88 research outputs found
The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia
No full textThe quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia
No full textAbstract Background Priority-setting for health research in low-income countries remains a major challenge. While there have been efforts to systematise and improve the processes, most of the initiatives have ended up being a one-off exercise and are yet to be institutionalised. This could, in part, be attributed to the limited capacity for the priority-setting institutions to identify and fund their own research priorities, since most of the priority-setting initiatives are driven by experts. This paper reports findings from a pilot project whose aim was to develop a systematic process to identify components of a locally desirable and feasible health research priority-setting approach and to contribute to capacity strengthening for the Zambia National Health Research Authority. Methods Synthesis of the current literature on the approaches to health research prioritisations. The results of the synthesis were presented and discussed with a sample of Zambian researchers and decision-makers who are involved in health research priority-setting. The ultimate aim was for them to explore the different approaches available for guiding health research priority-setting and to identify an approach that would be relevant and feasible to implement and sustain within the Zambian context. Results Based on the evidence that was presented, the participants were unable to identify one approach that met the criteria. They identified attributes from the different approaches that they thought would be most appropriate and proposed a process that they deemed feasible within the Zambian context. Conclusion While it is easier to implement prioritisation based on one approach that the initiator might be interested in, researchers interested in capacity-building for health research priority-setting organisations should expose the low-income country participants to all approaches. Researchers ought to be aware that sometimes one shoe may not fit all, as in the case of Zambia, instead of choosing one approach, the stakeholders may select desirable attributes from the different approaches and piece together an approach that would be feasible and acceptable within their context. An approach that builds on the decision-makers’ understanding of their contexts and their input to its development would foster local ownership and has a greater potential for sustainability
Tuberculosis in the mines of Zambia: A case for intervention
No full textAbstractZambia is among the sub-Saharan countries highly burdened with tuberculosis (TB) and has an estimated prevalence rate of 638 per 100000 population in those aged 15 years and above. The mining industry is the main contributor to the country's gross national product, although it is associated with public health challenges, with TB in the mines being among the occupational health diseases having a negative economic impact and threatening to delay the control of TB in the country. We reviewed available evidence on the extent of the burden of TB in the mines so as to inform the development of targeted interventions for the post-2015 End TB Strategy. This was a review of published data from Medline/Pubmed, Cochrane Library and Embase, including unpublished “grey” literature on the burden of TB and the risk factors of TB in the mines of Zambia. There is limited research in Zambia to fully understand the burden of TB and risk factors associated with TB in the mines. However, the few studies and data available have shown that TB is a significant health problem requiring interventions to improve the quality of life of miners, ex-miners and surrounding communities. TB is a potential problem in the mines of Zambia and the actual burden needs to be determined. Exposure to silica as a risk factor needs further investigation
Additional file 1: of The quest for a framework for sustainable and institutionalised priority-setting for health research in a low-resource setting: the case of Zambia
No full textDetailed references for the reviewed literature. (DOCX 54Â kb
Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia
No full textAbstract For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, we discuss the ongoing development of Zambia’s NHRS. We reflect on our experience in the ongoing consultative development of Zambia’s NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. We argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system’s boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.</p
The prevalence of HIV among adults with pulmonary TB at a population level in Zambia
No full textTuberculosis and HIV co-infection is one of the main drivers of poor outcome for both diseases in Zambia. HIV infection has been found to predict TB infection/disease and TB has been reported as a major cause of death among individuals with HIV. Improving case detection of TB/HIV co-infection has the potential to lead to early treatment of both conditions and can impact positively on treatment outcomes. This study was conducted in order to determine the HIV prevalence among adults with tuberculosis in a national prevalence survey setting in Zambia, 2013-2014. A countrywide cross sectional survey was conducted in 2013/2014 using stratified cluster sampling, proportional to population size for rural and urban populations. Each of the 66 countrywide clusters represented one census supervisory area with cluster size averaging 825 individuals. Socio-demographic characteristics were collected during a household visit by trained survey staff. A standard symptom-screening questionnaire was administered to 46,099 eligible individuals across all clusters, followed by chest x-ray reading for all eligible. Those symptomatic or with x-ray abnormalities were confirmed or ruled out as TB case by either liquid culture or Xpert MTBRif performed at the three central reference laboratories. HIV testing was offered to all participants at the survey site following the national testing algorithm with rapid tests. The prevalence was expressed as the proportion of HIV among TB cases with 95% confidence limits. A total of 265/6123 (4.3%) participants were confirmed of having tuberculosis. Thirty-six of 151 TB survey cases who accepted HIV testing were HIV-seropositive (23.8%; 95% CI 17.2-31.4). The mean age of the TB/HIV cases was 37.6 years (range 24-70). The majority of the TB/HIV cases had some chest x-ray abnormality (88.9%); were smear positive (50.0%), and/or had a positive culture result (94.4%). None of the 36 detected TB/HIV cases were already on TB treatment, and 5/36 (13.9%) had a previous history of TB treatment. The proportion of TB/HIV was higher in urban than in the rural clusters. The HIV status was unknown for 114/265 (43.0%) of the TB cases. The TB/HIV prevalence in the general population was found to be lower than what is routinely reported as incident TB/HIV cases at facility level. However; the TB/HIV co-infection was higher in areas with higher TB prevalence. Innovative and effective strategies for ensuring TB/HIV co-infected individuals are detected and treated early are require
The prevalence and socio-economic determinants of HIV among teenagers aged 15–18 years who were participating in a mobile testing population based survey in 2013–2014 in Zambia
No full textAbstract Background The objective of the study was to estimate the prevalence of HIV among teenagers in Zambia and determine whether age, sex, setting, educational level, marital and socioeconomic status were associated with being HIV positive. Methods A cross sectional population based survey of the prevalence of HIV among teenagers aged 15–18 years old who were also participants in a national Tuberculosis (TB) prevalence survey. Consenting teenagers were counselled and tested for HIV. The HIV prevalence was estimated using a logistic regression model. Associations of social demographic characteristics with HIV were determined using univariate and multivariate. Results The study involved 6,395 teenagers aged 15–18 years where 2,532 declined HIV testing, 44 tested positive and 3,806 tested negative. The HIV prevalence was estimated to be 1.1 % (95 % CI 0.71-1.60); in females the HIV prevalence was 1.6 % (95 % CI 0.99-2.20) whereas in males it was 0.58 % (95 % CI 0.10-1.10). The prevalence of HIV was twice as high among the urban (1.90 %; 95 % CI 0.99-2.90) than the rural teenagers (0.89 %; 95 % CI 0.46-1.30), and being divorced or widowed was associated with higher risk of HIV regardless of residence. The risk of HIV was lower among students or those who were in school compared to those who were unemployed and not in school. Conclusion HIV prevalence among teenagers was lower than the overall national level prevalence. The patterns of HIV risk among the young population will require further monitoring in order to identify appropriate tools for intervention
Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia
No full textAbstractObjectiveTo assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.MethodsThis cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis.ResultsOut of the 44 791 tuberculosis survey participants, 14 164 (31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15–24 years were associated with higher refusal rates.ConclusionsStrategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented
Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia
No full textAbstract Priority-setting (PS) for health research presents an opportunity for the relevant stakeholders to identify and create a list of priorities that reflects the country’s knowledge needs. Zambia has conducted several health research prioritisation exercises that have never been evaluated. Evaluation would facilitate gleaning of lessons of good practices that can be shared as well as the identification of areas of improvement. This paper describes and evaluates health research PS in Zambia from the perspectives of key stakeholders using an internationally validated evaluation framework. Methods This was a qualitative study based on 28 in-depth interviews with stakeholders who had participated in the PS exercises. An interview guide was employed. Data were analysed using NVIVO 10. Emerging themes were, in turn, compared to the framework parameters. Results Respondents reported that, while the Zambian political, economic, social and cultural context was conducive, there was a lack of co-ordination of funding sources, partners and research priorities. Although participatory, the process lacked community involvement, dissemination strategies and appeals mechanisms. Limited funding hampered implementation, monitoring and evaluation. Research was largely driven by the research funders. Conclusions Although there is apparent commitment to health research in Zambia, health research PS is limited by lack of funding, and consistently used explicit and fair processes. The designated national research organisation and the availability of tools that have been validated and pilot tested within Zambia provide an opportunity for focused capacity strengthening for systematic prioritisation, monitoring and evaluation. The utility of the evaluation framework in Zambia could indicate potential usefulness in similar low-income countries
A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia
No full textABSTRACTObjectiveTo establish the appropriateness of malaria case management at health facility level in four districts in Zambia.MethodsThis study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.ResultsOut of 4891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.ConclusionsMalaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines
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