From favours to entitlements: community voice and action and health service quality in Zambia

Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collected between November 2013 and January 2014. It included in-depth interviews and focus group discussions with program stakeholders. Secondary data were used iteratively—to inform the process for primary data collection, to guide primary data analysis and to contextualize findings from the primary data. CVA positively impacted the state, society, state–society relations and development coordination at the local level. Specifically, sustained improvements in some aspects of health system responsiveness, empowered citizens, the improved provision of public goods (health services) and increased consensus on development issues appeared to flow from CVA. The central challenge described by interviewees and FGD participants was the inability of CVA to address problems that required central level input. The mechanisms that generated these outcomes included productive state–society communication, enhanced trust, and state–society co-production of priorities and the provision of services. These mechanisms were activated in the context of existing structures for state–society interaction, willing political leaders, buy-in by traditional leaders, and WV’s strong reputation and access to resources. Prospective observational research in multiple contexts would shed more light on the context, mechanisms and outcomes of CVA programs. In addition to findings that are intuitive and well supported in the literature we identified new areas that are promising areas for future research. These include (1) the context of organizational reputation by the organization(s) spearheading social accountability efforts; (2) the potential relationship between social accountability efforts and making ambitious national programs operational at the frontlines of the health system and (3) the feasibility of scale up for certain types of local level responsiveness

Assessment of groundwater quality in rural areas of Mbala District, Zambia

Access to good quality drinking water still remains a challenge in most rural areas of Zambia, Africa. The aim of this study was to assess the quality of groundwater for human consumption in rural areas of Mbala district in Zambia. A total of fifty nine (59) water samples were collected from fifty nine (59) boreholes in the aforementioned district. The water samples were analysed for physical, chemical and microbiological parameters using standard techniques specific for each parameter. Results were compared to the Zambian Bureau of Standards (ZABS) guideline values for drinking water and in some cases, with WHO guideline values if known. In general, most water parameters in Mbala district complied with ZABS drinking water guideline values. A few chemical parameters which include pH ranging from 5.1 to 6.98, sodium from 0.001mg/L to 49.9mg/L, sulphate from 2mg/L to 18.76mg/L, iron from 0 to 10.22mg/L and manganese from 0 to 0.23mg/L did not meet ZABS drinking water guideline values at a few boreholes. TSS and turbidity ranged from 0 to 133mg/L and 2 to 358NTU respectively. A few exceedances of the aforementioned parameters were recorded at a few boreholes. In contrast, significantly high turbidity levels (>20NTU) were recorded at a few boreholes in the district thus posing a significant threat to the health of the consumers. In terms of microbiological parameters, a few boreholes did not meet the ZABS drinking water guideline values for total coliforms rendering the water supplies from the affected boreholes unfit for human consumption unless boiled or treated with chlorine.Keywords: Groundwater, Zambia, rural areas, water quality, Mbala distric

Pre-Service Teachers Perceptions of Inclusive Education at a University of Technology in South Africa

Currently inclusive education is one of the contemporary issues in education in both developed and developing countries though some countries are struggling to effectively implement it Research has demonstrated that inclusive education can only be firmly implemented if there is a proper curriculum appropriate resources and good teacher pedagogical and knowledge skills It is therefore imperative for teacher education to empower pre-service teachers with necessary knowledge and pedagogical skills to teach inclusively The article focused on Bachelor of Education B Ed 3rd year student teachers perceptions and views regarding inclusive education curriculum implementation at a University of Technology in South Africa UoT A qualitative research approach was employed with a case study design Purposive sampling was used to select 120 participants from 3rd year Bachelor of Education students from a University of technology in South Africa Structured focus group interviews were used to collect data and data was analysed using thematic analysi

Digital preservation practices in academic libraries in South Africa in the wake of the digital revolution

Background: The preservation of digital resources in academic institutions in South Africa is an imperative because of the proliferation of digital resources and the realities of the digital revolution. The study focused on digital preservation practices within academic libraries in South Africa. A number of studies were undertaken in the field of preservation in South Africa and they focused on the preservation of cultural heritage, preservation of electronic government and preservation of public digital information. The major gap in the literature reinforces the need to closely examine digital preservation practices in academic libraries in South Africa. There is a need to understand the extent of preservation of digital resources in various contexts in order to guarantee access to them for future generations. This will improve our understanding of the preservation of digital resources in academic libraries in the wake of the digital revolution. Objectives: The purpose of this study was to investigate digital preservation practices in academic libraries in South Africa in order to suggest solutions for effective digital preservation. Method: The survey research method was used for data collection. Twenty-seven academic institutions in South Africa were surveyed. Data were analysed through the Statistical Package for the Social Sciences. Results: The findings revealed that academic libraries experienced difficulties in preserving and sustaining their digital resources because of the absence of established standards, policies and procedures, inadequate resources, as well as a lack of skills and training. They also had difficulties with limited funding and collaboration efforts, and the threat of technological obsolescence because of the constantly changing software and hardware, poor technology infrastructure and legal issues. Conclusion: All these challenges have created the need for best practices and solutions to facilitate the long-term preservation of digital resources in the academic libraries. Recommendations were made on the basis of the results

Ward Round - Crocodile bites in Malawi: microbiology and surgical management

We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation. Malawi Medical Journal Vol. 21 (1) 2009: pp. 29-3

Effects of biochar and gypsum soil amendments on groundnut (Arachis hypogaea L.) dry matter yield and selected soil properties under water stress

The effects of amending soil with gypsum and biochar on groundnut chlorophyll concentration, water use efficiency (WUE), biomass yield and selected soil properties were investigated under water stress. Gypsum (CaSO4.2H2O) was applied at 0 and 200 kg/ha, groundnut shell biochar at 1, 2 and 4% w/w of soil, and water at 100, 70 and 40% of daily plant water requirement (PWR) as main, sub and sub-sub plots, respectively, in a split-split-plot design. Biochar neutralized the acid soil, significantly raising soil pH from 5 to 7.15 and increasing cation exchange capacity by 75%. Biochar amended at 1 and 2%, increased groundnut dry matter yield by 28%. The optimum biochar application rate for dry matter yield was 1.4% w/w. Biochar application at 4% and irrigation at 40% of PWR reduced the WUE by 45 and 50%, respectively. Chlorophyll concentration index was highest at 40% of PWR. The results suggest that biochar has potential to raise soil pH, increase moisture retention and improve crop performance. Applying water at 100% PWR can increase groundnut dry matter yields, while higher gypsum application rates may be required to affect crop performance

The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study.

BACKGROUND: Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. METHODS: This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. DISCUSSION: The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment

Evidence of Yersinia pestis DNA from fleas in an endemic plague area of Zambia

BACKGROUND: Yersinia pestis is a bacterium that causes plague which infects a variety of mammals throughout the world. The disease is usually transmitted among wild rodents through a flea vector. The sources and routes of transmission of plague are poorly researched in Africa, yet remains a concern in several sub-Saharan countries. In Zambia, the disease has been reported on annual basis with up to 20 cases per year, without investigating animal reservoirs or vectors that may be responsible in the maintenance and propagation of the bacterium. In this study, we undertook plague surveillance by using PCR amplification of the plasminogen activator gene in fleas. FINDINGS: Xenopsylla species of fleas were collected from 83 rodents trapped in a plague endemic area of Zambia. Of these rodents 5 had fleas positive (6.02%) for Y. pestis plasminogen activator gene. All the Y. pestis positive rodents were gerbils. CONCLUSIONS: We conclude that fleas may be responsible in the transmission of Y. pestis and that PCR may provide means of plague surveillance in the endemic areas of Zambia

Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review

Background: HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men. Methods: A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports. Results: The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males. Conclusion: In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.Peer Reviewe