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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

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

Tue, 09/11/2021 - 14:16
Dear HIFA-Zambia colleagues

We can now look back on 12-18 months of experience of the COVID-19 pandemic. Some countries have now entered a recovery phase with relatively few new cases and deaths (at least for now). Other countries continue to be facing heavy caseloads. Almost every country has been affected and we have seen that essential health services - reproductive health, child health, mental health, non-communicable disease, surgery - have been severely disrupted in many ways. Even for those countries that are in a recovery phase, there are major challenges in terms of late presentation of disease and delayed access to surgery.

I would like to invite you to shsre your experiences of how the pandemic has affected the delivery of essential health services in Zambia.

What have we learned? How can we better maintain newborn health services during a pandemic? What action(s) did your government take that facilitated (or hindered) the delivery of services? How can we build resilience moving forwards?

1. Looking back over the past 18 months, in what ways has COVID-19 affected your work? What impact has COVID-19 had on your organisation or your health facility? How have things changed over time and where are you now?

2. How have you responded to these challenges? What worked well and not so well?

3. A health service is only as good as the people who work within it. Health workers have been under extraordinary pressures for several months on end. What have we learned and how can we better support health workers going forward?

4. We have noted there is not only disruption to the delivery of services, but also in demand for services, associated with exaggerated fears of contagion from health facilities. How have attitudes changed in your experience/country?

Highlights of earlier HIFA discussions are available as two Action Briefs on the WHO website:

1. HIFA: A Thematic Discussion on Maintaining Essential Health Services
https://hlh.who.int/ab-detail/findings-from-a-hifa-thematic-discussion

2. How has COVID-19 affected delivery of EHS? HIFA 2nd Discussion
https://hlh.who.int/ab-detail/how-has-covid-19-affected-delivery-of-ehs-hifa-2nd-discussion

Best wishes, Neil

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

World Stroke Day 29 October

Mon, 01/11/2021 - 10:11
Extracts below from the World Stroke Organization
https://www.world-stroke.org/

'When somebody has a stroke, every second that goes by is crucial. As brain tissue and millions of neurons begin to fade away, time could not be more precious. Our #Precioustime campaign aims to raise awareness of stroke signs and the benefits of timely access to emergency medical care. This year 14.5 million people will have a stroke, 5.5 million people will die as a result.'

PREVENTION
'Up to 90% of strokes could be prevented by addressing a small number of risk factors, including hypertension, diet, smoking and exercise. Preventive action on stroke would also contribute to a massive scale reduction in stroke and would conribute to global goals to reduce cardiovascular disease, cancer, diabetes and other significant causes of death and suffering worldwide.'

DIAGNOSIS
Knowing the signs of stroke and getting treatment quickly saves lives and improves recovery. If you think someone may have had a stroke, do this FAST check:
Face: Is one side drooping?
Arms: Raise both arms. Is one side weak?
Speech: Is the person able to speak? Are words jumbled or slurred?
Time: Act quickly and call emergency services.

COMMENT (NPW): I would like to invite comment on the level of awareness of stroke symptoms in Zambia. Are you aware of any studies on this, or any anecdotal reports of stroke being missed?

This study from Malawi found concluded 'Knowledge about stroke is very low in this community, particularly among the least educated and poor. Programs to support prevention, early recognition, and timely hospital presentation after a stroke are needed'. (Community-Level Knowledge and Perceptions of Stroke in Rural Malawi: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.025105 )

Best wishes, Neil

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

Lancet GH: Expanding long-acting contraceptive options in Nigeria and Zambia (2)

Wed, 08/09/2021 - 06:54
Here is a Comment on the paper that I forwarded a few minutes ago:

CITATION: Empowering women through expanded contraceptive access in Nigeria and Zambia
Published online: August 30, 2021
Funmilola M OlaOlorun, John Casterline
The Lancet Global Health
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00388-0/fulltext

EXTRACTS
Brunie and colleagues documented high client satisfaction and high 12-month continuation rates among a prospective cohort of women who obtained a long-acting reversible contraceptive method (ie, hormonal intrauterine device, copper intrauterine device, or implant) from the private sector in Nigeria and the public sector in Zambia.,,

High satisfaction with the hormonal intrauterine device is valuable evidence for those who aspire to introduce and scale up this contraceptive method in LMICs...

The scale-up efforts should be designed to overcome potential barriers to the use of intrauterine devices. These barriers include the intrusiveness of a pelvic examination, the longer time and greater skills required to insert the device, the perception that intrauterine devices might not be as effective as other contraceptive options, and the misconceptions about this contraceptive method.6 Misconceptions are likely to differ by context, but anecdotal reports suggest that many health-care providers in Nigeria would not be willing to provide an intrauterine device to a nulliparous woman because of the incorrect belief of substantially increased risk of infertility...

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

Lancet GH: Expanding long-acting contraceptive options in Nigeria and Zambia

Wed, 08/09/2021 - 06:49
CITATION: Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia
Published online: August 30, 2021
Aurélie Brunie, Kayla Stankevitz, Anthony Adindu Nwala, Masauso Nqumayo, Mario Chen, Kendal Danna, Kayode Afolabi, Kate H Rademacher
The Lancet Global Health
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00318-1/fulltext

SUMMARY
Background: 30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia.

Methods: We did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia. Eligible women were aged 18–49 years in Nigeria and 16–49 years in Zambia, had chosen to receive the hormonal intrauterine device, copper intrauterine device, or implant (either a 5-year levonorgestrel-releasing subdermal implant or a 3-year etonogestrel-releasing subdermal implant), and, in Nigeria only, had access to a telephone. Women were interviewed within 100 days of receiving their contraceptive method either via telephone in Nigeria or in person in Zambia, with follow-up surveys at 6 months and 12 months. The primary outcomes were method-specific, 12-month continuation rates—ie, continuation rates of the hormonal intrauterine device, copper intrauterine device, and implant across Nigeria and Zambia. We used Kaplan-Meier methods to estimate the cumulative probabilities of method-specific continuation and a log-rank test to compare contraceptive methods. We analysed self-reported satisfaction and experiences as a secondary outcome.

Findings: Between June 25 and Nov 22, 2018, we enrolled a total of 1542 women (n=860 in Nigeria and n=682 in Zambia) receiving a long-acting reversible contraceptive. In total, 835 women (266 [32%] hormonal intrauterine device users, 274 [33%] copper intrauterine device users, and 295 [35%] implant users) in Nigeria and 367 (140 [38%] hormonal intrauterine device users, 149 [40%] copper intrauterine device users, and 78 [21%] implant users) in Zambia were included in the study analysis. The 12-month cumulative continuation rates were 86·8% (95% CI 82·1–90·4) for the hormonal intrauterine device, 86·9% (82·1–90·4) for the copper intrauterine device, and 85·0% (80·2–88·7) for implants in Nigeria. In Zambia, the 12-month cumulative continuation rates were 94·7% (89·2–97·4) for the hormonal intrauterine device, 89·1% (82·3–93·4) for the copper intrauterine device, and 83·1% (72·2–90·1) for implants. At least 71% of respondents across the timepoints were very satisfied with their method, and at least 55 (79%) of 70 reported having recommended their contraceptive method to someone else. Across the methods, the most commonly self-reported positive aspect of long-acting reversible contraceptive use at 12 months was effectiveness in Nigeria (range 93–94%) and long-lasting duration in Zambia (48–60%). Between 124 (50%) of 248 and 136 (59%) of 230 Nigerian participants and 26 (42%) of 62 and 66 (57%) of 117 Zambian participants reported nothing negative about their contraceptive method.

Interpretation: Our study showed high continuation rates and satisfaction across long-acting reversible contraceptives, including the hormonal intrauterine device, a method that has been largely underused in sub-Saharan Africa. This finding supports the inclusion of the hormonal intrauterine device as a valuable addition to the mix of contraceptive methods in Nigeria and Zambia.

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

African Alliance for Maternal Mental Health

Sat, 07/08/2021 - 12:42
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 Kings College London, UK. 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, Senior Clinical Research Fellow at Edinburgh University and a founder member of the AAMMH working in Malawi. The African Alliance for Maternal Mental Health is 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)<https://globalalliancematernalmentalhealth.org/>. The African Alliance has recently registered as an Non Governmental Organization in Malawi and we aim to have continental reach in Africa by partnering with organizations in various disciplines, including those covering mental health, maternal and child health, women’s rights, people with lived experience, etc.

We are currently in the process of establishing a database and I am reaching out to organisations in Zambia who we hope have interest in maternal mental health. Given your work to raise awareness of health issues and initiatives in Zambia, we would be delighted should you wish to join the AAMMH and we would also really appreciate it if you are aware of other organisations or initiatives that might also be interested. I am aware you had a goal of health information for all by 2015. Therefore if you are no longer operational, please accept my apologies. Please find attached [*] an information sheet with further details about AAMMH and a membership form to fill out.

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

Email: clarabella18 AT hotmail.com

[*Note from HIFA-Zambia moderator. HIFA does not carry attachments. Please contact Clare for details. Neil PW]

COVID-19 vaccine hesitancy in Zambia

Mon, 02/08/2021 - 10:09
Dear HIFA-Zambia and HIFA colleagues,

Citation, abstract and a oomment from me below.

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. (no pagination), 2021. Carcelen A.C.et al.
Full text: https://www.tandfonline.com/doi/epub/10.1080/21645515.2021.1948784?needAccess=true

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.

COMMENT (NPW): The authors note: 'We are also limited in our ability to delve deeper into the reasons behind hesitancy... Our findings and limitations highlight the need for future qualitative research to understand the underlying motivators and concerns among those who are and are not intending to receive a COVID-19 vaccine.' It would seem important that any study of vaccine hesitancy also explores the reasons behind it?

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

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

Unexplained stillbirth in Zambia and Tanzania

Sun, 01/08/2021 - 14:51
Dear HIFA and HIFA-Zambia colleagues,

CITATION: Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study.
BJOG: An International Journal of Obstetrics & Gynaecology. 128(7):1206-1214, 2021 Jun.
Bedwell C et al.

Abstract

OBJECTIVE: To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia.

DESIGN: Mixed-methods study.

SETTING: Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania.

SAMPLE: Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities.

METHODS: Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach.

RESULTS: A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23-2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families.

CONCLUSIONS: The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care.

TWEETABLE ABSTRACT: Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.
--

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

Health beliefs and health seeking behavior for lymphatic filariasis

Fri, 02/07/2021 - 18:04
This study from Zambia finds that 'Health seeking behavior for lymphatic filariasis in the district is mainly driven by negative [false] beliefs about the causes of the disease...'. The authors conclude that Lymphatic filariasis programs should promote strategies that seek to empower patients and community members with the required information to access and use the MMDP services at the health facilities. It would be interesting to understand more about what information is currently available and different strategies to meet information needs.

CITATION: Maritim P et al. Health beliefs and health seeking behavior towards lymphatic filariasis morbidity management and disability prevention services in Luangwa District, Zambia: Community and provider perspectives.
PLoS Neglected Tropical Diseases [electronic resource]. 15(2):e0009075, 2021 02. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009075

Abstract

BACKGROUND: Morbidity management and disability prevention (MMDP) services are essential for the management of chronic stages of lymphatic filariasis (LF) infection. However, there is limited information on health beliefs and health seeking behavior towards MMDP services for LF in endemic regions of Zambia. This study sought to document health beliefs and health seeking behavior towards MMDP services for LF in Luangwa District, Zambia.

METHODS: This was an exploratory qualitative study conducted with community members including LF patients, community health workers and healthcare providers. Data was collected through a series of four focus group discussions stratified by sex and 26 in-depth interviews. Data was analyzed by thematic analysis using NVivo software.

RESULTS: The perceived causes of the chronic manifestations of LF included; contact with animal faeces, use of traditional herbal aphrodisiacs (mutoto), witchcraft and sexual contact with women who were menstruating or had miscarried. LF patients opted to visit traditional healers before going to health facilities. Hydrocele patients were afraid of hydrocelectomies as they were thought to cause infertility or death. Very few community members were able to identify any home and facility-based care strategies for lymphoedema. Health system and cultural barriers to seeking healthcare included; long distances to the health facilities, lack of awareness of existing MMDP services, perceived costs of accessing MMDP services, gender and social norms, and fear of stigmatization.

CONCLUSION: Health seeking behavior for LF in the district is mainly driven by negative beliefs about the causes of the disease and lack of awareness of available MMDP services and homecare strategies. Lymphatic filariasis programs should promote strategies that seek to empower patients and community members with the required information to access and use the MMDP services at the health facilities, as well as adhere to self-care practices in their households.

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

Quality of health care (2) Quality of care and respectful care: Intrapartum experiences in Zambia and Tanzania

Fri, 02/07/2021 - 17:46
Dear HIFA and HIFA-Zambia colleagues,

CITATION: Lavender T et al. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania. BMJ Global Health. 6(4), 2021 04. https://gh.bmj.com/content/6/4/e004725

ABSTRACT

BACKGROUND: Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points.

METHODS: We used Strauss and Corbin's grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia... The process involved application of memos, reflexivity and positionality.

RESULTS: Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman's benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive.

CONCLUSION: Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women's and health-provider voices are pivotal to the development of such interventions.

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

Quality of health care (1)

Fri, 02/07/2021 - 17:09
Dear HIFA and HIFA-Zambia colleagues,

As we explore issues around how to increase quality of healthcare [https://www.hifa.org/news/learning-quality-health-services-new-thematic-discussion-hifa] I invite you to share current research on this topic.

Here is a paper from the journal Health care management science, looking at quality of HIV services in several African countries. Unfortunately the full text is restricted access. I have requested the full text from the authors.

CITATION: Sosa-Rubi S.G. et al. Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia.
Health care management science. 24 (1) (pp 41-54), 2021. Date of Publication: 01 Mar 2021. https://pubmed.ncbi.nlm.nih.gov/33544323/

ABSTRACT
Few studies have assessed the efficiency and quality of HIV services in low-resource settings or considered the factors that determine both performance dimensions. To provide insights on the performance of outpatient HIV prevention units, we used benchmarking methods to identify best-practices in terms of technical efficiency and process quality and uncover management practices with the potential to improve efficiency and quality. We used data collected in 338 facilities in Kenya, Nigeria, Rwanda, South Africa, and Zambia. Data envelopment analysis (DEA) was used to estimate technical efficiency. Process quality was estimated using data from medical vignettes. We mapped the relationship between efficiency and quality scores and studied the managerial determinants of best performance in terms of both efficiency and quality. We also explored the relationship between management factors and efficiency and quality independently. We found levels of both technical efficiency and process quality to be low, though there was substantial variation across countries. One third of facilities were mapped in the best-performing group with above-median efficiency and above-median quality. Several management practices were associated with best performance in terms of both efficiency and quality. When considering efficiency and quality independently, the patterns of associations between management practices and the two performance dimensions were not necessarily the same. One management characteristic was associated with best performance in terms of efficiency and quality and also positively associated with efficiency and quality independently: number of supervision visits to HIV units.

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

Cervical cancer prevention during COVID-19 pandemic: The CRS EPIC3-90 project, Zambia

Tue, 01/06/2021 - 15:06
Dear HIFA and HIFA-Zambia colleagues,

This paper finds 'it is possible to improve access to safe cervical cancer prevention services during the COVID-19 pandemic in WLHIV through a coordinated approach among key stakeholders and service providers'. Another way of reading this might be "there is no alternative to well-supported, coordinated services - no quick wins for low-resource settings". Are you involved in a cancer screening programme? What has been your experience during COVID-19?

CITATION: Cervical cancer prevention during COVID-19 pandemic: The CRS EPIC3-90 project, Zambia.
Topics in Antiviral Medicine. Conference: Conference on Retroviruses and Opportunistic Infections, CROI 2021. Virtual. 29 (1) (pp 175), 2021. Date of Publication: March 2021.
Chaila M.J et al.

ABSTRACT
Background: The Epidemic Control 90-90-90 (EpiC 3-90) Project is a U.S Centers for Disease Control & Prevention (CDC) funded project that supports the Ministry of Health (MOH) in Zambia to achieve the UNAIDS 90-90-90 targets in faith-based and Government facilities. The project also supports prevention activities including cervical cancer (CaCx) screening in Women Living with HIV (WLHIV). CaCx remains the most frequent cancer in Zambia accounting for about 25% of all new cancer cases annually. It is also the most common cause of cancer related death in the country. EpiC 3-90 carried out technical support to the 15 supported districts from April 2020 to September 2020 to improve the CaCx screening in WLHIV.

Method(s): EpiC 3-90 created an HIV prevention & comorbidities unit, with adequate staffing to support the establishment of CaCx screening points in supported regions...

Result(s): The average number of WLHIV screened for cervical cancer increased from 242 per month (October 2019-March 2020) to 442 (April-September 2020) indicating 82.6% improvement. This translated to an increase in the number of WLHIV who were screened from 1,450 in the first half of the year to 2,651 in the second half of the year. By September 2020, 4,101 WLHIV had been screened for CaCx (Figure 1).

Conclusion(s): It is possible to improve access to safe cervical cancer prevention services during the COVID-19 pandemic in WLHIV through a coordinated approach among key stakeholders and service providers. CaCx prevention services need to continue due to its high disease burden in Zambia.
--

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

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

Verbal autopsies for out-of-hospital infant deaths in Zambia

Sat, 01/05/2021 - 17:42
Dear HIFA-Zambia and CHIFA,

This paper on infant death emphasises the role of delays in seeking care. Citation, abstract and comment from me below.

CITATION: Lapidot, R. et al. Verbal autopsies for out-of-hospital infant deaths in Zambia. Pediatrics; 2021. 147(4). [restricted access]

ABSTRACT
OBJECTIVES: In Zambia, a significant number of infants die in the community. It is hypothesized that delays in care contribute to many of these so-called "brought in dead" infants.
METHODS: We analyzed free-text narratives from verbal autopsies, in which families narrate the final series of events leading to each infant's death. Using the 3-delays model framework and working iteratively to achieve consensus, we coded each narrative using NVivo software to identify, characterize, and quantify the contribution of delays and other factors to the fatal outcome.
RESULTS: Verbal autopsies were collected from 230 families of brought in dead infants younger than 6 months of age. As many as 82.8% of infants had 1 or more delays in care. The most-common delay was in the family's decision to seek care (54.8%), even as severe symptoms were frequently described. Similarly, 27.8% of infants died en route to a health care facility. Delays in receiving adequate care, including infants dying while waiting in line at a clinic or during referral from a clinic to a hospital, occurred in 24.7% of infants. A third of infants had been previously evaluated by a clinician in the days before their death.
CONCLUSIONS: Delays in care were the rule rather than the exception in this population of Zambian infants. Accessing care requires families to navigate significant logistic barriers, and balance complex forces in deciding to seek care. Strategies to avoid such delays could save many infants lives.

COMMENT: 'Strategies to avoid such delays could save many infants lives.' The question is: what strategies, and how can they be implemented. On CHIFA we have often emphasised the importance of access to basic healthcare information, and the ability to recognise danger signs. Research has repeatedly shown a lack of both. Of course, as the paper notes, there are many factors involved as parents 'balance complex forces in deciding to seek care'. Social autopsy (whereby an attempt is made to identify contributory factors leading up to death) is a valuable tool to understand such factors, but this is rarely feasible other than in occasional research settings.

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

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 coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org




The impact of COVID-19 lockdown on self-employed women in Zambia

Thu, 22/04/2021 - 17:35
Dear HIFA and HIFA-Zambia members,

One of the questions we have been exploring on HIFA is: What has been the impact of health service disruptions on the health and wellbeing of people in your health facility or country?

This paper from Zambia provides a valuable insight from direct testimonies of self-employed women in Zambia

CITATION: The impact of COVID-19 lockdown in a developing country: narratives of self-employed women in Ndola, Zambia. Health care for women international. 41 (11-12) (pp 1370-1383), 2020. Date of Publication: 01 Nov 2020.
Mathew N.; Deborah I.; Karonga T.; Rumbidzai C. https://www.tandfonline.com/doi/full/10.1080/07399332.2020.1823983

ABSTRACT
Women are normally self-employed in businesses involving buying and selling of goods. Such businesses were severely affected by the COVID-19 pandemic lock-down. The researchers explored the impact the of COVID-19 lockdown on self-employed women. The researchers used a qualitative approach. Interviews were used to collect data. Forty participants took part in the study. The data was thematically analyzed. The researchers found that participants were affected by Inadequate food supplies, Hopelessness to revive business, Poor access to health services, Psychological trauma, Defaulting medications, and Challenges of keeping children indoors. There is need to provide social and economic support to self-employed women.

The full text is freely accessible and I note that there is an option to *listen* to the text, which would clearly be useful for people with vision impairment.

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

Sexuality and life skills education in youth clubs in Zambia

Wed, 21/04/2021 - 06:14
Dear HIFA-Zambia and HIFA colleagues,

This paper in Global Public Health highlights two important factors for effective health education: co-development with local facilitators and ensuring the materials are in a language that people can understand.

CITATION: Glob Public Health 2021 Mar 4;1-15. doi: 10.1080/17441692.2021.1893371.
Experiences of teachers and community health workers implementing sexuality and life skills education in youth clubs in Zambia
Malizgani Paul Chavula 1, Joar Svanemyr 2 3, Joseph Mumba Zulu 1, Ingvild Fossgard Sandøy 2
https://pubmed.ncbi.nlm.nih.gov/33661081/

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

Working together for health in Zambia - Join HIFA-Zambia: http://www.hifa.org/forums/hifa-zambia

HIFA-Zambia profile: Neil Pakenham-Walsh is the coordinator of HIFA-Zambia and the HIFA campaign (Healthcare Information For All - www.hifa.org ). Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org

Knowledge of HIV epidemic and safe sex practices in Zambia - Does empowerment matter?

Sat, 03/04/2021 - 17:41
Unfortunately this paper begs the question 'what do the authors mean by empowerment?'. The full text would tell us but a google search did not give any results. If you happen to know the authors, please invite them to join us.

CITATION: Knowledge of HIV epidemic and safe sex practices in Zambia - Does empowerment matter? Journal of the International AIDS Society. Conference: 4th HIV Research for Prevention Conference, HIVRP. 24 (SUPPL 1) (pp 193), 2021. Date of Publication: February 2021. Sherafat-Kazemzadeh R.; Gaumer G.; New F.; Nandakumar A.

ABSTRACT

Background: The campaigns for increasing knowledge about HIV/ AIDS have shown mixed impacts on practice of safe. We hypothesize that individual's empowerment mediates the ability to act based on this knowledge and engage in safe sex practices.

Method(s): We used data from Population-based HIV Impact Assessment (PHIA) nationally representative survey of 2016 in Zambia. We limited the analysis on a subsample of adults selected for the HIV knowledge module and created scalar variables for empowerment, HIV knowledge and sexual behavior. We used regression analysis to assess the impact of empowerment on condom use, having single partner and composite behavior score.

Result(s): Among 9,544 responders (57% female), 9.1% (men) and 15.3% (women) were HIV+. Men and women reported condom use at 21% vs. 16%, and single partner at 67% vs. 83%, respectively. Mean behavior score was 2.34 +/- 0.02 (men) and 2.87 +/- 0.02 (women). Having single partner in previous year and behavior score showed significant positive association with empowerment. When modeling for empowerment effect, knowledge was associated with better behavior, but not with single partner. Wealth attenuated the impact of empowerment or knowledge on condom use. Education was significantly associated with higher condom use and better behavior, but not having single partner. Not living in a union
reduced behavior score. Middle wealth quintiles showed positive association with practice of safer sex. Those living in higher inequality regions showed lower rate of having single sexual partner.

Conclusion(s): Individual's empowerment is playing a role in improving safe sex practices. Successful policies to increase behaviors preventing HIV/AIDS requires incorporating strategies to improve individual's agency in decision making.
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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

COVID-19 in Africa: The nuances of social distancing and handwashing (2)

Tue, 30/03/2021 - 12:55
The commentary [https://www.ajol.info/index.php/mjz/article/view/205146] has brought out two key issues that I think have also affected compliance to measures right here in Zambia.

1) most information is restricted to media (coupled with misleading information) and most of the rural and peri urban have no access to it. They rely on health workers to share such information and in most cases this information is given at health facilities. The second wave especially has seen less of public awareness programs by institutions (leaving much room for misinformation and a sense that some parts are unaffected). Our approach has rather seemed to be Top bottom (we seem to prepare more for the clinical aspects of it and not preventing disease) instead of bottom top (pandemic is a public health issue and community engagement very much critical, intense prevention measures and awareness would have been used). Primary levels of care would have been more effective in getting communities to have access to scientific information, enhance compliance to measures and ultimately gain community support in the pandemic fight. This step will be even more important in the vaccination roll out with current vaccine skepticism being reported across the world.

2) access to clean water in most of these parts is still challenging. The need for improved access to water and sanitation can not be over emphasized and this should be championed in regions where we continue to lose lives due to oral fecal transmitted diseases. Culturally acceptable practices can only be developed if communities themselves design them. Therefore, our win against this is highly dependent on engaging the public at all levels in decision making process, be it prevention, treatment and vaccination.

HIFA-Zambia profile: Flata Mwale is a medical laboratory scientist at the Ministry of Health Zambia. She is currently also the Deputy lead and co-founder of Women in Global Health Zambia chapter, a part of the global movement championing gender equality in global health and local public health sector. She trained at the College of Medicine, University of Malawi. Professional interests: Health systems strengthening and health policy. Advocacy for equity and equality in access, utilization and distribution of health care. Email address: fltmwale AT gmail.com

COVID-19 in Africa: The nuances of social distancing and handwashing

Sun, 28/03/2021 - 11:04
Dear HIFA and HIFA-Zambia members,

Below are extracts from a new Commentary in the Medical Journal Of Zambia. Full text here: https://www.ajol.info/index.php/mjz/article/view/205146

COVID-19 in Africa: The nuances of social distancing and handwashing
Akwi W. Asombang et al.

I would like to invite discussion on the challenges of implementing public health measures such as social distancing and handwashing in rural areas and urban slums.

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Societal anxiety has led to a flurry of urban–rural migration which increases the risk of community transmission. Public education and guidance on hand hygiene, cough etiquette, social distancing, and disease identification are
communicated by the media which people in most remote parts cannot access

Social distancing erodes the core cultural and psychosocial values of African communities [driving] non-compliance...

In African slums and densely populated communities... Locally made hand washing amenities have supported handwashing in public places but the numbers are inadequate and hand sanitizers are expensive to purchase... Hand washing is not observed as access to water and soap or hand sanitizer is a challenge

Frequent and proper hand hygiene techniques should be taught in the local languages and communicated at the grassroots level using audio-visual demonstration...

Using community elders, opinion and religious leaders to champion public health initiatives at the community level is a proven behavior-change technique...

In conclusion, the impact of COVID-19 on Africa will be potentially devastating if the COVID-19 pandemic worsens on the continent. As the search for vaccines and treatment for COVID-19 continues, culturally applicable strategies to
mitigate the spread of COVID-19 transmission and strengthen the existing public health infrastructure in Africa are urgently needed.
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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

Introduction: Ibrahim Diouf, Senegal

Sat, 13/03/2021 - 08:19
Greetings from Senegal,

I am Ibrahim thanking yo for accepting me to Hifa Zambia Forum. As a consultant working on Entrepreneurship-Diaspora Program, I've had the opportunity to introduce Hifa work to the ministry of health in the past few years. This role as a representative allowed me to develop great projects in public health. Due to private reasons I stepped down from this position and launched another initiative through this NGO. Since I recently had a meeting with National human resources direction about coronavirus campaign response, I am joining this forum in order to stay up to date with international networks.

I hope this email finds you well and wish you a great week!

Thanks
Ibrahim

HIFA-Zambia profile: Ibrahim Diouf is a Consultant with E-Diaspora, Senegal. Email address: Ibrahim AT e-diaspora.org

Unexplained stillbirth in sub-Saharan Africa: Tanzania and Zambia

Sun, 14/02/2021 - 15:05
Dear HIFA-Zambia, HIFA and CHIFA colleagues,

An interesting new study below from Tanzania and Zambia.

CITATION: C Bedwell et al. Understanding the complexities of unexplained stillbirth in sub-Saharan Africa: a mixed-methods study
BJOG 2020
First published: 15 December 2020 https://doi.org/10.1111/1471-0528.16629
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16629

ABSTRACT
Objective: To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia.

Design: Mixed-methods study.

Setting: Tertiary, secondary and primary care facilities in Mansa, Zambia, and Mwanza, Tanzania.

Sample: Quantitative: 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative: 48 women and 19 partners from tertiary, secondary and primary care facilities.

Methods: Case review using data from a target of 2000 consecutive case records. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach.

Results: A total of 261 stillbirths were recorded, with a rate of 16% in Tanzania and 10% in Zambia, which is higher than the previous estimates of 2.24 and 2.09%, respectively, for those countries. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR 1.86, 95% CI 1.23–2.81). The cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by the poor communication skills of health professionals, who displayed little empathy and skill when counselling bereaved families.

Conclusions: The stillbirth risk in both facilities was far higher than the risk recorded from national data, with women reporting a previous stillbirth being at higher risk. Women want to know the cause of stillbirth and an exploration of appropriate investigations in this setting is required. Providing health professionals with support and continuing training is key to improving the experiences of women and future care.

TWEETABLE ABSTRACT
Stillbirths receive little investigation and are often unexplained. Communication with women about the death of their baby is limited.

QUOTES FROM PARTICIPANTS IN THE STUDY
When she loses the baby, they don't even sympathise with the mother. They will say it is bad luck, go home, and that's all. (Partner, Tanzania)

On discharge, no one talked or counselled me about my loss; to them, it was business as usual. (Woman, Zambia)

They just told me that my baby died in the uterus … but they didn't tell me what went wrong with my baby. (Woman, Tanzania)

I was in shock; it was unbelievable that I lost my baby just like that. The male nurse started blaming me for been lazy in pushing, I was so hurt but I could not speak. (Woman, Zambia)

SELECTED EXTRACT
Women were reluctant to raise questions about their stillbirth with health professionals, despite being keen to understand the cause. This may stem from the culture of blame experienced by women in sub‐Saharan Africa within their own communities. It may also relate to their gender and status, which often prevents them from having a voice in the community and health system.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org