Districts Of Zambia Research Articles

Predictors of stunting and pathway analysis for linear growth among children 2-3 years of age after a trial of small-quantity lipid-based nutrient supplements and home-installed growth charts in three districts in Zambia

Globally, 148 million children under 5 are stunted, with risk factors varying by context. Our 'Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia' (ZamCharts) trial observed persistently high rates of stunting in all treatment groups after 18-months of intervention with monthly distributions of small-quantity lipid-based nutrient supplements (SQ-LNS) and/or installation of a wall-mounted growth chart in children's homes. We sought to identify determinants of stunting and height-for-age z-score in children 27-36 months who participated in the ZamCharts endline survey (n=1911). Multi-level, log-binomial models were used to estimate univariable and multivariable prevalence ratios for predictors of stunting. Multi-level models were also used to predict height-for-age z-score (HAZ) with and without baseline HAZ (assessed at ages 2-11 months). We also conducted a path analysis using covariance analysis of linear structural equations to assess underlying and modifiable risk factors for impaired linear growth. Significant predictors of stunting in the multivariable model included: low asset ownership; being male; using biomass as cooking fuel; lower maternal height; a mother with ≤ primary education; lower baseline HAZ. and not being randomized to SQ-LNS. Significant predictors of a lower mean HAZ in the full multivariable models included all the same risk factors that predicted stunting, but also living in an urban area, having more than one child <5 years in the household and diarrhea in the previous 2 weeks. The multivariable model explained 48% of variability in endline HAZ; the strongest predictor was baseline HAZ, which explained 29% of endline HAZ variability in the univariable model. Preventing stunting in Zambia will require investments in early life (pre- and post-natal) determinants of growth trajectory as well as improving complementary feeding practices and addressing risk factors for infectious diseases; SQ-LNS can also improve linear growth and reduce stunting.

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts – Zambia, 2020–2022

BackgroundThe number of COVID-19 deaths reported in Zambia (N = 4069) is most likely an underestimate due to limited testing, incomplete death registration and inability to account for indirect deaths due to socioeconomic disruption during the pandemic. We sought to assess excess mortality during the COVID-19 pandemic in Zambia.MethodsWe conducted a retrospective analysis of monthly-death-counts (2017–2022) and individual-daily-deaths (2020–2022) of all reported health facility and community deaths at district referral health facility mortuaries in 12 districts in Zambia. We defined COVID-19 wave periods based on a sustained nationally reported SARS-CoV-2 test positivity of greater than 5%. Excess mortality was calculated as the difference between observed monthly death counts during the pandemic (2020–2022) and the median monthly death counts from the pre-pandemic period (2017–2019), which served as the expected number of deaths. This calculation was conducted using a Microsoft Excel-based tool. We compared median daily death counts, median age at death, and the proportion of deaths by place of death (health facility vs. community) by wave period using the Mann-Whitney-U test and chi-square test respectively in R.ResultsA total of 112,768 deaths were reported in the 12 districts between 2020 and 2022, of which 17,111 (15.2%) were excess. Wave periods had higher median daily death counts than non-wave periods (median [IQR], 107 [95–126] versus 96 [85–107], p < 0.001). The median age at death during wave periods was older than non-wave periods (44.0 [25.0–67.0] versus 41.0 [22.0–63.0] years, p < 0.001). Approximately half of all reported deaths occurred in the community, with an even greater proportion during wave periods (50.6% versus 53.1%, p < 0.001), respectively.ConclusionThere was excess mortality during the COVID-19 pandemic in Zambia, with more deaths occurring within the community during wave periods. This analysis suggests more COVID-19 deaths likely occurred in Zambia than suggested by officially reported numbers. Mortality surveillance can provide important information to monitor population health and inform public health programming during pandemics.

Motivation, Cues to Action, and Barriers to COVID-19 Vaccine Uptake: A Qualitative Application of the Health Belief Model among Women in Rural Zambia.

Vaccine hesitancy has played a major role in slowing the global COVID-19 response. Using cross-sectional, primarily qualitative data collected in four rural districts in Zambia, we aimed to explore community perceptions of COVID-19 disease and vaccines, including perceived motivators, cues to action, benefits, and barriers to vaccine uptake as guided by the Health Belief Model. In-depth interviews (IDIs) were conducted in late 2021 with women of reproductive age who were enrolled in an early childhood development study. Although two-thirds of the 106 respondents reported low perceived risk of catching COVID-19, they expressed concern that the COVID-19 pandemic had impacted their daily lives and feared effects of the disease. They had generally positive beliefs that the vaccine would be accepted among their communities when it became more widely available. Reported motivators to vaccine uptake included desire for protection against COVID-19 and understanding vaccine purpose, due to ongoing education from health personnel, neighbors, friends, radio, and church leaders. Misinformation or reported bad experiences served as cues away from vaccine uptake. Examples of misinformation included the vaccine causing COVID-19 or another disease and death and vaccines being associated with the devil and against Christian beliefs. Accounts of pain after receiving the vaccine also discouraged uptake. Perceived benefits included a desire to be protected from the disease, belief in the effectiveness of the vaccine, fear of catching COVID-19, and belief the vaccine would limit negative effects. Health system implementers and policy makers should consider recipient motivators and cues to action to further increase vaccination rates.

Adjusting mobile phone data to account for children's travel and the impact on measles dynamics in Zambia.

Models of measles transmission can be used to identify areas of high risk to tailor immunization strategies. Estimates of spatial connectivity can be derived from data such as mobile phone records, however it is not clear how this maps to the movement of children who are more likely to be infected. Using travel surveys across two districts in Zambia and national mobile phone data, we compared estimates of out-of-district travel for the population captured in the mobile phone data and child-specific travel from travel surveys. We then evaluated the impact of unadjusted and adjusted connectivity measures on simulated measles virus introduction events across Zambia. The number of trips made by children from the travel survey was three to five times lower than the general population estimates from mobile phone data. This decreased the percentage of districts with measles virus introduction events from 78% when using unadjusted data to 51% - 64% following adjustment. Failure to account for age-specific heterogeneities in travel estimated from mobile phone data resulted in overestimating subnational areas at high risk of introduction events, which could divert mitigation efforts to districts that are at lower risk.

The impact of home-installed growth charts and small-quantity lipid-based nutrient supplements (SQ-LNS) on child growth in Zambia: a four-arm parallel open-label cluster randomised controlled trial

BackgroundChildhood stunting remains common in many low-income settings and is associated with increased morbidity and mortality, as well as impaired child development.MethodsThe main objective of the study was to assess...

Neurocysticercosis Prevalence and Characteristics in Communities of Sinda District in Zambia: A Cross-Sectional Study.

This study aimed at describing the epidemiology of (neuro)cysticercosis as well as its clinical and radiological characteristics in a Taenia solium endemic district of Zambia. This was part of a cross-sectional community-based study conducted in Sinda district to evaluate an antibody-detecting T. solium point-of-care (TS POC) test for taeniosis and (neuro)cysticercosis. All TS POC cysticercosis positive (CC+) participants and a subset of the TS POC cysticercosis negative (CC-) received a clinical evaluation and cerebral computed tomography (CT) examination for neurocysticercosis (NCC) diagnosis and staging. Of the 1249 participants with a valid TS POC test result, 177 (14%) were TS POC CC+ . Cysticercosis sero-prevalence was estimated to be 20.1% (95% confidence intervals [CI] 14.6-27.0%). In total, 233 participants received a CT examination (151 TS POC CC+ , 82 TS POC CC-). Typical NCC lesions were present in 35/151 (23%) TS POC CC+ , and in 10/82 (12%) TS POC CC- participants. NCC prevalence was 13.5% (95% CI 8.4-21.1%) in the study population and 38.0% (95% CI 5.2-87.4%) among people reporting epileptic seizures. Participants with NCC were more likely to experience epileptic seizures (OR = 3.98, 95% CI 1.34-11.78, p = 0.01) than those without NCC, although only 7/45 (16%) people with NCC ever experienced epileptic seizures. The number of lesions did not differ by TS POC CC status (median: 3 [IQR 1-6] versus 2.5 [IQR 1-5.3], p = 0.64). Eight (23%) of the 35 TS POC CC+ participants with NCC had active stage lesions; in contrast none of the TS POC CC- participants was diagnosed with active NCC. NCC is common in communities in the Eastern province of Zambia, but a large proportion of people remain asymptomatic.

Quality of ultrasound images by midwives implementing ultrasound scanning services during antenatal clinics within selected healthcare facilities of Zambia

BackgroundLimited access to ultrasound services in low and middle-income countries (LMICs) prompts the development of an intensive training program for midwives. The aim of this study was to evaluate the quality of ultrasound images produced by midwives and assess their competency in gestational age assessment using femur length. MethodsA cross-sectional study conducted in 11 healthcare facilities across four districts in Zambia involved the evaluation of 928 images captured during the implementation of the Training in Ultrasound to Determine Gestational Age (TUDA) program in 2021. TUDA, collaboration under the DIPLOMATIC Study, trained 24 midwives intensively for 14 days, followed by eight weeks of supervised scanning. Image assessment utilized the Sarries four-point tool, and statistical analyses included descriptive and inferential statistics. ResultsMidwives achieved an 87.95 % competency level in basic ultrasound scans for gestational age determination using femur length. Assessment by four evaluators showed an average proportion of good-quality images also at 87.95 %. There were no statistically significant differences among assessors, indicating consistency in evaluations. Trainers and radiographers exhibited different average proportions of good-quality images at 91.5 % and 83.9 %, respectively, with no statistically significant differences observed between them.Furthermore, analysis of image quality revealed significant variation among different facilities. Specifically, in Chipata, 24.32 % of scans were classified as poor quality, while in George Clinic, only 2.30 % were considered poor quality. A Chi-square test indicated a substantial correlation between health facility and image quality (χ2 = 15.99, p = 0.025). However, no significant correlations were found between image quality and factors such as work experience, age group, or gender. ConclusionThis study provides critical evidence for successfully training midwives to competent produce high-quality ultrasound images for determining gestational age. These findings are essential for guiding interventions aimed at enhancing ultrasound service delivery and ensuring consistent, high-quality healthcare outcomes, because this is critical for effective prenatal care in Zambia. This has high potential to improve prenatal care. RecommendationZambia needs to train more midwives to provide routine ultrasound services during Antenatal Care (ANC) which may ultimately reduce preterm and still births. We recommend the inclusion of ultrasound scanning in-service and pre-service training and establishment of standardized protocols and guidelines for ultrasound scanning services during antenatal clinics.

Zipime-Weka-Schista study protocol: a longitudinal cohort study and economic evaluation of an integrated home-based approach for genital multipathogen screening in women, including female genital schistosomiasis, human papillomavirus, Trichomonas and HIV in Zambia

IntroductionMultiplathogen home-based self-sampling offers an opportunity to increase access to screening and treatment in endemic settings with high coinfection prevalence of sexually transmitted (HIV, Trichomonas vaginalis (Tv), human papillomavirus (HPV))...

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

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

Trends in SARS-CoV-2 seroprevalence among pregnant women attending first antenatal care visits in Zambia: A repeated cross-sectional survey, 2021-2022.

SARS-CoV-2 serosurveys help estimate the extent of transmission and guide the allocation of COVID-19 vaccines. We measured SARS-CoV-2 seroprevalence among women attending ANC clinics to assess exposure trends over time in Zambia. We conducted repeated cross-sectional SARS-CoV-2 seroprevalence surveys among pregnant women aged 15-49 years attending their first ANC visits in four districts of Zambia (two urban and two rural) during September 2021-September 2022. Serologic testing was done using a multiplex bead assay which detects IgG antibodies to the nucleocapsid protein and the spike protein receptor-binding domain (RBD). We calculated monthly SARS-CoV-2 seroprevalence by district. We also categorized seropositive results as infection alone, infection and vaccination, or vaccination alone based on anti-RBD and anti-nucleocapsid test results and self-reported COVID-19 vaccination status (vaccinated was having received ≥1 dose). Among 8,304 participants, 5,296 (63.8%) were cumulatively seropositive for SARS-CoV-2 antibodies from September 2021 through September 2022. SARS-CoV-2 seroprevalence primarily increased from September 2021 to September 2022 in three districts (Lusaka: 61.8-100.0%, Chongwe: 39.6-94.7%, Chipata: 56.5-95.0%), but in Chadiza, seroprevalence increased from 27.8% in September 2021 to 77.2% in April 2022 before gradually dropping to 56.6% in July 2022. Among 5,906 participants with a valid COVID-19 vaccination status, infection alone accounted for antibody responses in 77.7% (4,590) of participants. Most women attending ANC had evidence of prior SARS-CoV-2 infection and most SARS-CoV-2 seropositivity was infection-induced. Capturing COVID-19 vaccination status and using a multiplex bead assay with anti-nucleocapsid and anti-RBD targets facilitated distinguishing infection-induced versus vaccine-induced antibody responses during a period of increasing COVID-19 vaccine coverage in Zambia. Declining seroprevalence in Chadiza may indicate waning antibodies and a need for booster vaccines. ANC clinics have a potential role in ongoing SARS-CoV-2 serosurveillance and can continue to provide insights into SARS-CoV-2 antibody dynamics to inform near real-time public health responses.

Fostering students’ mathematical reasoning through a cooperative learning model

This study sought to ascertain whether the student teams-achievement division (STAD) model of cooperative learning is effective in fostering students’ mathematical reasoning. Using the cluster random sampling technique, 301 eleventh-grade students between the ages of 14 and 20 were chosen from six public secondary schools within one district in Zambia. Students were given tasks on quadratic equations and functions both before and after the intervention. A robust analysis of the covariance test revealed that students’ mathematical reasoning abilities were significantly higher for the group that received instruction using the STAD approach than for the group that was taught using conventional methods of instruction at each of the five design points where regression slopes were comparable. A Chi-square test of independence further revealed that the STAD learning approach was associated with a greater proportion of students who demonstrated an appropriate degree of mathematical reasoning ability for each of the three indicators (conjecturing, justifying, and mathematizing). These results demonstrate that enhancing students’ mathematical reasoning abilities through the integration of classroom activities that engage students intellectually, physically, and socially is beneficial.

Environmental factors associated with increased cholera cases in low-income districts in Zambia, 2017-2018

Environmental factors associated with increased cholera cases in low-income districts in Zambia, 2017-2018

Factors contributing to the withdrawal of wife battery cases at police stations: a case of Kitwe district in Zambia

This study sought to determine the factors that contribute to the withdrawal of wife battery casesin Kitwe District at police stations using a descriptive case study. The study utilized both primary and secondary data from a sample of 42 participants and a review of 40 police case dockets of the victims. Methods of data collection included observation, interviews and focus group discussions. Qualitative data were analyzed using thematic analysis and quantitative data were analyzed using descriptive statistics. The study findings showed that socioeconomic, psychosocial, socio-cultural and institutional factors contributed to the withdrawal of wife battery cases.

Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia

IntroductionFood security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs.MethodsWe conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period.ResultsCompared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period.ConclusionThe COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity.Trial Registration N/A.

Insecticide Treated Mosquito Nets (ITNs) on Demand for Wrong Reasons: A Case of Selected Districts in Zambia

Insecticide Treated Mosquito Nets (ITNs) on Demand for Wrong Reasons: A Case of Selected Districts in Zambia

Understanding and addressing the cholera outbreak in Zambian communities

Cholera is a bacterial infection caused by the Vibrio cholera bacterium, primarily transmitted through contaminated water and food. The effects of cholera on health can be severe and potentially life-threatening. The hallmark symptom of cholera is acute watery diarrhea, which can lead to rapid dehydration and electrolyte imbalance. As the body loses large amounts of fluid and essential salts, individuals with cholera often experience intense thirst, dry mucous membranes, sunken eyes, and lethargy. If left untreated, the dehydration can progress rapidly, causing a dangerous condition known as choleric dehydration and in most cases death. Hence, the study was conducted to analyze the effects of cholera on health in selected communities of Lusaka district in Zambia. The study employed both qualitative and quantitative methods and a descriptive survey design that sampled 42 participants purposively and conveniently. Data was obtained from the respondents by means of questionnaires and record reading. The data was analyzed by the use of software; Statistical Package for Social Sciences (version 26) and Microsoft Excel (version 16). Frequency tables, graphs, figures, and pie charts were also used to analyze the data. The findings revealed that the effect of cholera on health extends beyond dehydration, affecting various organ systems. Severe cases may lead to hypovolemic shock, characterized by a significant drop in blood pressure and inadequate perfusion of organs. The study also found that Cholera outbreaks pose significant public health challenges, particularly in areas with inadequate sanitation and limited access to clean water. The study therefore recommended that since cholera is highly contagious, primarily through contaminated water and food, those affected should be isolated to prevent the spread of the bacteria. Additionally, Proper hygiene, such as regular handwashing, is essential to reduce the risk of transmission.

Parental stress and child stimulation practices: examining associations with child developmental outcomes over time in Kenya and Zambia

BackgroundParental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes.MethodsThe findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children’s mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children’s developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers’ parenting stress, child stimulation practices, and child developmental outcomes.ResultsThe findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers’ stimulation practices and children’s developmental outcomes were not universally supported.ConclusionThe findings show that improved caregiver stimulation practices are likely to improve children’s developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs.Trial registrationPan African Clinical Trials Registry (https://pactr.samrc.ac.za/) database (ID number: PACTR20180774832663 Date: 26/July/2018.

Impact of enacted stigma on mental health, substance use, and HIV-related behaviors among sexual minority men in Zambia

Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18–35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤ .001), PTSD symptoms (χ2 = 7.13, p < .01), tobacco use (χ2 = 10.47, p < .01), cannabis use (χ2 = 5.90, p < .05), and a higher number of sexual partners (t = 1.99, p < .05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being.

Factors Leading to Early Marriages in Selected Communities of Lusaka District in Zambia

Early marriage is a harmful traditional practice that continues to affect millions around the world. Though it has declined over the years, it is still pervasive in developing countries. Hence, the purpose of carrying this study was to investigate into the factors contributing to early marriages in selected communities of Lusaka district in Zambia. The research was carried out at 6 selected schools where teachers are expected to understand learners’ Psychological state and the communities at large where different leaders as well as members of the community where giving and bringing out the factors, through their written texts because mostly the words and expressions used are indicative of the state of mind as well as revealing emotional states learners go through when they recount their experiences. The study employed both qualitative and quantitative methods and a descriptive survey design that sampled 60 participants purposively and conveniently. Data was collected through face-to-face interviews, observations and written text (script) analysis. The data was analyzed by the use of software; Statistical Package for Social Sciences (version 26) and Microsoft Excel (version 16). Frequency tables, graphs, figures, and pie charts were also used to analyze the data. The findings indicated that teachers have developed notions that belittle what pupils can do. Interviews revealed that learners especially at junior level, have been perceived and labelled to be potential upcoming wives. Such learners are not even helped to change their state of mind. Furthermore, the study revealed that learners’ outward appearance does not reflect or collaret with what they do or write in class. Learners who appear to be very clever orally perform the opposite in written texts. Therefore, the study recommended that teachers should actually play a very critical role using written texts by learners to help identify needy areas that may require shaping their writing skills, developing their critical reasoning and instilling good interpretive skills so that learners can come out as critical, classical and creative writers.

Determinants of Home Deliveries by Pregnant Mothers in Lumbo Chabbobboma Zone of Gwembe District in Zambia

Determinants of Home Deliveries by Pregnant Mothers in Lumbo Chabbobboma Zone of Gwembe District in Zambia