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A survey for abnormal haemoglobins in Zambia has demonstrated Haemoglobin S-including 187 cases of sickle-cell anaemia, Haemoglobin J Oxford on one occasion, and a new Haemoglobin Zambia in four unrelated families. No evidence for beta-thalassaemia was found, but Haemoglobin H disease and other evidence for alpha-thalassaemia were found.
A total of 3010 people from 3 areas of Zambia, - Lusaka Prison, Nakambala Sugar Estate and Kaande and Mabumbu in the Western Province; were given a tuberculin test of 1Tu. Only 82% returned for reading of the tuberculin reaction. The contribution of BCG to the reaction size is discussed. The tuberculosis infection rate increased from 6% in the 0-4 age group to 65% in those over 30 years being greater in men than in women.
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This country profile for Zambia was compiled between 1998 and 2002. The objectives of the exercise were to first of all avail policymakers, other key decision makers and leaders in Zambia, information about mental health in Zambia in order to assist policy and services development. Secondly, to facilitate comparative analyses of mental health services between countries. The work involved formation of a core group of experts who coordinated the collection of information from the various organizations in Zambia. The information was later shared to a broad spectrum of stakeholders for consensus. A series of focus group discussions (FGDs) supplemented the information collected. There are various factors that contribute to mental health in Zambia. It is clear from the Zambian perspective that social, demographic, economic, political, environmental, cultural and religious influences affect the mental health of the people. With a population of 10.3 million and annual growth rate of 2.9%, Zambia is one of the most urbanized countries in sub-Saharan Africa. Poverty levels stood at 72.9% in 1998. In terms of unemployment, the most urbanized provinces, Lusaka (the capital city), and the copper-belt are the most affected. The gross domestic product (GDP) is US$3.09 billion dollars while per capita income is US$300. The total budget allocation for health in the year 2002 was 15% while the proportion of the GDP per capita expenditure for health was 5.6%. The HIV/AIDS prevalence rates stand at 20% among the reproductive age group 15-49 years. Political instability and wars in neighbouring states has resulted in an influx of refugees. Environmental factors affecting the country include natural and man-made disasters such as floods and drought, mine accidents, and deforestation. To a large extent in Zambia, people who are mentally ill are stigmatized, feared, scorned at, humiliated and condemned. However, caring for mental ill health in old age is positively perceived. It is traditionally the duty and responsibility of the extended family to look after the aged. Gender based violence (GBV) is another issue. Women, who are totally dependent on their spouses economically, are forced by circumstances to continue living in abusive relationships to the detriment of their mental well-being. In Zambia, the family is considered sacrosanct and the affairs of the family members, private. It is within this context that GBV is regarded as a family affair and therefore a private affair, yet spouse beating has led to depression and in some cases death. In terms of psychiatric services, there are close to 560 beds for psychiatric patients across the country. Common mental disorders found in Zambia are acute psychotic episodes, schizophrenia, affective disorders, alcohol related problems and organic brain syndromes. About 70-80% of people with mental health problems consult traditional health practitioners before they seek help from conventional health practitioners. Over time the number of frontline mental health workers and professional staff has been declining. This is due to the 'brain drain', retirement, death and low output from training institutions. For practicing psychiatrists, only one is available for the whole country. Other key mental health workers such as psychologists, social workers and occupational therapists are also in short supply. All in all, the mental health services situation in Zambia could be described as critical, requiring urgent attention.
Distribution data for epidemiologically important ticks (Acari: Ixodidae) in the Southern Province of Zambia, one of the main cattle areas of the country, are presented. Boophilus microplus (Canestrini) was not recorded in southern Zambia, whereas Boophilus decoloratus (Koch) is present throughout the area. New distribution patterns for less economically important ixodid ticks are also discussed. Southern Zambia is a transition zone because it is the most northern area in Africa where mixed Rhipicephalus appendiculatus Neumann and Rhipicephalus zambeziensis Walker, Norval & Corwin populations were reported. Although a second generation of adult R. appendiculatus/R. zamnbeziensis was encountered, simulations indicated that this phenomenon is very rare in southern Zambia, mainly because of the colder temperatures during the early dry season and lower rainfall. These simulations were supported by a development trial under experimental conditions. Tick body size measurements showed that southern Zambian ticks are larger than eastern Zambian R. appendiculatus. It is hypothesized that body size is related to diapausing intensity in this species. The epidemiological consequences are that a different approach to control Theileria parva (Theiler) (Piroplasmida: Theileriidae) and other tick-borne diseases is needed in southern Zambia, compared to the one adopted in eastern Zambia.
Studies to evaluate use-effectiveness and cost-effectiveness of natural family planning (NFP) were conducted in Liberia and Zambia. The Liberian programme provided uni-purpose NFP services to 1055 clients mainly in rural areas; the Zambian programme provided NFP services integrated with MCH to 2709 clients predominantly in urban areas. The one-year life table continuation and unplanned pregnancy rates were 78.9 and 4.3 per 100 woman-years in Liberia, compared to 71.2 and 8.9 in Zambia. However, high rates of loss to follow-up mandate caution in interpretation of these results, especially in Zambia. More women progressed to autonomous NFP use in Liberia (58%) than in Zambia (35.3%). However, programme costs per couple-year protection were lower in Zambia (US$25.7) than in Liberia (US$47.1). Costs per couple-year protection were higher during learning than autonomy, and declined over time. These studies suggest that NFP programmes can achieve acceptable use- and cost-effectiveness in Africa.
BACKGROUND: Zambia, one of the world's poorest countries, also has one of the highest maternal mortality rates in the world. Most pregnant women in Zambia (96%) attend antenatal care, while 53% deliver at home. This may be related to socio-economic and cultural factors, but cultural childbirth practices and beliefs in Zambia have been little documented. AIM: The aim of this study was to explore cultural childbirth practices and beliefs in Zambia as related by women accompanying labouring women to maternity units. These social support women were also interviewed about their views on providing companionship to labouring women. METHODS: Thirty-six women accompanying labouring women to urban and rural maternity units in Zambia were interviewed A thematic guide with closed and open-ended questions was used. EPI INFO, an epidemiological statistical software package, was used to analyse the quantitative data; qualitative data were analysed using content analysis. FINDINGS: Eighteen of the women considered themselves to be mbusas, or traditional birth assistants and the rest said that they followed labouring women to maternity units. Those who considered themselves traditional birth assistants advised childbearing women on appropriate cultural childbirth practices and assisted with deliveries at home. They also advised women on the use of traditional medicine, for example, to widen the birth canal and to precipitate labour. If something went wrong during labour, they relied on traditional beliefs and witchcraft to explain the mishap and expected the woman in labour to confess her purported 'bad' behaviour. Twelve of the women were in favour of providing support to labouring women in maternity units and learning about childbirth care from midwives. CONCLUSION: These social support women, including those who considered themselves as mbusas, lacked understanding of the causes of obstetric complications during childbirth, and had inadequate knowledge of the appropriate management of labour. Culturally-specific knowledge from this study should be used to guide policy-makers and health planners in the future development of safe motherhood initiatives in developing countries. Midwives have a unique opportunity to ensure that care given during childbirth is clinically safe and culturally sensitive.
BACKGROUND: Several regions such as Zambia in sub-Saharan Africa experience very high levels of sterility. Current explanations for high levels of sterility in Zambia have focused on biological determinants and have paid little attention to the plausible effects of social determinants of sterility. AIM: This study has two objectives. The first objective is to examine the extent of sterility in Zambia during 1980 and 1990. The second objective is to assess the contribution of selected social determinants to the current levels of sterility in Zambia. SUBJECTS AND METHODS: Sterility among women in Zambia is calculated for two periods in 1980 and 1990 using census data. The study used parity progression ratios for the calculation of sterility rates. Selected social determinants of Zambian sterility were obtained from the Demographic Health Survey (ZDHS). Net effects of selected social determinants were examined using logistic regression. RESULTS: High sterility levels were found in a few Zambian Provinces. During 1980 and 1990, the rates for North Western, Eastern and Western provinces remained considerably higher than for other Zambian provinces. It was found that social level variables remained strong and significant even after controlling for the effects of incidence of biological factors such as sexually transmitted diseases (STDs). CONCLUSIONS: The findings of the study support the importance of developing social policies for eradicating sterility. The argument that sterility is biological and that it is not amenable to social interventions perhaps needs revision in the light of the findings of this study.
BACKGROUND: A consensus conference was held to discuss priorities for antiretroviral therapy (ART) research in Zambia, one of the world's most heavily HIV-afflicted nations. Zambia, like other resource-limited settings, has increasing access to highly active antiretroviral therapy (HAART) because of declining drug costs, use of government-purchased generic medications, and increased global donations. For sustained delivery of care with HAART in a resource-constrained medical and public health context, operational research is required and clinical trials are desirable. The priority areas for research are most relevant today given the increasing availability of HAART. METHODS: A conference was held in Lusaka, Zambia, in January 2002 to discuss priority areas for ART research in Zambia, with participants drawn from a broad cross section of Zambian society. State-of-the-art reviews and 6 intensive small group discussions helped to formulate a suggested research agenda. RESULTS: Conference participants believed that the most urgent research priorities were to assess how therapeutic resources could be applied for the greatest overall benefit and to minimize the impact of nonadherence and viral resistance. Identified research priorities were as follows:Conference participants recommended that HIV-related clinical care and research be integrated within home-based care services and operated within the existing health delivery structures to ensure sustainability, reduce costs, and strengthen the structures. CONCLUSION: Our consensus was that antiretroviral clinical trials and operational research are essential for Zambia to address the new challenges arising from increasing ART availability. There is global consensus that antiretroviral clinical trials in resource-constrained countries are possible, and the capacity for such trials should be developed further in Africa.
The integrated approach of the Primary Health Care Concept has obvious implications for development. In view of Zambia's commitment to Primary Health Care it is important to evaluate the effectiveness of present institutional frameworks and the problems that may arise in shifting towards community responsibility for the provision of health. It is often assumed that the Primary Health Care approach of working through the community should be free of serious implementation problems. However, experience from community participation projects in a wide variety fields carried out in many countries, including Zambia has shown that failure to account for local institutional arrangements and political interests has hindered success. This article presents the theoretical issues involved in community participation research, reviews relevant literature and presents a case study of a community health worker in Western Province, Zambia. The case study derives from an on-going UNICEF/Government of Zambia sponsored project which is monitoring and evaluating the impact of child health and nutrition services in rural areas. The study illustrates some of the problems encountered by a CHW because of clashes with local political interests. An alternative model is proposed which if implemented can help alleviate and/or avoid these types of conflicts.
OBJECTIVES: HIV-infected women living in resource-constrained nations like Zambia are now accessing antiretroviral therapy and thus may live long enough for HPV-induced cervical cancer to manifest and progress. We evaluated the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Zambia. METHODS: We screened 150 consecutive, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. We collected cervical specimens for cytological analysis by liquid-based monolayer cytology (ThinPrep Pap Test) and HPV typing using the Roche Linear Array PCR assay. RESULTS: The median age of study participants was 36 years (range 23-49 years) and their median CD4+ count was 165/microL (range 7-942). The prevalence of SIL on cytology was 76% (114/150), of which 23.3% (35/150) women had low-grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On univariate analyses, age of the participant, CD4+ cell count, and presence of any high-risk HPV type were significantly associated with the presence of severely abnormal cytological lesions (i.e., high-grade SIL and lesions suspicious for SCC). Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (adjusted OR: 12.4, 95% CI 2.62-58.1, p=0.02). CONCLUSIONS: The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. Screening of HIV-infected women in resource-constrained settings like Zambia should be implemented to prevent development of HPV-induced SCC.
African swine fever (ASF) has been reported in the Eastern Province of Zambia since 1912 and is now considered to be enzootic there. A survey of the distribution of ASF virus in Zambia was carried out by virus isolation from Ornithodoros moubata ticks collected from animal burrows in National Parks and Game Management Areas in northern, eastern, central and southern Zambia. ASF virus was isolated from ticks in all areas examined. The prevalence of infection in O. moubata was between 0.4% in South Luangwa National Park and 5.1% in Livingstone Game Park and mean infectious virus titres ranged from 10(3.4) HAD50/tick in Kakumbe Game Management Area to 10(5.9) HAD50/tick in Chunga and Nalusanga Game Management Areas. The prevalence of infection in adult ticks was between 4.7% and 5.3% in all areas examined except Sumbu National Park and Livingstone Game Park, where the prevalence was 15.1% and 13.2% respectively in adult ticks. The ratio of infected females to males for all the infected adult ticks in all areas of Zambia was 3.2:1.
Tick-borne diseases occurring in Zambia are assuming more importance as they continue to be a major economic problem not only in Zambia, but in many parts of Eastern, Southern and Central Africa. The current control methods, which include the use of toxic acaricides to kill ticks, and the virulent sporozoite infection and treatment method have limitations. Recombinant vaccines, currently in their experimental stages, offer hope for the future. The use of acaricides is hampered by the development of acaricide resistance and live vaccines are dependent on cold chain facilities, which are a formidable obstacle in the poorly developed infrastructure in parts of Zambia where the vaccine is most needed. Amidst these drawbacks are the results of the recent research on parasites and vector recombinant vaccines which promise to circumvent these problems. The history, current status and attitudes regarding the control of these diseases, taking into account their complexity, are reviewed. The establishment of the well-designed Central Veterinary Research Institute (CVRI) and Japanese International Cooperation Agency (JICA) sponsored veterinary school, both have a potential for high quality research, with access to a wealth of specimens a veritable goldmine of research material. It is thus hoped that this review will stimulate the desire to maximize the value of the tick and tick-borne disease research in both Zambia and the international research community.
OBJECTIVE: This article examines the degree of equity in access to condoms in urban Zambia. METHODOLOGY: This study uses data from representative samples of a). men and women in households in urban Zambia and b). providers at retail outlets in urban Zambia. RESULTS: A substantial proportion of outlets in urban Zambia (39%) stocked social marketing condoms in 1999. More than 30% of groceries and kiosks - outlets commonly found in low-income residential areas - stocked social marketing condoms. Consumer access to condoms (defined as estimated walking time to a condom source) was greater for poorer compared to wealthier respondents: compared to men with 7-13 assets (wealthier men), men with 2-6 assets were 1.5 times as likely and men with up to one asset were 1.8 times as likely to be within 10 minutes walk of a condom source. Multivariate analysis indicated that greater access to condoms among the poor was a function of greater condom availability in poorer neighbourhoods. CONCLUSIONS: Making condoms available in non-traditional outlet types that are commonly found in low-income areas (such as kiosks and groceries) can eliminate socioeconomic inequities in condom access.
OBJECTIVES: The objectives of the evaluation were to review the performance of the Zambia Quality Assurance Program (ZQAP) and provide recommendations to help design its next phase. DESIGN AND METHODS: Topics for evaluation were identified from a systems analysis of what an 'ideal' quality assurance (QA) program might look like. The evaluation team was made up of six experts who developed questionnaires to guide the interviews and related scoring tools. The evaluation team visited 24 health facilities in nine districts, representing all four regions of Zambia, and interviewed 140 persons, including health personnel from the public and private sectors, and non-health personnel. FINDINGS: In 5 years, senior staff built a QA structure and capacity throughout Zambia, generated enthusiasm for QA, and initiated teamwork on quality of care issues by motivated health staff. Some challenges remain: lack of integration of QA, uncoordinated standards, weak methods of standards communication, poor measurement of compliance with clinical care standards, constraints on the work of the quality improvement teams, and inconsistent support systems. RECOMMENDATIONS: The evaluation team made recommendations regarding a national QA policy, mechanisms to develop standards of care, monitoring of health providers' performance, needs of quality improvement teams, training in QA, and documentation of QA activities. CONCLUSIONS: Despite its success in covering the entire country with a network of QA coaches and trainers, the capacity of the public sector to sustain QA activities at the central and district levels remains a challenge. Lessons from the Zambia experience can benefit QA programs in other developing countries.
The United Nations Millennium Development Goals (MDGs) are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to age-old problems. Extreme poverty is a cause and consequence of low income, food insecurity and hunger, education and gender inequities, high disease burden, environmental degradation, insecure shelter, and lack of access to safe drinking water and basic sanitation. It is also directly linked to unsound governance and inequitable distribution of public wealth. While many regions in the world will strive to attain the MDGs by 2015, most of the countries in sub-Saharan Africa, with major human development challenges associated with socio-economic disparities, will not. Zambia's MDG progress reports of 2003 and 2005 show that despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV/AIDS epidemic, it is not likely that Zambia will achieve even half of the goals. Zambia's systems have been weakened by high disease burden and excess mortality, natural and man-made environmental threats and some negative effects of globalization such as huge external debt, low world prices for commodities and the human resource "brain drain", among others. Urgent action must follow political will, and some tried and tested strategies or "quick wins" that have been proven to produce high positive impact in the short term, need to be rapidly embarked upon by Zambia and other countries in sub-Saharan Africa if they are to achieve the Millennium Development Goals.