4 research outputs found
Stakeholders’ appraisals of the school history curriculum in Zambia on social media
No full textThis study attempted to capture stakeholders’ views on the school history curriculum in Zambia. Stakeholders’ views are an important aspect of curriculum development. Social media such as Facebook and WhatsApp have become platforms a section of Zambians uses to challenge the traditional education system. The study used a qualitative approach design by monitoring the e-comments of focus groups (teachers’ forums) and individuals on Facebook on what some Zambians thought about the history curriculum. Social media was used because it provides an environment that removes traditional inhibitions of authority figures and meets people in their comfort zone, making them free to discuss otherwise sensitive topics. This research revealed that various stakeholders found the curriculum content irrelevant to the future they envisioned for themselves. The study additionally found that people in Zambia had been side-lined in discussions concerning curriculum development for history. People felt that they had been placed into the straitlaced role of consumers, and their feedback has never been sought. The study recommends revisiting the school history curriculum content to reflect stakeholders’ needs and apply it to society. Curriculum developers should also pay attention to the voices of stakeholders in society
Towards a new method for evaluating large-scale maternal health programmes: measuring implementation strength of focused antenatal care and emergency obstetric care in Tanzania
No full textMeasuring the strength of public health programmes may reveal whether and how some programmes have an impact on target populations and others do not. Programme implementation strength (also known as programme intensity) refers to quantitative measure reflecting programme inputs, processes, and their duration. Measuring programme strength requires an understanding of how programmes work and involves defining measurable concepts, identifying sources of programme data and close programme follow-up. There are no standardized methods for measuring programme strength.
This thesis developed and tested an approach for estimating programme strength for use in evaluating large-scale maternal health programmes in low- and middle-income countries. It used focused antenatal care (FANC) and emergency obstetric care (EmOC) as tracer programmes, with WHO’s health-system-building blocks as programme components. The thesis used mixed methods including: developing a weighting scheme through opinions from maternal health experts, collecting FANC and EmOC data from 23 districts on programme strength, programme coverage, and programme contextual factors, using government official statistics, and using routine data from a central database. The thesis also tested the content and face validity of the approach.
Results from experts showed that, even though all six WHO blocks were required in programme implementation, human resources was given relatively higher weights than the other programme components. While the overall programme strength in districts scored an average of 41% (FANC) and 40% (EmOC), the overall programme coverage scored an average of 80% (FANC) and 64% (EmOC). Contextual factors significantly associated with the programmes included: total fertility rate, female literacy, water, sanitation, and famine. The content and face validity were both rated “very good”. This work aims to contribute towards an efficient way of evaluating large-scale maternal health programmes in low- and middle-income countries. The approach could also be of interest especially to district health management authorities for improving health programmes
Factors influencing uptake of HIV testing and non-initiation of and attrition from antiretroviral therapy care in Lusaka, Zambia
No full textThe Human Immunodeficiency Virus (HIV) still remains a global public health burden with an estimated 34 million people living with HIV; 69% of these residing in sub-Saharan Africa (SSA). Although many countries have made steady progress in reducing HIV prevalence, not everyone knows his or her HIV status and not all HIV-infected individuals who need antiretroviral therapy (ART) care are receiving it. Against this background, the aim of this PhD thesis was to explore factors influencing uptake of HIV testing and non-initiation of and attrition from antiretroviral therapy care in Lusaka, Zambia. The PhD study was conducted in Lusaka’s Jack compound residential area and nearby communities. The surrounding communities were Chawama, Kuku, Misisi, Kuomboka, John Howard, Kamwala south and Lilayi. The study settings are predominantly low-income, high-density urban residential areas located about 10 km south of Lusaka city centre, the capital city of Zambia. To explore the barriers and facilitators of uptake of HIV testing, a synthesis of qualitative findings on factors influencing uptake of HIV testing in SSA was first undertaken using meta-ethnographic approach first put forward by Noblit and Hare (1988). 5,686 citations were identified out of which 56 were selected for full-text review and synthesised 42 papers from 13 countries. Malpass’ (2009) notion of first-, second-, and third-order constructs was used to identify and interpret the findings. In addition, qualitative research was undertaken in Zambia to explore why individuals who knew the HIV-positive status of their marital partners opted not to seek HIV testing, and how couple HIV testing was achieved in an antenatal clinic. To investigate reasons for non-uptake of antiretroviral treatment, in-depth interviews were conducted with people living with HIV (PLHIV) that had dropped out of treatment or opted not to initiate treatment, health care providers, traditional medicine providers, herbalists and faith healers. The fieldwork in Zambia was conducted between March 2010 and September 2011. Atlas ti was used to organise and manage the data and latent content analysis was used to analyse and interpret the data. The social ecological framework was used to guide data analysis of factors undermining patient uptake of and retention into ART care. The predominant factors enabling uptake of HIV testing are deterioration of physical health and/or death of sexual partner or child. The roll-out of various HIV testing initiatives such as ‘opt-out’ provider-initiated HIV testing and mobile HIV testing has improved uptake of HIV testing by being conveniently available and attenuating fear of HIV-related stigma and financial costs. However, ‘opt-out’ HIV testing was reportedly being coercively implemented. Other enabling factors are availability of treatment and guarantees of social network support linked to maintenance of social relationships and economic support regardless of outcome of HIV-test results. Major barriers to uptake of HIV testing comprise perceived low risk of HIV infection, perceived health workers’ inability to maintain confidentiality and fear of HIV-related stigma. While the increasingly wider availability of life-saving treatment in SSA is an incentive to test, the perceived psychological burden of living with HIV inhibits uptake of HIV testing. Other barriers are direct and indirect financial costs of accessing HIV testing, and gender inequality, which undermines women’s decision making autonomy about HIV testing. Despite differences across SSA, the findings suggest comparable factors influencing HIV testing. Factors undermining uptake of HIV treatment and retention in ART care are lack of self-efficacy, negative perceptions of medication, desire to avoid stigma and maintain social identity and relationships and fear of treatment-induced physical body changes, all modulated by feeling healthy. Social relationships generated and perpetuated these health and treatment beliefs. Long waiting times at ART clinics, concerns about long-term availability of treatment and taking strong medication amidst livelihood insecurity also dissuaded PLHIV from being on treatment. PLHIV opted for herbal remedies and faith healing as alternatives to ART, with the former being regarded as effective as ART while the latter contributed to restoring normalcy through the promise of being healed. A complex and dynamic interplay of personal, social, health system and structural-level factors coalesce to influence uptake of ART care. In conclusion, improving uptake of HIV testing requires addressing perception of low risk of HIV infection and perceived psychological burden of living with an incurable condition. Building confidence in the health system through improving delivery of health care and scaling up HIV testing strategies that attenuate social and economic costs could also contribute towards increasing uptake of HIV testing in SSA. HIV testing initiatives that target social relationships – couple and household HIV testing – also require promotion while being mindful of the fragility of these social relationships. Ensuring PLHIV uptake of ART care requires interventions at different levels, addressing in particular, people’s health and treatment beliefs, changing perceptions about effectiveness of herbal remedies and faith healing, improving ART delivery to attenuate social and economic costs and allaying concerns about future non-availability of treatment
The Global Retinoblastoma Outcome Study: a prospective, cluster-based analysis of 4064 patients from 149 countries
No full textBackground Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. Methods We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1,2017, and Dec 31,2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. Findings The cohort included 4064 children from 149 countries. The median age at diagnosis was 23.2 months (IQR 11.0-36.5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0.8%) of 636 children from high-income countries, 55 (5.4%) of 1027 children from upper-middle-income countries, 342 (19. 7%) of 1738 children from lower-middle-income countries, and 196 (42.9%) of 457 children from low-income countries. Enudeation surgery was available for all children and intravenous chemotherapy was available for 4014 (98.8%) of 4064 children. The 3-year survival rate was 99.5% (95% CI 98.8-100.0) for children from high-income countries, 91.2% (89.5-93.0) for children from upper-middle-income countries, 80.3% (78.3-82.3) for children from lower-middle-income countries, and 57.3% (524-63-0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16.67; 95% CI 4.76-50.00), cT4 advanced tumour compared to cT1 (8.98; 4.44-18.18), and older age at diagnosis in children up to 3 years (1.38 per year; 1.23-1.56). For children aged 3-7 years, the mortality risk decreased slightly (p=0.0104 for the change in slope). Interpretation This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Y
