Barriers to prompt malaria treatment among under five children in Mpika District

Background: Prompt malaria treatment is a key malaria control strategy in Zambia, which has helped to reduce the incidence of malaria and consequently, reduce the infant mortality rate. However, studies done in Zambia show that as low as 19% of children under five years of age are accessing prompt malaria treatment at health facilities. The barriers to this important malaria control strategy need to be established. Therefore, this study aimed at determining barriers to prompt malaria treatment among this vulnerable age group in Mpika district.Objective: To determine the barriers to prompt malaria treatment among children under five years of age with malaria in Mpika district. Study design: This was an analytical cross-sectional study conducted in Mpika district of Zambia at eight Rural Health Centres. The study had a sample size of 380 caretakers of under 5 children with confirmed malaria infection; and exit interviews used to collect the data.Results: The study found that out of the total sample size of 380 participants, only 13.9% of children diagnosed with malaria received prompt malaria treatment. The following were barriers identified to prompt malaria treatment; caregivers residing at a distance of more than five kilometres to the health facility (OR 2.09 95%CI: 1.03 – 4.22 P = 0.041, inadequate household income (OR 2.89 95%CI: 1.18 – 4.39 P = 0.001), self-treatment of children at home with antipyretics prior to seeking care (OR 1.83 95%CI: 1.28 – 3.26 P = 0.018 and lack of community health education (IEC) (OR 2.14 95%CI: 1.10 – 4.13 P = 0.024.Conclusion: The findings of this study highlight the factors that negatively influence access to prompt malaria treatment in a rural setting of Zambia. It underscores the need to formulate and implement interventions aimed at fostering appropriate health seeking behaviours that are setting-specific among caretakers of under five children through community health education. There is also need to address the socioeconomic constraints, both at household and health facility level that hinder access to early and effective malaria treatment in children

Factors influencing utilization of Natural Family Planning among Child Bearing Women in Chilonga Northern Province Zambia

Objectives: The study sought to determine factors influencing utilization of Natural Family Planning (NFP) among child bearing women in Chilonga Catchment area. The literature review was mainly obtained from studies conducted globally, regionally and Zambia inclusively. Literature review revealed that information concerning the use of NFP method in Zambia is poor.Methods: A cross sectional study was done in five health posts of Chilonga Catchment area between July to November 2010. Systemic random sampling was used with a sampling interval of 1: 5. Mothers coming for under five and antenatal clinics were interviewed. A total of 425 questionnaires were issued. Of these 411 were successfully utilized which gave a dropout rate of 3%.Teachers trained in NFP method were purposively selected into the study for Focus Group Discussions (FGD) that is 10 per FGD. Total number of teachers selected were 20. Data was collected using a structured interview schedule comprising of open ended and closed ended questions .The study sought to answer the research question: What are the factors influencing utilization or non-utilization of NFP among child bearing women in Chilonga? The study was analysed using SPSS version 17.0 and content analysis. Chi-square was used to determine the association of between categorical variables. The findings have been presented using frequency tables and cross tabulations.Results: The majority (74%) of the respondents had heard of NFP method, though 26% had never heard of it. However, of the total, 58.4% did not know any method of NFP. Ever-used NFP was 50.4%, Current use of family planning (FP) was 38.4 % and most of the respondents (67.9 %) were in favour of NFP. Contraceptive pills were the commonest method in use 27.0% followed by NFP 23.6 %. There was no significant association between FP use and desired number of children (÷2 = 9.530; p > 0.023). There was also no significant association between FP use and education status (÷2 = 0.263; p > 0.005).Conclusion: The majority of the respondents (72.8%) wanted to have more than 4-10 children. This means they did not know what impact large families will have on the poverty stricken households. There is some ignorance about NFP methods. They are more used to artificial harmful methods of Family Planning. Therefore, there is need to intensify Health Education in this area.Keywords: Abstinence, Couple, Determinants, Family Planning (FP), Fertility, Fertile period, Intraspousal communication, Knowledge, Utilizatio

Factors influencing utilization of intermittent presumptive treatment of malaria (IPTP) services by pregnant women in Sesheke district of western province Zambia

Background: Intermittent presumptive treatment of malaria in pregnancy (IPTp) is one of the recommended interventions by World Health Organization to mitigate the impact of malaria in pregnancy in malaria stable transmission zones such as Sub Saharan regions so as to ensure the best outcome for both the mother and her unborn child. In line with the Zambian policy in malarian control, Sesheke District started implementing IPTp in the year 2003 as one of the methods to combat malaria in pregnancy. This intervention augments the use of Insecticide treated mosquito nets (ITNs) to prevent malaria transmission and early case detection and effective case management of malaria. Despite the availability of IPTp services in all the health facilities in district, the uptake of IPTp is still very low especially for the second and third doses of IPTp (fansidar). The main purpose of the study was to identify the factors influencing utilization of IPTp services by pregnant women in Sesheke District.Methodology: This study was a cross sectional, non intervention descriptive type. The study was conducted in Sesheke District in Western province of Zambia. Multistage sampling method was used to identify respondents to be included in the study. A purposeful method was used to select women to be included in the focus group discussions. Triangulation approach method was used to collect data which included one semi structured interview schedule which was administered to 403 eligible women who had delivered from January 2012 to March 2013 in communities of eight selected centers under study, one separate structured questionnaire which was administered to both the Health Center in- charge and to the community health workers providing IPTp services in that catchment area. Two focus group discussions were also conducted, one from a hard to reach Health Center (Mkusi) and another one from not so hard to reach Health Center (Mulimambango). Stock control cards were also checked in order to determine the availability of fansidar in the eight selected health centers during the year 2012. In order to ensure that the findings were valid, statistical significant was set at p<0.05.Results: The study found that the uptake of IPTp among pregnant women in Sesheke for the third dose of IPTp (fansidar) was very low (30%). Factors influencing IPTp utilization identified in the study included; educational status of a woman, knowledge level of a woman about IPTp services, gestational age of the pregnancy at which a woman first starts antenatal care, number of times a woman attends antenatal care, and cultural misconceptions in the community. Lack of resources and transport in order for health providers to reach women in far and hard to reach areas was also identified as one of the most important challenges. The study also found that stock levels of fansidar in most of the health centers were good and that the majority of the women perceived use of fansidar during pregnancy as safe. The focus group discussions (FGD) also revealed that most of the women were willing to take fansidar despite the associated side effects. The commonest side effects were headache, dizziness, nausea and vomiting. Conclusion: This study demonstrates that effective IPTp service utilization in Sesheke District is very low. The study also identified factors and some challenges influencing IPTp service utilization. These factors and deficiencies urgently needed to be addressed if the district is to combat malaria in pregnancy. Address of these factors and deficiencies will not only contribute towards achievement of millennium development goals (MDGs) but also to overall improvement of maternal and child health.Keywords: Malaria in pregnancy, intermittent presumptive treatment of malaria during pregnancy(IPTp), effective IPTp service utilization, and fansidar doses

Characterization and Local Perceptions of Poverty Among Rural Households in Northern Zambia

Background: Poverty has been linked with poor  health outcomes in world health reports and cited by many scholars and leading health economists and public health specialist as a cause for poor health seeking behaviours especially for the rural poor. Poverty and ill-health are so closely intertwined that it is possible to use the words interchangeably, and still mean the same thing. Poverty has been defined as “a state of relative equilibrium of body form and function which results from its successful dynamic adjustments to forces tending to disturb it. It is not a passive interplay between body and forces impinging upon it but an active response of body forces working towards readjustment”. Poverty on the other hand has been defined as a “lack of access to income, employment, and normal internal entitlements for the citizens to such things as freely determined consumption of goods and services, shelter and other basic needs of life”. The poverty and ill-health situation has grown grimmer for Africa and some Asian countries. The last decade has seen an emergence of new and a resurgence of old infections with a virulence and velocity hard to compare. East Asia and Sub-Saharan Africa have been at the receiving end of most the consequences of poverty and the ill health that result exacerbated by the HIV and AIDS pandemic. It has been suggested that attacking poverty is the answer to better health. Many agree with this notion of improving health. The million dollar question has however remained how to proceed with the war against poverty. Experts and scholars have done commendable work studying, defining and designing solutions for poverty. That much has been achieved in these lines, again there is no denying. Success in reducing poverty has however remained elusive, especially in sub-Saharan Africa. World Health Organisation (WHO) in its World Health Report for 2005, admits failure in improvement of most health indicators in sub-Saharan Africa and more so for Zambia.Methods: The participatory action research (PAR) was conducted in Chikoti village in Luwingu area among 212 households, Kungu village in Kasama with 236 households, Mpepo village in Mpika with 220 households and Ilondola village with 360 households. The study investigated the relationship between poverty and ill-health and how the rural poor respond to this discourse.Results: The communities demonstrated a clear understanding of their own environment and were able to define factors which make them vulnerable to poverty and inversely to poor health. The study communities were able to distinctly define their own poverty levels and identify the categories of community members into the poverty status that is: managing poor, moderately poor and the extremely poor according to their local conditions and in their own local language.Conclusion: It is clear from the study findings that the rural communities do perceive poverty to affect all of the community members equally regardless of age or education levels. The study participants also demonstrated that they understood the vulnerability of women and children to poverty and its effects. It was also observed that poverty stricken communities often give preference to food than health, introducing ill-health due to negligence

The Process of Producing the Modified Ministry of Health (MOH) TBA Training Curriculum

Background: The MOH TBATraining Curriculum has been in Draft form since its documentation in 1996. This curriculum does not state when it was reviewed last or when it needs to be reviewed again in-order to incorporate new trends and concepts in infection prevention practices. The purpose of the modification is to facilitate task–shifting (a component of knowledge management) from the health professionals to non-professionals in the health care systems.Methods: We conducted a desk review, training needs assessment, focus group discussion and, analysing baseline data on maternal and infant morbidity and mortality rates.Results: The Desk review showed non-uniform TBA training curricula being used, infection prevention omissions, inadequate integration of positive socio-cultural and traditional beliefs in the curriculum, training needs assessment showed poor knowledge and practice among existing TBAs, focus group discussions showed inadequate resource and support supervision of the TBAs while the baseline data showed high maternal and infant morbidity and mortality rates in Chongwe District.Conclusion: Policy implications advocates that Low-income resource countries may need to formulate Primary Health Care (PHC) oriented Reproductive Health Policy that supports the training of TBAs through task-shifting anchored on evidence-based modified curriculum in the interim period until there are sufficient skilled birth attendants to service the hardest-to reach rural settings

Effect of Indoor Residual Spraying on the Incidence of Malaria in Kaoma District of Western Zambia

Background: Indoor residual spraying (IRS), the application of a chemical to the internal walls of the structure in order to kill an insect that sits on the wall treated with such a chemical, is one of the methods adopted by World Health Organisation in combating malaria by controlling the vector mosquito. In line with the Zambian policy on malaria control Kaoma district in Western province of Zambia in 2008, started implementing IRS as the method of combating malaria. The main purpose of the study was to ascertain the effect of indoor residual spraying on incidence of malaria in Kaoma district of Western Province of Zambia.Materials and Methods: The study was a retrospective cohort analysis of incidence data across a single spray season, mixed with cross sectional survey to assess levels of intervention, community understanding and perceptions, and quality of IRS efforts, which were compared with households sprayed. Interviewees included household heads or the representative. The other party interviewed included the supervisors for the IRS program. Multistage sampling was used to select respondents from households and probability proportional to size (PPS) was used to select clusters in which respondents were picked. To validate the findings of the study, statistical significance was set at p < 0.05.Results: The study demonstrated that areas with a larger percentage of the population (greater than 60%) protected by Indoor residual spraying had lower incidence of malaria (82/1000 and 400/1000) compared to unsprayed area (398/1000 and 773/1000) both at the beginning and pick of malaria transmission season. A chi-square test shows that there was an association between spraying and reduced malaria incidence, p <0.05. Factors such as length of Insecticide Treated Nets ownership and building material for the house (p-value<0.04 and 0.03) respectively, had an association with the level of IRS acceptance. Acceptance of indoor residual spraying program was good at 64% of the 100% response rate interviewed. Reasons given for those who did not have the houses sprayed among others was absence from home (79%). There was an association between Knowledge of the use for IRS and school attendance p-value < 0.001. Management of the program was poor, negatively affecting results of indoor residual spraying, starting from ill timing (wrong season) to management of commodities such as personal protective equipment, Insecticide, inadequate transport and short notice given to the households. Conclusion: Indoor residual spraying was associated with reduced malaria incidence in Kaoma district in areas where it was implemented. Poor management of the programme, however, negatively affected the results. The district needs to focus on management of logistics, intensify sensitisation and improve on the starting time of IRS if it has to have the desired impact in preventing malaria

The Quality of Poliomyelitis Linked Acute Flaccid Paralysis Surveillance Systems in Zambian Districts Bordering Angola and the Democratic Republic of Congo

Objective: To evaluate the quality of poliomyelitis linked Acute Flaccid Paralysis (AFP) surveillance system in Zambian districts bordering Angola and the Democratic Republic of Congo.Design: A concurrent mixed method design was used to collect data in 7 of 9 provinces; cross sectional surveys, a retrospective descriptive analysis on secondary AFP surveillance data and routine immunization trivalent Oral Polio Vaccine (tOPV) coverage data collected between 2000 and 2009. A case study on community based AFP surveillance was conducted utilizing focus group discussions.Results: Sixteen out of twenty-five districts did not attain 90% target for OPV 3 immunization in the period under review (2000 to 2009).All provinces attained the 80% target of the stool adequacy indicator while the Nonpolio AFP rate indicator of 2/100,000 children aged <15 years was not attained. Levels of knowledge on all aspects of AFP surveillance were generally low regardless of administrative level (province, district & health facility) duration of service, work department, profession and geographical location.Knowledge levels were lowest (P value=<.0001) at health facility level (8.4%). Only 31.8% heath workers were trained across all levels. Logistics for AFP surveillance were not adequate at health facility level. There was inadequate staffing and supervision for AFP surveillance, especially at health facility level. Focus group discussions revealed that communities were not involved and not sensitized in AFP surveillance.Conclusions: There is suboptimal AFP surveillance quality in districts bordering Angola and DRC. The gaps identified need to be addressed, or could result in failure to detect imported wild polio viruses from neighbouring countries or from any part the world. This would lead to sustained transmission of the polio virus and resurgence of poliomyelitis, given the fluctuatingt OPV 3 immunization coverage

Review of the Oral Polio Vaccineimmunization Coverage with Regard to Polio Eradication in Zambia: 2000-2009

Objectives: To review the Oral Polio Vaccine (OPV) immunization coverage (routine and supplemental) in Zambia from 2000 to 2009, with the view of identifying opportunities for system strengthening, given that routine immunization is the “bed rock” for polio eradication.Design: A retrospective descriptive analysis design was conducted on secondary routine and supplemental immunization data for Zambia for the period 2000-2009, consisting of all children aged<5years who had received OPV country wide. Immunization performance was evaluated using the WHO-specified 90% targetResults: The target of 90% for Routine Immunization (RI)could not be reached in most provinces. Only Central province attained the target throughout the stated period. In 2004 and 2008, all provinces apart from Copperbelt attained the target. The 90%target for supplemental immunization activities were reached during all rounds of National Immunization Days (NIDs) apart from the first two (2) rounds in1996. The two rounds of Mopping –up immunization in 2002 attained the90% targetConclusion: Routine immunization for the oral polio vaccine has been an integral part of immunization activities in Zambia. The WHO target for OPV immunization was not attained in most districts and provinces in the period under review. This situation needs to be addressed through partner collaboration to raise herd immunity in case of imported polio viruses. While RI alone cannot eradicate the disease, good routine OPV coverage reduces the incidence of polio and makes eradication feasible. It also prevents the re-establishment of poliovirus if it is re-introduced from other countries, through international travelers and migrant populations from conflict area

Effectiveness of rapid diagnosti test for Malaria diagnosis in children under 15 years of age of Nchelenge District in the Luapula Province

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Transfusion Transmissible Infections among Voluntary Blood Donors at the University Teaching Hospital, Lusaka, Zambia

Background: HIV1&2, HBsAg, anti-HCV and syphilis antibody are mandatory disease marker tests of Transfusion Transmissible Infections (TTIs) conducted on every donated unit of blood in Zambia. Blood is donated by first time voluntary donors and repeat/regular donors of ages between 16 and 65 years. Both first time and regular blood donors undergo the same screening eligibility criteria in the form of medical questionnaire, history and physical examination prior to blood donation. Units, which test positive for any of the four TTIs, are discarded. The cost of producing one unit of blood in Zambia is about $40US and there is need to keep the discard rate to a minimum. The study aimed at finding out which sub-category of donors was responsible for the discards at the Lusaka Blood Transfusion Centre and conversely which was the safest.Methodology: A cross-sectional study involvingretrospective review of all blood donors and screening records of voluntary non-remunerated donors at the Lusaka Province/UTH Blood Transfusion Centre covering the period of January to December 2012. For each unit of donated blood, information on donor age, gender, whether first or repeat donor and test result of disease marker of the four TTIs was entered on a spreadsheet and subjected to descriptive and inferential analysis.Results: Of the 16,027 units donated in 2012, 11,516 (71.9%) were from males, and the majority (77.8%) were aged between 16-24 years. The proportion of first time donors was 60.4%. The overall discard rate due to TTIs was 10.1% (1,622). Most discards were for a single disease marker positivity (1526, 94.1%). Disease marker positivity for HIV, Hepatitis B, Hepatitis C, and Syphilis was: 2.9%, 6.0%, 0.6%, and 1.2% respectively. Using multivariate logistic regression, the safest donors (i.e. with a useable unit, not discarded due to a TTI) were females (OR 1.25, 95% CI 1.11-1.41), repeat donors (OR 1.37, 95% CI 1.23-1.53), and those in the age category 16-24 years (OR 2.35, 95% CI 1.95-2.84).Conclusions: Repeat/regular, female, young (16-24 years of age), voluntary blood donors were the safest source of tested blood at the UTH/Lusaka Province Blood Transfusion Centre in 2012. Hepatitis B remains the most common TTI as a cause for discard and points to the need for adequate prevention strategies. There is a small but significant discard rate due to hepatitis C. The overall 10.1% discard rate due to TTIs suggests an inevitable need to consider safer donor retention strategies as drivers for the sustainable blood transfusion program in Zambia.Keywords: Blood donors, Transfusion Transmissible Infections, voluntary donors, Zambi