The relationship between alcohol purchasing, rurality, and poverty status in Zambia

The Zambian alcohol industry continues to facilitate increasing alcohol purchasing and consumption despite high rates of poverty. Data from the 2006 and 2015 Living Conditions Monitoring Surveys were analyzed to examine relationships between selfreported poverty status, alcohol purchasing, and alcohol expenditure stratified by rural-urban status. Across all poverty levels in 2006 and among the  moderately poor in 2015, rural households purchased alcohol at similar or greater levels compared to urban households. Overall alcohol purchasing decreased; however, significant differences in alcohol expenditure from 2006 to 2015 were observed among rural (p = 0.014) and urban (p = 0.009)  drinkers. Research is needed, to better understand driving factors for alcohol use and to provide targeted prevention and treatment programs in rural Zambia

Training a Christian public health workforce: A qualitative study of Christian public health training programs

Objective: The objective of this qualitative pilot study was to identify opportunities and challenges Christian public health training programs experience when it comes to equipping public health students to work within Christian health mission organizations. Methods: A sample of seven out of seventeen (41 percent response rate) primarily American Christian public health institutions completed an online survey. Thematic analysis was conducted to identify major themes in the following areas: values specific to a Christian worldview, competencies focused on integrating a Christian worldview, challenges to integrating a Christian worldview, and training available to students interested in Christian health missions. Results: Values focused on Christ-like humility in serving God and others, discipleship, respecting human dignity in the image of God, and collaborative community partnership. More than half of the respondents identified the interrelationship between culture, religion, spirituality, and health as the primary competency integrating a Christian worldview. Global health was identified as the second competency followed by understanding the history and philosophy behind global health and missions. Identified challenges include faith of students and faculty, limited availability of Christian public health textbooks, and secularization of concepts such as poverty and development. Conclusion: The holistic nature of public health is conducive to integrating a Christian worldview into program content. The results show that Christian public health institutions have biblical values and integrate a Christian worldview in understanding the interrelationship between culture, religion, spirituality, and health primarily through the lens of global health. Programs experience significant challenges to embedding a Christian perspective into other content areas. Opportunities for integrating competencies with a Christian worldview include offering a certificate in global health/development ministry, teaching methods for engaging individuals and groups in holistic health discussions, and incorporating spiritual metrics and instruments into program evaluation courses to measure the influence of faith, hope, and discipleship alongside physical and social health metrics

Scaling up success to improve health: Towards a rapid assessment guide for decision makers

Introduction Evidence-based health interventions exist and are effectively implemented throughout resource-limited settings. The literature regarding scale-up strategies and frameworks is growing. The purpose of this paper is to identify and systematically document the variation in scale-up strategies to develop a rapid assessment tool for decision-makers looking to identify the most appropriate strategy for their organizational and environmental contexts. Methods A list of scale-up strategies and frameworks were identified through an in-depth literature review and conversations with scale-up and quality improvement leaders. The literature search included a broad range of terms that might be used interchangeably with scale-up of best practices. Terms included: implementation research, knowledge translation, translational research, quality improvement research, health systems improvement, scale-up, best practices, improvement collaborative, and community based research. Based on this research, 18 strategies and frameworks were identified, and nine met our inclusion criteria for scale-up of health-related strategies. We interviewed the key contact for four of the nine strategies to obtain additional information regarding the strategy’s scale-up components, targets, underlying theories, evaluation efforts, facilitating factors, and barriers. A comparative analysis of common elements and strategy characteristics was completed by two of the authors on the nine selected strategies. Key strategy characteristics and common factors that facilitate or hinder the strategy’s success in scaling up health-related interventions were identified. Results Common features of scale-up strategies include: 1) the development of context-specific evidence; 2) collaborative partnerships; 3) iterative processes; and 4) shared decision-making. Facilitating factors include strong leadership, community engagement, communication, government collaboration, and a focus on human rights. The analysis informed the development of a two-step rapid assessment tool that can be used to guide decision-makers in identifying the most appropriate scale-up strategy given their political environment, leadership styles, and program characteristics. Conclusion The rapid assessment proposed in this paper can be used to help bridge the gap in bringing evidence-based health interventions to communities that need them the most. The purpose of the assessment tool is to decrease the time required to scale effective interventions by identifying and applying a strategy appropriate to the innovation, organizational capacity, and social and political environment

Cross-sectional study of alcohol preferences and expenditures on food insecurity between urban and rural settings in Zambia

This study investigated potential differences in rural and urban alcohol expenditures and the relationship between alcohol and food insecurity. The 2015 Zambia Living Conditions Monitoring Survey was used with a sample of 12,260 households. Bivariate analyses and logistical regression evaluated the differences in rural/urban alcohol preferences and the relationship between alcohol and food insecurity. Traditional brew consumption was found to be significantly higher in rural areas (p<0.001). Rural households with alcohol expenditures had 23 percent lower odds (OR: 0.770, p<0.01) of eating three or more meals a day compared to households without alcohol expenditures. Rural characteristics around alcohol consumption need to be taken into consideration when determining food security and nutrition policies. Alcohol assessments and services should be adapted to rural conditions in Zambia to increase the effectiveness of prevention programs