selected DUs in Lusaka district were inadequate. A fully functional dental chair was available only in fifty percent of the DUs, only twenty percent of the facilities had fully functional ultrasonic scaling unit, none of the facilities had all the instruments for polishing. The DTs work under stressful conditions as sixty percent of the facilities were understaffed; the supply of dental instruments and materials was poor; delay in repairing faulty equipment; risk of exposure to air borne infections as most of the facilities have space and ventilation problems. Recommendations of this study point towards an urgent need to improve and coordinate the oral health care system.