Lusaka District Research Articles

Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems

BackgroundDespite several global interventions, tuberculosis (TB) remains a leading cause of death affecting millions of people globally. Many TB patients either have no access to quality care or go undetected by national health systems. Several multilevel factors account for under-detection of persons with TB. This study sought to explore patient-related software, community and health systems software and hardware factors influencing time to notification of TB in Lusaka District, Zambia.MethodsThis was an exploratory qualitative case study that adopted a software and hardware lens of conceptualizing health systems. Data were collected from across three sites – urban and peri-urban areas: Chongwe, Kafue, and Lusaka – within Lusaka Province, Zambia. Sixteen key informants - TB corner nurses, community TB treatment supporters, and TB program managers - were interviewed. Six focus groups were held with TB patients. Data were analyzed using thematic analysis.ResultsThe study identified factors influencing timely TB notification, categorized into software and hardware elements.Patient-related software elements, including TB knowledge and awareness, and health-seeking behavior, are crucial for prompt notification among TB patients.In the community health system, software elements like social stigma and undesirable community attitudes towards contact tracing, and hardware elements such as unbalanced schedules, excessive workload and limited capacity of community TB treatment supporters contribute to delayed TB notification.In the formal health system, software elements like negative attitudes of health providers towards TB patients and demotivation of TB staff, and hardware elements such as high diagnostics and transportation costs, outdated diagnostics in primary care facilities, and slow referral mechanisms, can also delay TB notification.ConclusionDelays in time to TB notification are influenced by a combination of software (attitudinal and behavioral) and hardware (resource-related) elements across TB patients, community health systems, community TB treatment supporters, health providers, and TB staff. Addressing these factors, particularly social stigma, negative attitudes, and resource constraints, is crucial to improving timely TB detection and treatment.

Genotypic Characterisation and Antimicrobial Resistance of Extended-Spectrum β-Lactamase-Producing Escherichia coli in Humans, Animals, and the Environment from Lusaka, Zambia: Public Health Implications and One Health Surveillance.

Extended-spectrum β-lactamases (ESBL) in Escherichia coli are a serious concern due to their role in developing multidrug resistance (MDR) and difficult-to-treat infections. This study aimed to identify ESBL-carrying E. coli strains from both clinical and environmental sources in Lusaka District, Zambia. This cross-sectional study included 58 ESBL-producing E. coli strains from hospital inpatients, outpatients, and non-hospital environments. Antimicrobial susceptibility was assessed using the Kirby-Bauer disk diffusion method and the VITEK® 2 Compact System, while genotypic analyses utilised the Illumina NextSeq 2000 sequencing platform. Among the strains isolated strains, phylogroup B2 was the most common, with resistant MLST sequence types including ST131, ST167, ST156, and ST69. ESBL genes such as blaTEM-1B, blaCTX-M,blaOXA-1, blaNDM-5, and blaCMY were identified, with ST131 and ST410 being the most common. ST131 exhibited a high prevalence of blaCTX-M-15 and resistance to fluoroquinolones. Clinical and environmental isolates carried blaNDM-5 (3.4%), with clinical isolates showing a higher risk of carbapenemase resistance genes and the frequent occurrence of blaCTX-M and blaTEM variants, especially blaCTX-M-15 in ST131. This study underscores the public health risks of blaCTX-M-15- and blaNDM-5-carrying E. coli. The strengthening antimicrobial stewardship programmes and the continuous surveillance of AMR in clinical and environmental settings are recommended to mitigate the spread of resistant pathogens.

Addressing Traffic congestion in Lusaka District: Solutions for a Better Urban Future

Addressing Traffic congestion in Lusaka District: Solutions for a Better Urban Future

Antimicrobial resistance profiles of and associated risk factors for Pseudomonas aeruginosa nosocomial infection among patients at two tertiary healthcare facilities in Lusaka and Copperbelt Provinces, Zambia.

Antimicrobial resistance (AMR) of pathogens such as Pseudomonas aeruginosa is among the top 10 threats to global health. However, clinical and molecular data are scarce in Zambia. We, therefore, evaluated the AMR profiles of P. aeruginosa nosocomial infections (NIs). A year-long hospital-based cross-sectional study was conducted at two large tertiary-level hospitals in Zambia. Patients with current or previous hospital contact were screened for NIs. The current study focused on patients diagnosed with P. aeruginosa NIs. Clinical specimens were collected for bacteriological culture, and PCR amplification of 16S rRNA gene fragments was performed on pure isolates. Hospital or NIs were defined as infections that arise during hospitalization, occurring at least 48 h after admission. The Kirby-Bauer's disk diffusion method was used to evaluate antibiotic resistance patterns. The association between AMR and risk factors was analysed using the χ2 test. Eight hundred and forty-one patients were screened, and clinical specimens were collected and analysed. Of them, 116 (13.7%) were diagnosed with P. aeruginosa NIs. The participants' ages ranged from 15 to 98 years, with a mean of 51 (SD ± 18). Catheter-associated urinary tract infections (57%) were the most common, followed by pressure sores (38.7%). P. aeruginosa isolates were primarily susceptible to amikacin, which had the highest resistance to FEP. We observed a high prevalence of multidrug resistance (73.6%). The AMR was associated with carbapenem-hydrolysing β-lactamase gene blaOXA-51 and surgical care. This study has demonstrated that multidrug-resistant P. aeruginosa is prevalent in hospitals in Zambia's Lusaka and Ndola districts and possibly countrywide.

Determining water quality and the associated risk factors to contamination in kalingalinga compound of Lusaka District, Zambia

Determining water quality and the associated risk factors to contamination in kalingalinga compound of Lusaka District, Zambia

Factors Influencing the Adoption of Green Practices: A Case of Five Selected Shopping Malls in Lusaka District

There is growing recognition for the need for eco-friendly commercial buildings. However, there exists a significant gap between the potential for developing them and the actual implementation. Zambia faces the tangible impacts of climate change, such as droughts and floods, while the uptake of green initiatives remains sluggish. Environmental degradation, worsened by the absence of green initiatives, threatens ecosystems, biodiversity, and the overall health of the planet. Recognizing the urgent need for change, there is a growing consensus that economic growth should no longer be pursued at the expense of environmental degradation. Yet, despite the abundance of opportunities to develop and implement green practices, various stakeholders have not fully embraced these options. This study delved into the factors influencing green practice adoption, focusing on five prominent shopping malls in Lusaka district, Zambia. A mixed methods approach was adopted, and involved 25 purposively selected respondents that attended a questionnaire uploaded via google forms and semi-structured in-depth interviews. Quantitative data was analyzed using SPSS while content analysis was adopted for qualitative data. The study found a positive correlation between perceived benefits of green practices and willingness to adopt green practices. However, the study showed a disconnect between knowledge of climate change effects and adoption of green practices, which meant that the choice to implement green practices was not influenced by the knowledge of the consequential effects of climate change. This study findings underscore the importance of the educational knowledge on the benefits green implementation and government incentives had in fostering green practice adoption within commercial establishments. While the study provides valuable insights into the dynamics of green practice adoption in the context of Lusaka district, limitations and potential biases underscore the need for further research in this area.

Factors Determining the Actual Emptying Fees for Fecal Sludge in Unplanned Residential Areas of Lusaka District, Zambia

Factors Determining the Actual Emptying Fees for Fecal Sludge in Unplanned Residential Areas of Lusaka District, Zambia

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...

A Critical Analysis of Challenges and Prospects of the National Health Insurance Scheme in Zambia-A Case Study of Lusaka District

Zambia’s National Health Insurance (NHI) was established by the enactment of the NHI Act No. 2 of 2018 and supported by statutory instrument No. 63 of 2019 which led to the establishment of the National Health Insurance Scheme (NHIS) under the management of the National Health Insurance Management Authority (NHIMA). The goal of the NHIS was to guarantee the provision of universal health insurance coverage for all residents, regardless of their socioeconomic status. As one of the prospective financing solutions for protecting populations from high health care service prices, NHIS is receiving increased attention from the international community. This study set out to investigate the difficulties and opportunities that the plan faces from the standpoint of the service providers and subscribers in Lusaka, Zambia. The study used the descriptive research design since it seeks to analyze the prospects and challenges of the national health insurance scheme in Lusaka, Zambia. The study came to a conclusion that in Lusaka, Zambia, consumers who wish to utilize the NHIS plan face challenges related to health literacy and awareness, fraud, and corruption, as well as, subpar service quality. The survey also discovered that consumers in Lusaka have difficulties with enrolment and registration while attempting to use the NHIS program due to intermittent availability and constant breakdown of the NHIMA system. The study further came to conclude that some of the prospects for the NHIS plan in Lusaka is public knowledge and involvement, enhancing monitoring and evaluation of the private and public health facilities accredited with NHIMA and improving the internet connectivity of the NHIMA system to enhance service delivery.

Free Education vs. Quality Education: A systematic analysis

Overview: The debate between free education and quality education remains a critical issue in the global education landscape. This systematic analysis aimed to dissect the intricate relationship between the provision of free education and the assurance of quality education. While free education is often lauded for its role in increasing accessibility and promoting educational equity, concerns about the potential compromise in quality cannot be overlooked. Body of Knowledge: The study’s analysis drew on a comprehensive review of existing literature, case studies, and empirical data from various countries that have implemented free education policies. Central to this analysis is the understanding that free education, though essential for fostering inclusivity, often faces challenges such as underfunding, overcrowded classrooms, and inadequate infrastructure. These issues can severely impact the quality of education delivered, resulting in poor learning outcomes and diminished educational standards. Methods: The study engaged both the qualitative and quantitative methods and a descriptive research design that sampled 150 respondents; head teachers, teachers and learners from selected secondary schools in Lusaka district, Zambia. Data was obtained from the respondents by means of interviews and questionnaires. Thematic analysis was used to analyze the qualitative data whereas quantitative data were analyzed by the use of the Statistical Package for Social Sciences (version 26) and Microsoft Excel (version 16). Results: The study’s analysis delves into the economic implications of free education. While it alleviates the financial burden on families, especially in low-income regions, the long-term sustainability of such policies is questioned. The study examined various funding models and the role of government expenditure in maintaining high educational standards without imposing direct costs on students. Recommendation: The study therefore recommended for policymakers to adopt a holistic view, ensuring that the drive towards free education is matched with adequate resources, effective management, and a commitment to continuous improvement in educational standards.

Living a private lie: intersectional stigma, depression and suicidal thoughts for selected young key populations living with HIV in Zambia

BackgroundLimited research has been conducted on the forms, manifestations and effects of intersectional stigma among young HIV-positive men who have sex with men (MSM) and transgender women (TGW) in Zambia. In this study, we aimed to address this gap by elucidating the experiences of these in a small group of young, HIV + MSM and TGW in Zambia.MethodsWe applied a mixed-methods design. Data were collected from January 2022 to May 2022. Qualitative data were collected using in-depth interviews while quantitative data were collected using a questionnaire. Qualitative transcripts were coded using thematic analysis while paper-based questionnaire data were entered into Kobo Connect. Descriptive statistics, using chi-squared tests were calculated using Excel. In this paper, we provide a descriptive profile of the sample and then focus on the qualitative findings on intersectional stigma, depression, and contemplation of suicide.ResultsWe recruited 56 participants from three sites: Lusaka, Chipata, and Solwezi districts. Participants’ mean age was 23 years. The study found that 36% of all participants had moderate to significant symptoms of depression, 7% had major depression, 30% had moderate signs of anxiety, 11% had high signs of anxiety, 4% had very high signs of anxiety and 36% had contemplated suicide at least once. A greater proportion of TGW had moderate to significant symptoms of depression (40%) or major depression (10%) compared to MSM, at 33% and 6%, respectively (X2 = 0.65; p = 0.42). Similarly, more TGW (55%) had contemplated suicide than MSM peers (36%, X2=1.87; p = 0.17). In the qualitative data, four emergent themes about the forms, manifestations, and effects of intersectional stigma were (1) HIV, sexual orientation, and gender identity disclosure; (2) Dual identity; (3) Challenges of finding and maintaining sexual partners; (4) Coping and resilience. Overall, having to hide both one’s sexuality and HIV status had a compounding effect and was described as living “a private lie.”ConclusionEffectively addressing stigmas and poor mental health outcomes among young HIV-positive MSM and TGW will require adopting a socio-ecological approach that focuses on structural interventions, more trauma-informed and identity-supportive care for young people with HIV, as well as strengthening of authentic community-informed public health efforts.

Genetic diversity and population genetics of Schistosoma haematobium isolated from children in Lusaka and Siavonga districts, Zambia.

Urogenital schistosomiasis remains a pervasive health challenge in rural Zambian communities. This study explores the molecular epidemiology and genetic diversity of Schistosoma haematobium using mitochondrial genes (cox1 and nadh1). Urine samples from 421 children in Siavonga and Lusaka districts, Zambia, were collected between December 2020 and February 2022. Microscopy and DNA extraction facilitated the identification of S. haematobium, followed by amplification, sequencing, and phylogenetic analysis of cox1 and nadh1 genes. Phylogenetic analysis revealed clustering with samples from mainland African countries, emphasizing shared haplotypes. Both mitochondrial genes exhibited substantial diversity, with 5 haplotypes from 37 cox1 sequences and 12 haplotypes from 23 nadh1 sequences. High haplotype diversity (0.621-0.808) and low nucleotide diversity (0.00181-0.03288) were observed. Siavonga and Lusaka districts shared the majority of S. haematobium haplotypes. Molecular variance and genetic differentiation analysis indicated variations within populations rather than between populations (cox1: -0.025, nadh1: 0.01646). These findings suggest a limited differentiation between S. haematobium populations in Siavonga and Lusaka, potentially indicating gene flow. Tajima's test revealed negative values, indicating a departure from neutrality, introduction of rare alleles, and recent population expansion. This study contributes essential insights into S. haematobium population genetics, crucial for effective urogenital schistosomiasis control in Zambia.

Magnitude and Determinants of Pregnancy Induced Hypertension in Selected General Hospitals in Lusaka, Zambia: A Cross-Sectional Study

Background:Hypertension in pregnancy continue to be among the major causes of maternal and perinatal morbidity and mortality, affecting 5-6% of pregnancies globally and contributing to a significant diseaseburden. Aims and objectives: To assess prevalence and factors associated with pregnancy induced hypertension among pregnant women aged 15 to 49 years at three general hospitals of Lusaka District. Methodology:Conducted cross sectional study with 413 systematically selected pregnant women attending antenatal clinics at Chawama, Chipata and Matero general hospitals from January 2019 to July 2020. The sample size for each hospital was determined proportionally based on twelve months of antenatal care visit data. Blood pressure, heights, weights, Body mass index and urinalysis were measured on all the study participants. A structured questionnaire collected data on social demographic and economic factors, reproductive and medical history. Data was analyzed using STATA version 13. Chi-square and fisher’s exact tests identified association between PIH and various variables with multiple logistic regression used to control for confounders. Statistical significance was set at <0.05. Results:The prevalence of Pregnancy induced hypertension was found to be 21%. Significant predictors of PIH included Stress during pregnancy (AOR = 2.28, 95% CI =1.35-3.85, p=0.002), lack of exercise (AOR = 0.48, 95% CI =0.28-0.81, p=0.007), high BMI (AOR = 1.57, 95% CI =1.12-2.19, p=0.007) and consuming alcohol (AOR = 2.29, 95% CI =1.03-5.09, p=0.042).Conclusion:The prevalence of PIH was 21% with significant association observed between PIH and stress, alcohol consumption, lack of exercise and high BMI during pregnanc. Keywords: Pregnancy Induced hypertension; Prevalence; Associated factors, Antenatal mothers.

Promoting democratic values through civic education: A case of selected secondary schools in lusaka District, Zambia

Overview: Promoting democratic values through civic education is essential for fostering an informed and engaged citizenry capable of upholding democratic principles. Hence, this paper delves into the critical role of civic education in fostering democratic values within contemporary societies. The study was carried in Lusaka district from 6 selected secondary schools. Body of Knowledge: Civic education encompasses teaching the fundamentals of democracy, including the importance of individual rights, the rule of law, and the responsibilities of citizenship. Civic education serves as a counterbalance to authoritarian tendencies and political apathy by encouraging active and informed participation in public life. The analysis underscores the importance of early and continuous civic education to build a resilient democratic society that values diversity, equity, and justice. Methods: The study employed both the qualitative and quantitative methods and a descriptive survey design that sampled Head Teachers, Teachers of Civic Education, Community Members and students in Civic Education classes. The study consisted a sample of 300 respondents from the selected secondary schools. Data was obtained from the respondents by means of interviews and questionnaires. The qualitative data gathered was analyzed according to the themes of the study and the order of the research objectives. Data generated from the questionnaires (quantitative) were analyzed using the Statistical Package for Social Sciences (version 26) and Microsoft Excel (version 16) to come up with tables, and figures. Results: The comprehensive analysis revealed that effective civic education programs are characterized by an inclusive curriculum that integrates critical thinking, discussion of current events, and hands-on participation in democratic processes. These programs aim to cultivate a sense of civic duty, political efficacy, and tolerance among students. Empirical studies indicated that well-designed civic education can significantly enhance students' knowledge of political systems, their skills in democratic participation, and their commitment to democratic values. Recommendation: The government should; collaborate with education authorities to enhance democratic ideals in civic education curriculum; and through the education standard officer and other stakeholders need to enhance professional development workshops for teachers of civic education to enable them effectively teach and practice democratic ideals as espoused in civic education.

Religious education and people’s perception on the subject: A case of selected secondary schools in Lusaka District, Zambia

Overview: Religious education plays a pivotal role globally, reflecting diverse perspectives and practices across continents. In Africa, religious education intertwines with cultural heritage, shaping moral frameworks and societal norms. The study was conducted in Lusaka district, the capital city of Zambia. Body of Knowledge: The theoretical and practical insights gained from this study contribute to enhancing understanding of the role of religious education in fostering moral and ethical development, promoting intercultural dialogue, and cultivating inclusive educational environments. By addressing the identified challenges and leveraging opportunities for collaboration between schools, families, and communities, stakeholders can work towards creating inclusive educational policies and practices that respect and celebrate religious diversity. Methods: The study employed both the qualitative and quantitative methods and a descriptive survey design that sampled Head teachers, RE teachers, and Pupils of RE. The sample size for this study was 150. Data was obtained from the respondents by means of interviews and questionnaires. This study used descriptive analysis to analyze the data. Tables, graphs and pie-charts were used in combination with the use of software, MS access and MS Excel to analyze data. Results: Religious education plays a significant role in shaping students' moral and ethical values. Despite some skepticism about its relevance in a modern, pluralistic society, the majority of participants including pupils, teachers, and parents viewed religious education positively. They believed it fosters tolerance, empathy, and respect for diverse beliefs. However, there were also concerns about the potential for religious education to become doctrinal rather than educational, emphasizing the need for a balanced and inclusive curriculum that respects all faiths. Recommendation: The study highlighted the importance of training educators to handle religious education in a way that promotes critical thinking and open dialogue, rather than mere indoctrination.

Assessment of Knowledge and Fire Safety Preparedness among Employees at Shopping Malls in Lusaka District

Fire disasters in public buildings continue to raise major concerns about the safety of individuals who occupy thesebuildings, as well as the customers. The objective of this study was to assess the knowledge and fire safetypreparedness among employees of shopping malls in Lusaka district. This study employed cross sectional descriptivedesign, with quantitative methods. Data was collected using a structured questionnaire from 83 respondents(employees) who were purposively sampled from six shopping malls in Lusaka. Collected data was analysed usingdescriptive statistics. The findings revealed that employees’ levels of knowledge on fire safety preparedness is low.Further, that there is low or lack of implementation of practices aimed at ensuring fire safety. The study therefore,recommends that employees in public buildings be trained on how to ensure fire safety and appropriate responses incase of fire. Moreso, fire safety plans should always be displayed to the public.

The experiences of women diagnosed with HIV during pregnancy at selected Health facilities in Lusaka district, Zambia: a descriptive cross-sectional study

The experiences of women diagnosed with HIV during pregnancy at selected Health facilities in Lusaka district, Zambia: a descriptive cross-sectional study

Gender Equality and Economic Growth: A Case of Lusaka District, Zambia

Gender Equality and Economic Growth: A Case of Lusaka District, Zambia

Occurrence and factors associated with Cryptosporidium infection in livestock in three districts of Zambia

Cryptosporidium is one of the most important enteric diarrhoeal parasites that infect humans and animals worldwide. The current study investigated the occurrence and risk factors associated with Cryptosporidium infection in ruminants aged ≤6 months in Monze, Mumbwa, and Lusaka districts of Zambia. Faecal samples were collected from 328 calves, 190 lambs, and 245 goat kids and analysed for Cryptosporidium oocysts using modified Ziehl Neelsen staining. A closed structured questionnaire was used to obtain epidemiological characteristics and potential risk factors for Cryptosporidium infection. The overall occurrence of Cryptosporidium was 7.9% (60/763), while that in calves, lambs and goat kids was 14.5% (47/328), 5.3% (10/190), and 1.2% (3/245) respectively. Watery/pasty stool and sampling during the rainy season were independently associated with increased risk of infection. In calves, the odds of infection increased during the rainy season, while daily kraal cleaning reduced the infection risk. Lambs showed increased odds of infection with pasty/watery stool and male sex, whereas the wearing of protective clothing by handlers significantly reduced the risk. There were district variations in infection occurrence with Mumbwa district having higher prevalence. The findings of this study show that livestock in Zambia continue to be frequently infected with Cryptosporidium. Protective measures and appropriate farm cleanliness should be implemented in control of this infection. Regional and host-species-specific variations emphasize the need for targeted interventions. These findings, therefore, contribute to effective strategies for Cryptosporidium control, promoting good livestock health and management.

Civic Education and National Development: A Comprehensive Analysis of Zambia

Overview: Civic education plays a crucial role in the development of nations by fostering informed and responsible citizenship, promoting democratic values, and strengthening social cohesion. Hence, this study presented a thorough examination of the relationship between civic education and national development. The study was conducted in Lusaka district, the capital city of Zambia from which the participants were selected for the study from 5 different organizations. Body of Knowledge: The study comprehended various aspects, including the definition and objectives of civic education, its importance in fostering democratic values, and its impact on social cohesion and economic growth. It dwelt into the crucial role civic education plays in shaping informed and responsible citizens who actively contribute to the progress of their nations. This study was guided by the social learning theory. The social learning theory has been widely applied in the study of human behavior, including in the context of civic education and national development. Methods: The total target population was 1000. The sample size involved a total of 100 respondents, which was 10% of the target population. A mixed method approach was used in this study in combination with the descriptive survey design. Interviews and questionnaires were used to collect data. Tables, graphs and pie-charts were used to analyze the quantitative and qualitative data obtained. Data was then analyzed manually in some cases and also, a combination of software MS Access, MS Excel, and SPSS. Results: The following key findings were established on the effect of civic education on national development; increased awareness, enhanced civic engagement, strengthened community bonds, improved governance understanding, empowered citizenry while regarding the factors that hinder citizen participation in national development, the study found; lack of awareness, limited access to information, distrust in institutions, socioeconomic challenges and ineffective communication channels. Recommendation: The Ministry of Education need to integrating civic education into educational curricula and policymaking initiatives to facilitate sustainable development and democratic governance.