School-based professional development in a developing context: lessons learnt from a case study in Zambia

This paper reports on the development and outcomes of the second phase of OER4Schools, a schoolbased professional development programme supporting interactive forms of subject teaching in conjunction with Open Educational Resources (OER) and technology in Zambian primary schools. We worked with partners to identify the needs of school-based continuing professional development (CPD) adapted to the local context; the programme was based on participatory, collaborative and inquiry-based pedagogies for both classroom learning and teacher development. We worked over a 1-year period with four experienced teachers in two basic (primary) schools serving disadvantaged communities. Data were collected from observations, interviews, surveys, lesson planning / review meetings and team workshops. All participants integrated OER and technology into mathematics and science lessons and developed more interactive practices, including collaborative learning. Professional dialogue, quality conversations, reflective practice, cultural sensitivity, peer learning and co-operation were pivotal mechanisms through which teachers shifted their focus from teaching (and teacher exposition) to student learning. Seeing students as capable individuals, teachers raised their expectations, and developed insight into interactive practices such as group work, providing meaningful opportunities for student collaboration and active learning by all.We are most grateful to the teachers and the two schools who participated in our trials. Thanks also to Riikka Hofmann for useful comments on an earlier draft. Other partners supporting the work included iSchool Zambia (http://www.ischool.zm), the Ministry of Education (Zambia), Aptivate (UK-based NGO), the National In-Service Teachers’ College (now Chalimbana University, Zambia), and VVOB Zambia. The OER4Schools programme was based in the University of Cambridge Centre for Commonwealth Education and was supported by the Commonwealth Education Trust,This is the author accepted manuscript. The final published version is available via Taylor & Francis at http://www.tandfonline.com/doi/full/10.1080/19415257.2014.938355#.VVNgXy73Q80

Adapting Fadel’s Four-Dimensional Education Model in Teaching and Learning Civic Education In 21st Century Zambia

This study focused on contextualizing Charles Fadel’s four-dimensional model of education to teaching and learning Civic Education in secondary schools in of the 21st century Zambia. The study confirmed the importance of Fadel’s four-dimensional model of education in teaching and learning Civic Education in secondary schools in the 21st century in Zambia. All the four interlinked educational components in the model are crucial in teaching and learning of Civic Education in secondary schools. The study recommends the review of Civic Education curriculum course that secondary school teacher training institutions offer in colleges and universities in Zambia to incorporate the 21st teaching and learning methods as espoused in the four-dimensional education model; and the need to periodically review how methods used in teaching and learning Civic Education help prepare learners for civic agency, give them confidence to vote, and engage with their communities voluntarily as these are the tenets of the 21st teaching and learning of this epoch. Key Terms: Civic Education, Teaching, learning, four-dimensional, and education. DOI: 10.7176/JEP/13-33-15 Publication date: November 30th 202

Challenges and advocated solutions for environmental protection legislation for building infrastructure projects in developing countries: Evidence from Zambia

Environment protection legislation is often inadequate and poorly implemented in Africa even though literature shows that it is important for environmental protection. Furthermore, there is a paucity of studies which examine the catalytic role of legislation in the building infrastructure sustainability agenda. Therefore, to bridge that knowledge gap, this study examined the adequacy of environment protection legislation for building infrastructure projects in Zambia and their associated challenges and solutions. The study used an exploratory qualitative approach using semi-structured interviews with key stakeholders on environment protection. The study theorises that environment protection legislation in Zambia is fairly adequate but with inadequacies in its implementation, some with omitted content, and poor understanding of the importance of environment protection. Solutions include increasing the level of implementation of the legislation and championing awareness of the importance of protecting the environment. The findings have implications for sustainability transitioning in Africa

Potential contribution of cereal and milk based fermented foods to dietary nutrient intake of 1-5 years old children in Central province in Zambia

Zambia is still facing undernutrition and micronutrient deficiencies despite fortification and supplementation programmes stressing the need for additional solutions. Fermented foods have the potential to improve nutrient intake and, therefore, could have an important role in food based recommendations (FBRs) to ensure adequate intake of nutrients for optimal health of populations. Secondary dietary intake data was used in Optifood, a linear programming software to develop FBRs, for children aged 1–3 and 4–5 years in Mkushi district of Zambia. Three scenarios per age group were modeled to determine FBRs based on: (1) FBRs based on local available foods (2) FBR and Mabisi, a fermented milk beverage, and (3) FBR with Munkoyo, a cereal fermented beverage. The scenarios were compared to assess whether addition of Mabisi or Munkoyo achieved a better nutrient intake. FBRs based on only locally available non-fermented foods did not meet ≥70% of recommended nutrient intake (RNI) for calcium, fat, iron and zinc, so-called problem nutrients. The addition of Munkoyo to the FBRs did not reduce the number of problem nutrients, but after adding Mabisi to the FBR’s only iron (67% of RNI) in the 1–3 year age group and only zinc (67% of RNI) in the 4–5 year age group remained problem nutrients. Mabisi, a fermented milk product in combination with the local food pattern is a good additional source of nutrients for these age groups. However, additional nutrition sensitive and cost-effective measures would still be needed to improve nutrient intake, especially that of iron and zinc.</p

Immune response profiles of calves following vaccination with live BCG and inactivated Mycobacterium bovis vaccine candidates

<div><p>Conventional control and eradication strategies for bovine tuberculosis (BTB) face tremendous difficulties in developing countries; countries with wildlife reservoirs, a complex wildlife-livestock-human interface or a lack of veterinary and veterinary public health surveillance. Vaccination of cattle and other species might in some cases provide the only suitable control strategy for BTB, while in others it may supplement existing test-and-slaughter schemes. However, the use of live BCG has several limitations and the global rise of HIV/AIDS infections has furthermore warranted the exploration of inactivated vaccine preparations. The aim of this study was to compare the immune response profiles in response to parenteral vaccination with live BCG and two inactivated vaccine candidates in cattle.</p><p>Twenty-four mixed breed calves (<i>Bos taurus</i>) aged 4–6 months, were allocated to one of four groups and vaccinated sub-cutaneously with live <i>M</i>. <i>bovis</i> BCG (Danish 1331), formalin-inactivated <i>M</i>. <i>bovis</i> BCG, heat-killed <i>M</i>. <i>bovis</i> or PBS/Montanide™ (control). Interferon-γ responsiveness and antibody production were measured prior to vaccination and at weekly intervals thereafter for twelve weeks. At nine weeks post-priming, animals were skin tested using tuberculins and MTBC specific protein cocktails and subsequently challenged through intranodular injection of live <i>M</i>. <i>bovis</i> BCG.</p><p>The animals in the heat-killed <i>M</i>. <i>bovis</i> group demonstrated strong and sustained cell-mediated and humoral immune responses, significantly higher than the control group in response to vaccination, which may indicate a protective immune profile. Animals in this group showed reactivity to the skin test reagents, confirming good vaccine take. Lastly, although not statistically significant, recovery of BCG after challenge was lowest in the heat-killed <i>M</i>. <i>bovis</i> group.</p><p>In conclusion, the parenteral heat-killed <i>M</i>. <i>bovis</i> vaccine proved to be clearly immunogenic in cattle in the present study, urging further evaluation of the vaccine in challenge studies using virulent <i>M</i>. <i>bovis</i> and assessment of vaccine efficacy in field conditions.</p></div

Risk Factors for Mortality in Children Hospitalized With Severe Malaria in Northern Zambia: A Retrospective Case-Control Study

Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, P \u3c 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death (P £ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals

Screening for tuberculosis and testing for human immunodeficiency virus in Zambian prisons

Objective: To improve the Zambia Prisons Service's implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing. Methods: For both tuberculosis and HIV, we implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. We also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia's prisons. Findings: In a period of 9 months, we screened 7638 individuals and diagnosed 409 new patients with tuberculosis. We tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments – 6.4% (6428/100 000) – is 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive. Conclusion: Both tuberculosis and HIV infection are common within Zambian prisons. We enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. Our observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere

Stakeholder narratives on trypanosomiasis, their effect on policy and the scope for One Health

Background This paper explores the framings of trypanosomiasis, a widespread and potentially fatal zoonotic disease transmitted by tsetse flies (Glossina species) affecting both humans and livestock. This is a country case study focusing on the political economy of knowledge in Zambia. It is a pertinent time to examine this issue as human population growth and other factors have led to migration into tsetse-inhabited areas with little historical influence from livestock. Disease transmission in new human-wildlife interfaces such as these is a greater risk, and opinions on the best way to manage this are deeply divided. Methods A qualitative case study method was used to examine the narratives on trypanosomiasis in the Zambian policy context through a series of key informant interviews. Interviewees included key actors from international organisations, research organisations and local activists from a variety of perspectives acknowledging the need to explore the relationships between the human, animal and environmental sectors. Principal Findings Diverse framings are held by key actors looking from, variously, the perspectives of wildlife and environmental protection, agricultural development, poverty alleviation, and veterinary and public health. From these viewpoints, four narratives about trypanosomiasis policy were identified, focused around four different beliefs: that trypanosomiasis is protecting the environment, is causing poverty, is not a major problem, and finally, that it is a Zambian rather than international issue to contend with. Within these narratives there are also conflicting views on the best control methods to use and different reasoning behind the pathways of response. These are based on apparently incompatible priorities of people, land, animals, the economy and the environment. The extent to which a One Health approach has been embraced and the potential usefulness of this as a way of reconciling the aims of these framings and narratives is considered throughout the paper. Conclusions/Significance While there has historically been a lack of One Health working in this context, the complex, interacting factors that impact the disease show the need for cross-sector, interdisciplinary decision making to stop rival narratives leading to competing actions. Additional recommendations include implementing: surveillance to assess under-reporting of disease and consequential under-estimation of disease risk; evidence-based decision making; increased and structurally managed funding across countries; and focus on interactions between disease drivers, disease incidence at the community level, and poverty and equity impacts

Community-facility linkage models and maternal and infant health outcomes in Malawi’s PMTCT/ART program: a cohort study

Background: In sub-Saharan Africa, 3 community-facility linkage (CFL) models—Expert Clients, Community Health Workers (CHWs), and Mentor Mothers—have been widely implemented to support pregnant and breastfeeding women (PBFW) living with HIV and their infants to access and sustain care for prevention of mother-to-child transmission of HIV (PMTCT), yet their comparative impact under real-world conditions is poorly understood. Methods and findings: We sought to estimate the effects of CFL models on a primary outcome of maternal loss to follow-up (LTFU), and secondary outcomes of maternal longitudinal viral suppression and infant “poor outcome” (encompassing documented HIV-positive test result, LTFU, or death), in Malawi’s PMTCT/ART program. We sampled 30 of 42 high-volume health facilities (“sites”) in 5 Malawi districts for study inclusion. At each site, we reviewed medical records for all newly HIV-diagnosed PBFW entering the PMTCT program between July 1, 2016 and June 30, 2017, and, for pregnancies resulting in live births, their HIV-exposed infants, yielding 2,589 potentially eligible mother–infant pairs. Of these, 2,049 (79.1%) had an available HIV treatment record and formed the study cohort. A randomly selected subset of 817 (40.0%) cohort members underwent a field survey, consisting of a questionnaire and HIV biomarker assessment. Survey responses and biomarker results were used to impute CFL model exposure, maternal viral load, and early infant diagnosis (EID) outcomes for those missing these measures to enrich data in the larger cohort. We applied sampling weights in all statistical analyses to account for the differing proportions of facilities sampled by district. Of the 2,049 mother–infant pairs analyzed, 62.2% enrolled in PMTCT at a primary health center, at which time 43.7% of PBFW were ≤24 years old, and 778 (38.0%) received the Expert Client model, 640 (31.2%) the CHW model, 345 (16.8%) the Mentor Mother model, 192 (9.4%) ≥2 models, and 94 (4.6%) no model. Maternal LTFU varied by model, with LTFU being more likely among Mentor Mother model recipients (adjusted hazard ratio [aHR]: 1.45; 95% confidence interval [CI]: 1.14, 1.84; p = 0.003) than Expert Client recipients. Over 2 years from HIV diagnosis, PBFW supported by CHWs spent 14.3% (95% CI: 2.6%, 26.1%; p = 0.02) more days in an optimal state of antiretroviral therapy (ART) retention with viral suppression than women supported by Expert Clients. Infants receiving the Mentor Mother model (aHR: 1.24, 95% CI: 1.01, 1.52; p = 0.04) and ≥2 models (aHR: 1.44, 95% CI: 1.20, 1.74; p < 0.001) were more likely to undergo EID testing by age 6 months than infants supported by Expert Clients. Infants receiving the CHW and Mentor Mother models were 1.15 (95% CI: 0.80, 1.67; p = 0.44) and 0.84 (95% CI: 0.50, 1.42; p = 0.51) times as likely, respectively, to experience a poor outcome by 1 year than those supported by Expert Clients, but not significantly so. Study limitations include possible residual confounding, which may lead to inaccurate conclusions about the impacts of CFL models, uncertain generalizability of findings to other settings, and missing infant medical record data that limited the precision of infant outcome measurement. Conclusions: In this descriptive study, we observed widespread reach of CFL models in Malawi, with favorable maternal outcomes in the CHW model and greater infant EID testing uptake in the Mentor Mother model. Our findings point to important differences in maternal and infant HIV outcomes by CFL model along the PMTCT continuum and suggest future opportunities to identify key features of CFL models driving these outcome differences

“I would love if there was a young woman to encourage us, to ease our anxiety which we would have if we were alone”: Adapting the mothers2mothers mentor mother model for adolescent mothers living with HIV in Malawi

Pregnant and post-partum adolescent girls and young women (AGYW) living with HIV in sub-Saharan Africa experience inferior outcomes along the prevention of mother-to-child transmission of HIV (PMTCT) cascade compared to their adult counterparts. Yet, despite this inequality in outcomes, scarce data from the region describe AGYW perspectives to inform adolescent-sensitive PMTCT programming. In this paper, we report findings from formative implementation research examining barriers to, and facilitators of, PMTCT care for HIV-infected AGYW in Malawi, and explore strategies for adapting the mothers2mothers (m2m) Mentor Mother Model to better meet AGYW service delivery-related needs and preferences