Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia.

BACKGROUND: Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia. METHODS: A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance. FINDINGS: The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation. CONCLUSIONS: Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

Factors associated with stunting among children below five years of age in Zambia: evidence from the 2014 Zambia demographic and health survey.

BACKGROUND: Stunting continues to be a major public health problem globally. Stunting is a manifestation of many factors including inadequate food intake and poor health conditions. However, poor quality nutritional diets during pregnancy, infancy and early childhood lead to inadequate nutrient intake. The prevalence of stunting in Zambia has been over 40% and remains unacceptably high. There is limited information on factors associated with stunting in Zambia. Thus to better understand factors contributing to the high stunting levels, the 2013/14 Zambia Demographic and Health Survey (ZDHS) data was analysed. METHODS: Data was extracted using a data extraction tool and analysed using Stata version 13. Sample data of 12, 328 children aged 0-59 months was analysed. The analysis involved simple and multiple logistic regression to find associations between independent variables and stunting. RESULTS: The prevalence of stunting among under five children in Zambia is 40%. From the 4937 children who were stunted, stunting was higher among male children as compared to female children (42.4 and 37.6% respectively). Additional analysis revealed that children whose source of drinking water was improved (33.7%) were less likely to be stunted compared to children whose source of drinking water was poor (47.7%). Stunting was associated with sex and age of a child; mother's age and education; residence; wealth and duration of breastfeeding. For instance, children whose mothers had higher education showed a 75% reduction of odds compared to children whose mothers had no education (AOR = 0.35, 95%CI: 0.22, 0.54; p < 0.05). Similarly, wealth status showed an inverse relationship. Children who came from rich households showed a 32% reduction of odds compared to children who came from poor households (AOR = 0.68, 95%CI: 0.57, 0.82; p < 0.05). CONCLUSION: The study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; mother's age and level of education; wealth status; improved source of drinking water; duration of breastfeeding and residence. Therefore, multiple measures targeted at reducing child stunting should be taken in a bid to influence policy and conceiving of programmes.

Under-five mortality among displaced populations in Meheba refugee camp, Zambia, 2008-2014.

BACKGROUND: Under-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed. METHODS: The study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008-2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings. RESULTS: Malaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year. CONCLUSION: In addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.