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Updated: 10 hours 32 min ago

Healthcare workers’ perspectives on access to SRH services in Kenya, Tanzania, Uganda and Zambia

Tue, 02/08/2022 - 14:15
Dear HIFA and HIFA-Zambia,

'According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%)' This is the main finding of a paper from Kenya, Tanzania, Uganda and Zambia. Citation, abstract and a comment from me below.

CITATION: Healthcare workers’ perspectives on access to sexual and reproductive health services in the public, private and private not-for-profit sectors: insights from Kenya, Tanzania, Uganda and Zambia
Gaby I. Ooms et al.
BMC Health Services Research volume 22, Article number: 873 (2022) Cite this article
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-08249-y

ABSTRACT
Background: Access to sexual and reproductive health services remains a challenge for many in Kenya, Tanzania, Uganda and Zambia...

Methods: A cross-sectional survey was conducted among healthcare workers working in health facilities offering sexual and reproductive health services in Kenya (n = 212), Tanzania (n = 371), Uganda (n = 145) and Zambia (n = 243)...

Results: According to healthcare workers, the most common barrier to accessing sexual and reproductive health services was poor patient knowledge (37.1%). Following, issues with supply of commodities (42.5%) and frequent stockouts (36.0%) were most often raised in the public sector; in the other sectors these were also raised as an issue. Patient costs were a more significant barrier in the private (33.3%) and private not-for-profit sectors (21.1%) compared to the public sector (4.6%), and religious beliefs were a significant barrier in the private not-for-profit sector compared to the public sector (odds ratio = 2.46, 95% confidence interval = 1.69–3.56). In all sectors delays in the delivery of supplies (37.4-63.9%) was given as main stockout cause. Healthcare workers further believed that it was common that clients were reluctant to access sexual and reproductive health services, due to fear of stigmatisation, their lack of knowledge, myths/superstitions, religious beliefs, and fear of side effects. Healthcare workers recommended client education to tackle this.

Conclusions: Demand and supply side barriers were manifold across the public, private and private not-for-profit sectors, with some sector-specific, but mostly cross-cutting barriers. To improve access to sexual and reproductive health services, a multi-pronged approach is needed, targeting client knowledge, the weak supply chain system, high costs in the private and private not-for-profit sectors, and religious beliefs.

The authors conclude that: 'Efforts should focus on improving knowledge through client education, HCW sensitisation and education regarding unhelpful religious and cultural beliefs, improving supply chain systems through strengthening logistic management information systems, training staff in supply chain management, and allocating sufficient budget to commodity procurement.'
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COMMENT (NPW): This paper confirms yet again the importance of access to reliable, relevant healthcare information. However, the author's concluding sentence "Efforts should..." cannot be derived on the basis of a relatively small survey of health workers' perceptions. What is needed is more research on the role of (lack of) healthcare information (among patients and health workers) vis a vis other drivers/barriers to high-quality care.

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Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
Working in official relations with WHO

Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey

Sat, 02/07/2022 - 08:53
Dear HIFA and HIFA-Zambia colleagues,

CITATION: Access to mass media and teenage pregnancy among adolescents in Zambia: a national cross-sectional survey
Quraish Sserwanja1 et al. BMJ Open 2022
https://bmjopen.bmj.com/content/12/6/e052684

ABSTRACT
Objective: Teenage pregnancies and childbirths are associated with negative health outcomes. Access to health information enables adolescents to make appropriate decisions. However, the relationship between access to health information through mass media and teenage pregnancy has not received much attention in existing literature. We therefore examined the association between access to mass media and teenage pregnancy in Zambia.

Design: Cross-sectional.

Setting: Zambia.

Participants: Weighted sample of 3000 adolescents aged 15–19 years.

Outcome measure: Teenage pregnancy that included adolescents who were currently pregnant or had had an abortion or had given birth in the last 5 years preceding the survey.

Results: Out of 3000 adolescents, 897 (29.9%, 95% CI: 28.1% to 31.3%) were pregnant or had ever been pregnant. Majority of the adolescents resided in rural areas (55.9%) and had secondary education (53.6%). Adolescents who had exposure to internet, newspapers or magazines, radio and television were 10.5%, 22.6%, 43.1% and 43.1%, respectively. Adolescents who had daily access to newspapers or magazines (adjusted OR (AOR): 0.33, 95% CI: 0.13 to 0.82) or using internet (AOR: 0.54, 95% CI: 0.30 to 0.95) were less likely to be pregnant or to have had a pregnancy compared with those with no access to newspapers and internet, respectively.

Conclusion: Our study suggests that internet use and reading of newspapers or magazines may trigger behavioural change as an effective approach to reducing teenage pregnancy. Behavioural change communicators can implement mass media campaigns using newspapers, magazines and the internet to publicise adolescent health messages that can encourage adolescents to adopt healthy behaviours and prevent teenage pregnancies.

COMMENT (NPW): The full text of the paper acknowledges that 'The observed association between watching TV and listening to radio with teenage pregnancy at bivariable analysis level was lost when socioeconomic variables were included during multivariable analysis'.

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
Working in official relations with WHO

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Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six LMICs

Sat, 02/07/2022 - 08:08
Dear HIFA and HIFA-Zambia colleagues,

This paper concludes 'there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID-19 period compared with the previous year'.

CITATION: Health care in pregnancy during the COVID-19 pandemic and pregnancy outcomes in six low- and-middle-income countries: Evidence from a prospective, observational registry of the Global Network for Women’s and Children’s Health. Seemab Naqvi et al.
First published: 04 April 2022 https://doi.org/10.1111/1471-0528.17175

ABSTRACT
Objective: To assess, on a population basis, the medical care for pregnant women in specific geographic regions of six countries before and during the first year of the coronavirus disease 2019 (COVID-19) pandemic in relationship to pregnancy outcomes.

Design: Prospective, population-based study.

Setting: Communities in Kenya, Zambia, the Democratic Republic of the Congo, Pakistan, India and Guatemala.

Population: Pregnant women enrolled in the Global Network for Women's and Children's Health's Maternal and Newborn Health Registry.

Methods: Pregnancy/delivery care services and pregnancy outcomes in the pre-COVID-19 time-period (March 2019–February 2020) were compared with the COVID-19 time-period (March 2020–February 2021).

Main outcome measures: Stillbirth, neonatal mortality, preterm birth, low birthweight and maternal mortality.

Results: Across all sites, a small but statistically significant increase in home births occurred between the pre-COVID-19 and COVID-19 periods (18.9% versus 20.3%, adjusted relative risk [aRR] 1.12, 95% CI 1.05–1.19). A small but significant decrease in the mean number of antenatal care visits (from 4.1 to 4.0, p = <0.0001) was seen during the COVID-19 period. Of outcomes evaluated, overall, a small but significant decrease in low-birthweight infants in the COVID-19 period occurred (15.7% versus 14.6%, aRR 0.94, 95% CI 0.89–0.99), but we did not observe any significant differences in other outcomes. There was no change observed in maternal mortality or antenatal haemorrhage overall or at any of the sites.

Conclusions: Small but significant increases in home births and decreases in the antenatal care services were observed during the initial COVID-19 period; however, there was not an increase in the stillbirth, neonatal mortality, maternal mortality, low birthweight, or preterm birth rates during the COVID-19 period compared with the previous year. Further research should help to elucidate the relationship between access to and use of pregnancy-related medical services and birth outcomes over an extended period
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Best wishes, Neil

Coordinator, WHO-HIFA project on Essential Health Services and COVID-19
https://www.hifa.org/projects/essential-health-services-and-covid-19

Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is global coordinator of Healthcare Information For All - www.hifa.org - a global health community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. Twitter: @hifa_org neil@hifa.org


Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia (2)

Wed, 08/06/2022 - 07:00
Hi Neil,

Thank you for sharing this.

I am interested in getting full access to this publication, can anyone with full access kindly share the pdf with me. Will love to learn from the study. [*see note below]

So how do we tackle those perceived bottlenecks? Whats on the menu?

Regards,

Dr. Wezi P. M. Sunkutu,
Clinical Research Fellow,
University North Carolina -Global Projects Zambia (UNC-GPZ)
Cell: +260-977-518-949
Skype name: wezi_sunkutu
"The most important question to ask on the job is not, "what am I getting?" The most important question to ask on the job is, "what am I becoming?" - Jim Rohn.

HIFA profile: Wezi P. M. Sunkutu is a medical doctor (GP) with over 5yrs exposure in the rural parts of the country at both clinical and administrative level. He is now in the private sector and developing his special interest in the role nutrition plays in the management of diseases. http://www.wezisunkutu.flp.com/home.jsf drwezisunkutu AT gmail.com

[*Note from NPW, moderator: I have just done a search on Google Scholar and the full text article is available on ResearchGate here:
https://www.researchgate.net/profile/Malizgani-Chavula/publication/349822845_Experiences_of_teachers_and_community_health_workers_implementing_sexuality_and_life_skills_education_in_youth_clubs_in_Zambia/links/608f0510a6fdccaebd02d338/Experiences-of-teachers-and-community-health-workers-implementing-sexuality-and-life-skills-education-in-youth-clubs-in-Zambia.pdf ]

Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia

Tue, 07/06/2022 - 10:42
Dear HIFA, CHIFA and HIFA-Zambia colleagues,

The conclusion of this paper is perhaps predictable: 'piloting of the curriculum with local facilitators and translating the manuals into the local languages before they are implemented, is recommended'. Unfortunately the full text of the paper is restricted-access and is therefore not available to most of us.

CITATION: Chavula MP, Svanemyr J, Zulu JM, Sandøy IF. Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia. Glob Public Health. 2022 Jun;17(6):926-940. doi: 10.1080/17441692.2021.1893371. Epub 2021 Mar 4. PMID: 33661081.
Download citation https://doi.org/10.1080/17441692.2021.1893371

ABSTRACT
Zambia, like other low- and middle-income countries, faces numerous adolescent sexual and reproductive health challenges such as teenage pregnancies. This study aimed at understanding teachers' and community health workers' (CHWs) implementation of comprehensive sexuality education (CSE) as part of a comprehensive support package for adolescent girls to prevent early childbearing. Data collected using in-depth interviews [n = 28] with teachers [n = 15] and community health workers [n = 13] were analysed using thematic analysis. The teachers and CHWs reported that the use of participatory approaches and collaboration between them in implementing CSE enabled them to increase girls' and boys' participation youth clubs. However, some teachers and CHWs experienced practical challenges with the manuals because some concepts were difficult to understand and translate into local language. The participants perceived that the youth club increased knowledge on CSE, assertiveness and self-esteem among the learners. Training and providing a detailed teaching manual with participatory approaches for delivering CSE, and collaborative teaching enabled teachers and CHWs to easily communicate sensitive SRH topics to the learners. However, for the adoption of CSE to be even more successful, piloting of the curriculum with local facilitators and translating the manuals into the local languages before they are implemented, is recommended.

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Best wishes, Neil

Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is global coordinator of Healthcare Information For All - www.hifa.org - a global health community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. Twitter: @hifa_org neil@hifa.org


MCH Journal: Care-Seeking Behavior for Newborns in Rural Zambia

Tue, 07/06/2022 - 10:33
Dear CHIFA and HIFA-Zambia members

This paper concludes: 'Training both Traditional Birth Attendants and CHWs in providing community-based newborn care and appropriate referrals could improve care-seeking and prevent newborn mortality in rural Zambia.' Citation and abstract below. The full text is unfortunately restricted-access and therefore is unavailable to many of us.

CITATION: Care-Seeking Behavior for Newborns in Rural Zambia
Lucy Thairu, Hanna Gehling, Sarah Kafwanda, Kojo Yeboah-Antwi, Davidson H. Hamer & Karsten Lunze
Maternal and Child Health Journal volume 26, pages1375–1383 (2022)Cite this article
Published: 14 January 2022
https://link.springer.com/article/10.1007/s10995-021-03329-7

ABSTRACT
Objectives: Mothers in resource-limited areas face barriers in initiating care for ill newborns, leading to delays that may contribute to newborn mortality. This qualitative study conducted in rural Lufwanyama District in Zambia aimed to (1) explore mothers’ healthcare-seeking related to newborn illness and (2) identify reasons for delaying care-seeking for ill newborns.

Methods: We examined the perspectives of 60 mothers and 77 grandmothers of children under three years of age in 14 focus group discussions as part of the Lufwanyama Integrated Neonatal and Child Health Program study. We conducted a thematic analysis of verbatim transcripts using dedicated software.

Results: Mothers and grandmothers were generally able to identify newborn danger signs and established a hierarchy of care-seeking based on the perceived severity of danger signs. However, inability to afford transportation, inaccessible health care facilities, high costs of medication prescribed at the health clinics, lack of respectful treatment and fear of newborns dying in the hospital prevented participants from seeking timely care. As traditional birth attendants (TBAs) and community health care workers (CHWs) have limited roles in newborns care beyond the immediate delivery setting, mothers often resorted to traditional healers for newborn care.

Conclusions: Based on cultural beliefs and influenced by traditions, mothers in Lufwanyama have developed hierarchical strategies to seek care for ill newborns. Barriers to treatment at health facilities often resulted in traditional care. Training both TBAs and CHWs in providing community-based newborn care and appropriate referrals could improve care-seeking and prevent newborn mortality in rural Zambia.

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Best wishes, Neil

Let's build a future where every person has access to reliable healthcare information and is protected from misinformation - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is global coordinator of Healthcare Information For All - www.hifa.org - a global health community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. Twitter: @hifa_org neil@hifa.org


COVID-19 vaccine hesitancy in Zambia (2)

Sun, 01/05/2022 - 11:37
This paper finds that only one-third of participants would accept the COVID-19 vaccine if made available to them.

CITATION: Prevalence and factors associated with COVID-19 vaccine acceptance in Zambia: a web-based cross-sectional study.
Pan African Medical Journal. 41 (no pagination), 2022. Article Number: 112. Date of Publication: Jan-Apr 2022.
Mudenda S. et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8994469/

ABSTRACT
Introduction: vaccinations against COVID-19 have been instituted to contain the pandemic. However, information about the acceptability of COVID-19 vaccines in Zambia is lacking. Therefore, the study assessed the prevalence and factors associated with COVID-19 vaccine acceptance among the general population in Zambia.

Methods: this was an online questionnaire-based cross-sectional study conducted from 13th April to 21st May 2021. We included adult Zambians who had access to Facebook and WhatsApp. A multivariable logistic regression model was fitted to determine factors influencing vaccine acceptability. Data were analysed using Stata version 16.1.

Results: of the 677 participants, only 33.4% (n = 226) would accept the vaccine if made available to them. In multivariable regression analysis, respondents who were older than 41 years compared to the 18 to 23 years age group (aOR: 2.77, 95% CI: 1.03-7.48), those who agreed (aOR; 22.85, 95% CI: 11.49-45.49) or did not know (aOR; 3.73, 95% CI: 2.29-6.07) compared to those who disagreed that the COVID-19 vaccine passed through all the necessary stages to ensure its safety and effectiveness, and those who were aware (aOR; 11.13, 95% CI: 5.31-23.35) compared to those who were not aware that the COVID-19 vaccine reduces virus transmission, were more likely to accept the vaccine. Conversely, entrepreneurs compared to government employees (aOR; 0.24, 95% CI: 0.07-0.79) were less likely to accept vaccination.

Conclusion: awareness of the COVID-19 vaccine was high despite low acceptability levels. These findings are significant as they highlight the need to develop strategies for improving vaccine acceptability in Zambia.

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Coordinator, HIFA project on COVID-19, supported by University of Edinburgh
https://www.hifa.org/projects/covid-19

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COVID-19 vaccine hesitancy in Zambia

Sun, 01/05/2022 - 11:25
Dear HIFA and HIFA-Zambia colleagues,

Below are the citation and abstract of a new paper that looks at vaccine hesitancy among parents in Zambia, which found 'high acceptability of COVID-19 vaccination of their children, but substantial uncertainty and hesitancy about receiving the vaccine themselves'.

CITATION: COVID-19 vaccine hesitancy in Zambia: a glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa.
Human Vaccines and Immunotherapeutics. 18(1) (pp 1-6), 2022. Date of Publication: 2022.
Carcelen A.C. et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920139/

ABSTRACT
With unprecedented speed, multiple vaccines against SARS-CoV-2 are available 1 year after the COVID-19 pandemic was first identified. As we push to achieve global control through these new vaccines, old challenges present themselves, including cold-chain storage, the logistics of mass vaccination, and vaccine hesitancy. Understanding how much hesitancy toward COVID-19 vaccines might occur and what factors may be driving these concerns can improve the ability of public health workers and communicators to maximize vaccine uptake. We nested a survey within a measles-rubella mass vaccination campaign in Zambia in November 2020 and asked about sentiments and beliefs toward COVID-19 and COVID-19 vaccines. Among parents bringing their children to receive a measles-rubella vaccine, we found high acceptability of COVID-19 vaccination of their children, but substantial uncertainty and hesitancy about receiving the vaccine themselves. COVID-19 vaccination hesitancy was correlated with beliefs around COVID-19 severity and risk, as well as vaccine safety and effectiveness.

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

Coordinator, HIFA project on COVID-19, supported by University of Edinburgh
https://www.hifa.org/projects/covid-19

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Zambia's response to the COVID-19 pandemic

Sat, 02/04/2022 - 09:22
Dear HIFA and HIFA-Zambia colleagues,

'A lack of resources, misinformation, myths and vaccine hesitancy posed challenges in the fight against COVID-19 in Zambia. There is a need for continuous public education and sensitization on COVID-19 and the importance of vaccinations'.

CITATION: Mudenda, S.; Chileshe, M.; Mukosha, M.; Hikaambo, C. N.; Banda, M.; Kampamba, M.; Mwila, K.; Banda, D. C.; Mufwambi, W.; Daka, V.
Zambia's response to the COVID-19 pandemic: exploring lessons, challenges and implications for future policies and strategies.
Pharmacology and Pharmacy; 2022. 13(1):11-33. 122 ref.
https://www.scirp.org/journal/paperinformation.aspx?paperid=115052

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is a global public health problem that has affected the globe in different ways. There is little information published on the challenges and lessons learnt in responding to the COVID-19 epidemic in Zambia. Objective: To establish Zambia’s response, lessons and the challenges experienced in the fight against COVID-19. Results: Since the emergence of COVID-19, Zambia has experienced three waves, with the third wave being the most severe. The Zambian government responded positively and effectively to all three pandemics with the help of cooperating partners. Zambia adopted the World Health Organization (WHO) recommended prevention methods such as hand hygiene, masking up in public, physical distancing, avoiding crowded areas and staying at home to prevent the further spread of the disease. Additionally, surveillance of COVID-19 was strengthened, which led to the early detection of cases. Besides, there has been a strong call for all Zambian adults to receive the COVID-19 vaccine as a way of controlling the epidemic. However, since the launch of the COVID-19 vaccination programs, there has been a high level of vaccine hesitancy, causing Zambia to fall below the 10% of the adult population required to be vaccinated. Conclusion: The Zambian government put in place effective strategies in the fight against COVID-19. However, a lack of resources, misinformation, myths and vaccine hesitancy posed challenges in the fight against COVID-19 in Zambia. There is a need for continuous public education and sensitization on COVID-19 and the importance of vaccinations.

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Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

SUPPORT-SYSTEMS (1) Open public meetings and community health in Zambia

Sat, 02/04/2022 - 09:13
Dear HIFA and HIFA-Zambia colleagues,

Over the next 3 years HIFA is contributing to a new research project: Can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable? https://www.hifa.org/news/can-decision-making-processes-health-systems-strengthening-and-universal-health-coverage-be

With this in mind I was interested to see this new paper in the International journal of health policy and management.

CITATION: Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability: Lessons From Zambia.
International journal of health policy and management. 11(2) (pp 160-172), 2022. Date of Publication: 01 Feb 2022.
Vian T.; Fong R.M.; Kaiser J.L.; Bwalya M.; Sakanga V.I.R.; Ngoma T.; Scott N.A.
https://www.ijhpm.com/article_3837.html

ABSTRACT

Background: Community-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members.

Methods: We applied a principally qualitative design using observation and analysis of written documentation of public meetings to answer our research question: how do governance committees enact inward transparency and demonstrate accountability to their communities. The analysis measured participation and stakeholder representation at public meetings, the types and purposes of accountability sought by community members as evidenced by questions asked of the governance committee, and responsiveness of the governance committee to issues raised at public meetings.

Results: Public meetings were attended by 6 out of 7 possible stakeholder groups, and reports were generally transparent. Stakeholders asked probing questions focused mainly on financial performance. Governance committee members were responsive to questions raised by participants, with 59% of answers rated as fully or mostly responsive (showing understanding of and answering the question). Six of the 10 sites held elections to re-elect or replace governance committee members. Only 2 sites reached the target set by local stakeholder committees of 50% female membership, down from 3 at formation. To further improve transparency and accountability, community governance committees need to engage in advance preparation of reports, and should consult with stakeholders on broader measures for performance assessment. Despite receiving training, community-level governance committees lacked understanding of the strategic purpose of open public meetings and elections, and how these relate to democratic accountability. They were therefore not motivated to engage in tactics to manage stakeholders effectively.

Conclusion: While open meetings and elections have potential to enhance good governance at the community level, continuous training and mentoring are needed to build capacity and enhance sustainability.
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Best wishes, Neil

Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org

African Alliance for Maternal Mental Health

Thu, 17/03/2022 - 07:16
African Alliance for Maternal Mental Health

Dear Health Information for All - Zambia

Greetings from the African Alliance for Maternal Mental Health.

I am a research epidemiologist with a PhD in perinatal psychiatry from the UK and I am currently working with the African Alliance for Maternal Mental Health (AAMMH) and with Dr Robert Stewart (cc’d) who is a perinatal psychiatrist and founder member of the AAMMH working in Malawi. We have recently joined HIFA.

The African Alliance of Maternal Mental Health African Alliance for Maternal Mental Health (aammh.org) is an alliance of organisations working to improve and advocate for the mental health of mothers across Africa. We are registered as a Non Governmental Organization in Malawi and are aiming to expand across the continent by partnering with organizations in various disciplines, including those covering mental health, maternal and child health, women’s rights, people with lived experience, disability, education etc. This we hope will facilitate networking within and between countries. We are part of the Global Alliance for Maternal Mental Health, a coalition of international organisations committed to improving the mental health and wellbeing of women and children during pregnancy and the first postnatal year throughout the world (globalalliancematernalmentalhealth.org).

We are looking to partner with organizations in each country spanning a variety of relevant disciplines, and are currently in the process of establishing a database of organisations including hospitals and health care services, NGOs, professional associations, educational institutions etc. This we hope will facilitate networking within countries and across Africa and I am currently looking for organisations in Zambia who might wish to join us. I previously emailed this forum and had a great response. At the moment, I am particularly I am looking to add those who work in Women’s Rights, and of course any organisations across health and mental health. Please find attached an information sheet with further details about AAMMH and a membership form for organizations to fill out. We are also running a free webinar series for members of the African Alliance for Maternal Mental Health starting in April. I have attached the flyer also. [HIFA does not carry attachments - Neil]

AAMMH will only succeed with the support of its members. We look forward to a fruitful partnership.

Please feel free to forward this email to other organizations in your networks that will be interested or to pass on any contact details you feel may be of interest to us.

If you have any further questions please do not hesitate to contact me.

Kind regards,
Dr Clare Taylor

HIFA profile: Clare Taylor is a research epidemiologist with a PhD in perinatal psychiatry from the UK, currently working with the African Alliance for Maternal Mental Health African Alliance for Maternal Mental Health (aammh.org). The African Alliance for Maternal Mental Health is an alliance of organisations working to improve and advocate for the mental health of mothers across the Africa. clarabella18 AT hotmail.com

The Current State of Snakebite Care in Kenya, Uganda, and Zambia

Mon, 28/02/2022 - 11:21
CITATION: The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers' Perspectives and Knowledge, and Health Facilities' Treatment Capacity
Gaby I Ooms 1 2, Janneke van Oirschot 1, Benjamin Waldmann 1, Sophie von Bernus 1, Hendrika A van den Ham 2, Aukje K Mantel-Teeuwisse 2, Tim Reed 1
Am J Trop Med Hyg. 2020 Nov 23;104(2):774-782. doi: 10.4269/ajtmh.20-1078.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866361

ABSTRACT
Snakebites continue to be a public health concern in sub-Saharan Africa, where availability of appropriate medical treatment is rare, even though death and disability can be prevented with timely intervention. A challenge is the lack of sociopolitical studies to inform health policies. This study aimed to identify snakebite patient profiles, healthcare workers' (HCWs) knowledge of snakebite, and facilities' snakebite treatment capacity in Kenya, Uganda, and Zambia to inform interventions to improve access to appropriate treatment.

The research comprised a cross-sectional key informant survey among HCWs from health facilities in Kenya (n = 145), Uganda (n = 144), and Zambia (n = 108). Data were collected between March 2018 and November 2019.

Most of the HCWs suggested that the number of snakebite incidents was similar between the genders, that most patients were aged 21-30 years, and most people were bitten when farming or walking. Overall, only 12% of HCWs had received formal training in snakebite management. Only about 20% of HCWs in each country said their health facility had the medicines needed to treat snakebites, with antivenom available in 0-34% of facilities across the sectors and countries, and snakebites were not systematically recorded.

This research shows that an integrative approach through policies to increase resource allocation for health system strengthening, including community education, HCW training, and improved access to snakebite treatment, is needed. Part of this approach should include regulations that ensure antivenoms available in health facilities meet quality control standards and that snakebites are accommodated into routine reporting systems to assess progress.
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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

Dementia knowledge in three countries in sub-Saharan Africa

Mon, 28/02/2022 - 11:13
Dementia knowledge in three countries in sub-Saharan Africa.

Citation and abstract of a paper in the journal of the Alzheimer's Association.

CITATION: Dementia knowledge in three countries in sub-Saharan Africa.
Alzheimer's & dementia : the journal of the Alzheimer's Association.
17(Supplement 7) (pp e057649), 2021. Date of Publication: 01 Dec 2021.
Willis R.; Manful A.S.; Igbafe L.; Mukayagi P.
https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/alz.057649

ABSTRACT
BACKGROUND: Limited research has been carried out in sub-Saharan Africa about knowledge of dementia, although studies report that supernatural causes predominate while the biomedical model has less adherence. The biomedical model has been called the pathway to care, but this is less useful when infrastructure and services for dementia are limited. Three African researchers sought to explore knowledge about dementia in three sub-Saharan African countries. This article provides added value by performing a synthesis across the three countries.
METHOD(S): Qualitative research was performed in Zambia (healthcare professionals and the general public), Kenya (people providing care for parents), and Nigeria (family members providing care for relatives). Individual interviews were analysed with thematic analysis. The findings from the three countries were synthesised to identify shared messages and areas of transferability.
RESULT(S): Zambian findings showed partial adherence to the biomedical model of dementia among professionals but not among the general public. There was evidence of othering those who believed in supernatural origins. In Kenya information-seeking strategies were used when carers realised something unusual was happening, indicating high levels of social capital are necessary. Nigerian findings demonstrated a similar process of gradual recognition of symptoms, but also labels of madness and expectations of recovery.
CONCLUSION(S): Overall, the three sets of data imply that adherence to the biomedical model of dementia is more widespread in sub-Saharan Africa than has been previously thought, but without care and support services and accompanying policies this will not benefit people with dementia and their families.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

Career-Development Cancer Research Training in Africa: The BIG Cat/AORTIC initiatives

Tue, 01/02/2022 - 13:47
[Forwarded from HIFA]

A new special issue has just been published in ecancer which features the research of four Beginning Investigator Grant for Catalytic Research (BIG Cat) awardees. The cancer burden in Africa continues to grow rapidly, due in part to the dearth of research into understanding the determinants of this disease among African populations and the limited human resources that are available on the continent. These four articles cover topics such as the risk of depression among patients with advanced cancer, racial disparities in cervical cancer burden and the relation between selenium and the incidence of gastric cancer in Zambia.

The spectrum of these studies exemplifies the overarching goal of the BIG Cat initiative, founded by the African Organization for Research and Training in Cancer (AORTIC) and supported by the American Association for Cancer Research (AACR) and Center for Global Health (CGH) of the National Cancer Institute (NCI) as well as institutional and industrial partners.

The hope is that many more African cancer early-stage investigators will take this opportunity to accelerate their cancer research career and contribute to developing strategies that will control the burden of cancer in Africa.

Read the special issue here (open access):
https://ecancer.org/en/journal/special-issue/31-career-development-cancer-research-training-in-africa-the-big-cat-aortic-initiatives

*Katie Foxall*
Head of Publishing
+44(0) 117 942 085213 King Square Avenue, Bristol, BS2 8HU

HIFA profile: Katie Foxall is Head of Publishing at eCancer, Bristol, UK. katie AT ecancer.org

Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

Mon, 03/01/2022 - 13:50
Dear HIFA and HIFA-Zambia colleagues,

Citation, abstract and comment from me below. Full text: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260571

CITATION: Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia
Carlos Pineda-Antunez, David Contreras-Loya, Alejandra Rodriguez-Atristain, Marjorie Opuni, Sergio Bautista-Arredondo
Published: December 2, 2021
https://doi.org/10.1371/journal.pone.0260571

ABSTRACT
Background: Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics.

Methods: We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58)...

Results: The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels.

Conclusions: HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.

COMMENT (NPW): It's interesting that the data for this study are 7-8 years old. Can anyone comment on why there is often a delay of several years bewteen research and publication? Also, assessment of knowledge as 'high, medium or low' is dependent on the measures/scores that are used to make the assessment, which will vary from one study to another. Can anyone comment on the feasibility of a more standardised and replicable approach to knowledge assessment?

Many thanks, Neil

Join HIFA: www.hifa.org/joinhifa
Join HIFA-Zambia: http://www.hifa.org/join/join-hifa-zambia

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org



Coronavirus (1414) NYT: As Vaccines Trickle into Africa, Zambia’s Challenges Highlight Other Obstacles

Sun, 12/12/2021 - 17:31
Dear HIFA and HIFA-Zambia colleagues,

Extracts below from a New York Times article. Full text here: https://www.nytimes.com/2021/12/11/health/covid-vaccine-africa.html

Does this resonate with your experience in Zambia or neighbouring countries?

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NGWERERE, Zambia — Four people turned up at a health clinic tucked in a sprawl of commercial maize farms on a recent morning, looking for Covid-19 vaccines. The staff had vials of the Johnson & Johnson vaccine stashed in the fridge. But the staff members apologetically declined to vaccinate the four and suggested they try another day.

A vial of the Johnson & Johnson vaccine holds five doses, and the staff was under orders not to waste a single one.

Ida Musonda, the nurse who supervises the vaccination effort, suspected that her team might have found more takers if they packed the vials in Styrofoam coolers and headed out to markets and churches. “But we have no fuel for the vehicle to take the vaccines there,” she said.

They did vaccinate 100 people on their last trip to a farm; the records from that trip sat in a paper heap in the clinic because the data manager had no internet connection to access an electronic records system...

“I’d like to get it but I work Monday to Saturday, and I don’t know if they vaccinate on Sunday,” said Bernadette Kawango, who supports a large extended family with her wages from an auto-parts store in a low-income neighborhood on the edge of Lusaka, the capital. She has heard many rumors: that people who receive the vaccine will die in two years; that the vaccine is part of a plot by Europeans to kill Africans and take their land; that Bill Gates is on a campaign to reduce the world population... Covid is not at the top of her list of health care worries. “It’s cholera season, and people have malaria, and there is H.I.V. and TB,” she said. She does not know anyone who has been diagnosed with Covid.
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Join HIFA: www.hifa.org/joinhifa
Join HIFA-Zambia: http://www.hifa.org/join/join-hifa-zambia

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

The potential of school-based WASH programming to support children as agents of change in rural Zambian households

Sun, 05/12/2021 - 15:22
Dear HIFA-Zambia and CHIFA colleagues,

Many of us are familiar with the work of Children for Health, which aims to empower children to act as change agents for family and community health. This paper complements and corrobarates this work.

CITATION: The potential of school-based WASH programming to support children as agents of change in rural Zambian households
James C. Winter, Gary L. Darmstadt, Samantha J. Lee & Jennifer Davis
BMC Public Health volume 21, Article number: 1812 (2021)
Published: 08 October 2021
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11824-3

Abstract
Background: Water, sanitation, and hygiene (WASH) interventions frequently assume that students who learn positive WASH behaviors will disseminate this information to their families. This is most prominent in school-based programs, which rely on students to act as “agents of change” to translate impact from school to home. However, there is little evidence to support or contradict this assumption.

Methods: We conducted a quasi-experimental, prospective cohort study in 12 schools in rural, southern Zambia to measure the impact of WASH UP!, a school-based WASH program designed by the creators of Sesame Street. WASH UP! is an educational program that uses stories and interactive games to teach students in grades 1–4 about healthy behaviors, such as washing hands and using the latrine. We completed in-person interviews with grade 1 and 4 students (N = 392 and 369, respectively), their teachers (N = 24) and caregivers (N = 729) using structured surveys containing both open- and closed-ended questions. We measured changes in knowledge and whether students reported sharing WASH-related messages learned in school with their caregivers at home.

Results: Student knowledge increased significantly, but primarily among students in grade 1. Overall rates of students reporting that they shared messages from the curriculum with their caregivers rose from 7 to 23% (p <  0.001). Students in grade 4 were 5.2 times as likely as those in grade 1 to report sharing a WASH-related message with their caregivers (ARR = 5.2, 95% C.I. = (2.3, 8.9); p <  0.001).

Conclusions: Although we measured only modest levels of student dissemination of WASH UP! messages from the school to the home, students in grade 4 showed significantly more promise as agents of change than those in grade 1. Future work should prioritize developing curricula that reflect the variability in needs, capabilities and support in the home and community among primary school students rather than a single approach for a wide range of ages and contexts.
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Join CHIFA (child health and rights): http://www.hifa.org/joinchifa
Join HIFA-Zambia: http://www.hifa.org/join/join-hifa-zambia

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org



Colorectal cancer screening in Zambia

Fri, 03/12/2021 - 09:18
Dear HIFA and HIFA-Zambia colleagues,

The authors of this conference poster note that colorectal cancer screening is 'rarely practiced in most African countries' and reveal 'poor colorectal cancer screening knowledge and attitudes among medical doctors in Zambia'. Citation, abstract and a comment from me below.

CITATION: Colorectal Cancer Screening in Zambia, Southern Africa: A Nationwide Survey on Knowledge, Attitudes, and Practices (KAP) Amongst Medical Doctors
Conference poster, October 26, 2021. Comfort Asante et al.
https://www.eventscribe.net/2021/ACGPosters/fsPopup.asp?efp=SEhPSVVZQkoxNTA4Nw%20&PosterID=417695%20&rnd=0.6459513&mode=posterinfo

ABSTRACT
Introduction: Colorectal cancer (CRC) is a global public health problem that requires early diagnosis and management to decrease mortality and morbidity. Yet, despite the existence of international CRC screening guidelines and recommendations, CRC screening is rarely practiced in most African countries and Zambia is no exception. We conducted a survey to understand the knowledge, attitudes, and practices about colorectal cancer screening among medical doctors in Zambia and assessed treatment referral patterns.

Methods: A multi-institutional cross-sectional study of all registered medical doctors working in Zambia using a self-administered online structured survey was carried out. The survey comprised of 23 standardized qualitative and quantitative questions. Descriptive analysis was used to describe frequencies of the variables; chi square analysis was used to determine associations between knowledge, attitudes and practices and multiple logistic regression was used to describe associations between knowledge of CRC screening and referral patterns. Statistical significance was evaluated at P <0.05.

Results: Out of 243 medical doctors, 147 medical doctors completed the survey giving us a response rate of 61%. Of the respondents 93 (63.3%) were male, with mean years in clinical practice of 3 years (± 3.4 years). Most see about 60 patients per day. One-third (n=50, 34%) of respondents had good knowledge on the appropriate age of initiation of CRC screening, while almost all (n=138, 95.2%) had poor knowledge on the screening modalities of CRC. Three-fifths (n=84, 60%) exhibited poor attitudes towards CRC, while more than half (n=86, 58.5%) report having referred patients for some form of CRC treatment in past year. There was no association between the knowledge and attitude towards screening (p= 0.948) or knowledge of CRC screening practices (p= 0.414) and referral patterns (p=0.433). Provider factors associated with CRC screening include a reduced clinic patient volume (p= 0.0176), and patient factors include family history of ulcerative colitis (p= 0.0151), having at least one first degree relative with CRC younger than 50 (p=0.0542), and knowledge that screening impacts management (p= 0.0571).

Discussion: The poor colorectal cancer screening knowledge and attitudes among medical doctors in Zambia suggests a need for studies that explore the magnitude of association between knowledge and practices to help establish national screening guidelines.

COMMENT (NPW): This research is potentially important, but raises a number of questions: What is the disease burden of colorectal cancer in Zambia? What is the policy of the Ministry of Health of Zambia regarding screening for colorectal cancer? If there is a national policy, to what extent is this being implemented and what are the barriers? I invite HIFA and HIFA-Zambia colleagues to comment.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org


Quality of family planning services in Zambia from perspective of patients and providers

Thu, 02/12/2021 - 18:33
Dear HIFA and HIFA-Zambia colleagues,

This new paper from Zambia concludes: 'The community and health providers indicated the necessity of quality FP/C services that included: appropriate facility infrastructure, skilled healthcare providers, positive healthcare provider attitudes such as treating clients with respect and understanding their needs, the provision of clients’ preferred methods with adequate information and engagement of community members in FP/C services.'

CITATION: Theresa Nkole et al. Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia
Sex Reprod Health Matters. 2021 Dec;29(1):1985945. doi: 10.1080/26410397.2021.1985945.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583990/

ABSTRACT: Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers' and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October-December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

A new HIFA thematic discussion: Maintaining essential health services during the pandemic: What have we learned? Starts 15 November 2021 (2)

Thu, 11/11/2021 - 07:52
Dear Neil and members,

Interesting questions! [ https://www.hifa.org/dgroups-rss/new-hifa-thematic-discussion-maintaining-essential-health-services-during-pandemic-1 ]

From the NetherLands it is hardly possible to answer that.

As secretary to two Dutch Foundations I can only say:
- The West was not fair in sharing their vaccines and knowledge to prevent further spread of the Covid virus for Zambia. The Europeen Union promised a lot but did little so far via WHO or their Covax programm.
- Both foundations tried their best to help their friends in Zambians (sending money to purchase protection materials) but due to travel restrictions board members could not visit them personally. Being on the spot is much better to continue the relation. Contact via Skype was possible but a poor substitute.
- I learned from the manager of a big hospital that due to admitted patients with Covid-19, women treated for VVF, were spread all over the hospital as the gyn ward was a Covid ward at that time. The worn out nurses with knowledge how to care for those women had to go around to all wards.

Kind regards,
Arlet Splint

HIFA-Zambia profile: Arlet Splint is Secretary of Platform Zambia, a group of Dutch Foundations, all working for Zambian citizens, spread all over the country. All board members are board member of their "own" foundation but saw it is possible to help each other (sharing knowledge, sharing space in a container etc) if we join via internet and Zambia-days. The last day the Zambian ambassador for the Benelux came from Brussels. There are Foundations working for a school, for an orphanage, for a hospital etc. We show stories and sometimes even a vacancy on our website: www.platformzambia.nl pasplint AT hetnet.nl