Effects of the ECHO tele-mentoring program on HIV/TB service delivery in health facilities in Zambia: a mixed-methods, retrospective program evaluation.

BACKGROUND: In the quest to ensure that quality healthcare is provided to all citizens through building healthcare worker capacity and extending reach for expert services, Zambia's Ministry of Health (MoH) in collaboration with its partners PEPFAR through the CDC and HRSA, began to implement the Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program across the country through the Health Workers for the 21st Century (HW21) Project and University Teaching Hospital HIV/AIDS Project (UTH-HAP). This ECHO tele-mentoring approach was deemed pivotal in helping to improve the human immunodeficiency virus (HIV) service delivery capacity of health care workers. METHOD: The study used a mixed method, retrospective program evaluation to examine ECHO participants' performance in the management of HIV/AIDS patients in all the 10 provinces of Zambia. CASE PRESENTATION: A phenomenological design was applied in order to elicit common experiences of ECHO users through focus group discussions using semi-structured facilitation guides in four provinces (Eastern, Lusaka, Southern and Western) implementing ECHO tele-mentoring approach. These provinces were purposively selected for this study. From which, only participants that had a monthly frequency of ECHO attendance of ten (10) and above were selected. The participants were purposively selected based on the type of cadre as well as facility type so that the final sample consisted of Doctors, Nurses, Midwives, Clinical Officers, Medical Licentiates, Pharmacy and Laboratory Personnel. All sessions were audio recorded and transcribed by the data collectors. A thematic content analysis approach was adopted for analyzing content of the interview's transcripts. RESULTS: Enhanced knowledge and skills of participants on HIV/TB improved by 46/70 (65.7%) in all provinces, while 47/70 (67.1%) of the participants reported that ECHO improved their clinical practice. Further, 12/70 (17.1%) of participants in all provinces reported that presenter/presentation characteristics facilitated ECHO implementation and participation. While, 15/70(21.4%) of the participants reported that ownership of the program had contributed to ECHO implementation and participation. Coordination, another enabler accounted for 14/70 (20%). Inclusiveness was reported as a barrier by 16/70 (22.8%) of the participants while 6/70 (8.6%) of them reported attitudes as a barrier (8.6%) to ECHO participation. In addition, 34/70 (48.6%) reported poor connectivity as a barrier to ECHO implementation and participation while 8/70 (11.5%) of the participants reported that the lack of ownership of the ECHO program was a barrier. 22/70 (31.4%) reported that increased workload was also a barrier to the program's implementation. CONCLUSION: Consistent with its logical pathway model, healthcare providers' participation in ECHO sessions and onsite mentorship contributed to improved knowledge on HIV/TB among health care providers and patient health outcomes. In addition, barriers to ECHO implementation were intrinsic to the program its self, such as coordination, presenter and presentation characteristics other barriers were extrinsic to the program such as poor connectivity, poor infrastructure in health facilities and negative attitudes towards ECHO. Improving on intrinsic factors and mitigating extrinsic factors may help improve ECHO outcomes and scale-up plans.

Epidemiology of Cancers in Zambia: A significant variation in Cancer incidence and prevalence across the nation.

BACKGROUND: Cancer is one of the leading causes of death worldwide. More than two-thirds of deaths due to cancers occur in low- and middle-income countries where Zambia belongs. This study, therefore, sought to assess the epidemiology of various types of cancers in Zambia. METHODS: We conducted a retrospective observational study using the Zambia National Cancer Registry (ZNCR) population based data from 2007 to 2014. Zambia Central Statistics Office (CSO) demographic data were used to determine catchment area denominator used to calculate prevalence and incidence rates of cancers. Age-adjusted rates and case fatality rates were estimated using standard methods. We used a Poisson Approximation for calculating 95% confidence intervals (CI). RESULTS: The seven most cancer prevalent districts in Zambia were Luangwa, Kabwe, Lusaka, Monze, Mongu, Katete and Chipata. Cervical cancer, prostate cancer, breast cancer and Kaposi's sarcoma were the four most prevalent cancers as well as major causes of cancer related deaths in Zambia. Age adjusted rates and 95% CI for these cancers were: cervix uteri (186.3; CI = 181.77 - 190.83), prostate (60.03; CI = 57.03 - 63.03), breast (38.08; CI = 36.0 - 40.16) and Kaposi's sarcoma (26.18; CI = 25.14 - 27.22). CFR were: Leukaemia (38.1%); pancreatic cancer (36.3%); lung cancer (33.3%); and brain, nervous system (30.2%). The cancer population was associated with HIV with p-value of 0.000 and a Pearson correlation coefficient of 0.818. CONCLUSIONS: The widespread distribution of cancers with high prevalence observed in the southern zone may have been perpetrated by lifestyle and sexual culture (traditional male circumcision known to prevent STIs is practiced in the northern belt) as well as geography. Intensifying cancer screening and early detection countrywide as well as changing the lifestyle and sexual culture would greatly help in the reduction of cancer cases in Zambia.

Assessment of carcinogenic and toxic substances in 'Insunko' herb.

There has emerged a herb in Zambia called 'insunko' which has unknown chemical composition. The use of 'insunko' herb with unknown chemical composition has brought mixed feelings among many Zambians. This study, therefore, aimed to assess the toxic and carcinogenic substances in'insunko' herb. 'Insunko' herb was purchased from Chipata, Lusaka, Mpika, Mwense, Kitwe, and Solwezi. 5 samples were collected from each of these districts and were thoroughly mixed to give 6 consolidated samples (n = 6). Nicotine and, nitrosamines were analysed using UV spectrometer lambda 35 Perkin Elmer while trace metals were analysed using ICP-MS Inductively Coupled Plasma Mass Spectroscopy (Agilent Technologies, Santa Clara, CA, USA). Nicotine, nitrosamines, and trace metals were detected in high concentrations. The concentrations ranged from 3.87 to 9.83 mg/kg for nitrosamines and 10.94-34.01 mg/kg for nicotine. Hazard Indexes for arsenic, cadmium, chromium, manganese, and copper were greater than one (HI > 1). 'Insunko' herb is a potentially toxic and carcinogenic substance because it contains toxic and carcinogenic constituents in high concentrations. These toxic and carcinogenic constituents have been confirmed to cause gastrointestinal disorders, cancers, degenerative, cardiovascular, hematopoietic, neurologic and cognitive problems as well as male infertility.

Epidemiology of Kaposi's sarcoma in Zambia, 2007 - 2014.

BACKGROUND: Kaposi's sarcoma (KS) is the most prevalent HIV and AIDS-associated cancer in the world. Zambia has been considered as part of the "KS belt", where endemic KS has been prevalent. This study, therefore, aimed to present the descriptive epidemiology of Kaposi's sarcoma in Zambia from 2007 - 2014. METHODS: We conducted the descriptive epidemiology of Kaposi's sarcoma in Zambia nested on two data sources; the Zambia National Cancer Registry (ZNCR) Kaposi's sarcoma (KS) data, and population-based HIV data from the Zambia National AIDS Council (NAC). Central Statistics Office (CSO) demographic data were used to determine the prevalence and annual incidence of KS. KS sample was 2521while HIV data from NAC were already population-based (HIV impact assessment survey). We used Microsoft Excel and SPSS version 21 in graphical computation and statistical analyses. RESULTS: Both HIV and KS were highly prevalent in Lusaka, Central, and Southern provinces. ART coverage ranged from 40% - 60%; HIV prevalence was 14.9% in females and 9.5% in males while KS prevalence was 13/100,000 in females and 21/100,000 in males. HIV prevalence was associated with KS prevalence with r = 0.827 and a p-value of 0.001 in males, and r = 0.898 with a p-value of 0.000 in females. There were 61% confirmed HIV seropositive KS, 18% confirmed HIV seronegative KS and 21% unknown HIV status KS. CONCLUSION: The high prevalence of KS in Zambia is as a result of the high prevalence of HIV. The identified two key interventions for the reduction of KS morbidity are; reducing HIV infection rate and improving ART coverage across the country.