Assessment of groundwater quality in rural areas of Mbala District, Zambia

Access to good quality drinking water still remains a challenge in most rural areas of Zambia, Africa. The aim of this study was to assess the quality of groundwater for human consumption in rural areas of Mbala district in Zambia. A total of fifty nine (59) water samples were collected from fifty nine (59) boreholes in the aforementioned district. The water samples were analysed for physical, chemical and microbiological parameters using standard techniques specific for each parameter. Results were compared to the Zambian Bureau of Standards (ZABS) guideline values for drinking water and in some cases, with WHO guideline values if known. In general, most water parameters in Mbala district complied with ZABS drinking water guideline values. A few chemical parameters which include pH ranging from 5.1 to 6.98, sodium from 0.001mg/L to 49.9mg/L, sulphate from 2mg/L to 18.76mg/L, iron from 0 to 10.22mg/L and manganese from 0 to 0.23mg/L did not meet ZABS drinking water guideline values at a few boreholes. TSS and turbidity ranged from 0 to 133mg/L and 2 to 358NTU respectively. A few exceedances of the aforementioned parameters were recorded at a few boreholes. In contrast, significantly high turbidity levels (>20NTU) were recorded at a few boreholes in the district thus posing a significant threat to the health of the consumers. In terms of microbiological parameters, a few boreholes did not meet the ZABS drinking water guideline values for total coliforms rendering the water supplies from the affected boreholes unfit for human consumption unless boiled or treated with chlorine.Keywords: Groundwater, Zambia, rural areas, water quality, Mbala distric

Effect of apical dominance on bud take in Citrus vegetative propagation

The objective of the study was to identify the grafting method, which will have a higher success rate of scion development. The study was conducted at Mount Makulu Central Research station in Chilanga, Zambia (15o33S / 28o11E) from April 2010 to November 2011. The study had 4 vegetative propagation methods that varied in the treatment of the rootstock and scion. The four methods were Standard T- budding (STB); Modified TBudding with decapitation (TBD); T- budding with scion bending (TBB); Crown grafting (CG). Bud take, shoot growth, leaf emergence and Leaf area index were measured up to 11 weeks after treatment (WAT). With CG there was 100 % bud take. STB had a bud take of 58.3 %. TBD had a bud take of 50 %. The lowest bud take percentage was recorded in TBB, which had a bud take of 41.7 %. At 5 weeks the STB and TBB treatment had shoot length of 0.7 and 1.0 cm respectively which were the shortest; this was followed by the CG treatment at 15.3 cm and the modified TBD with apical shoot decapitation (21.7 cm). STB shoots did not start growing until about 5 weeks, which was 2 weeks after the rootstock was cut off. At 5 weeks, the TBB and STB were yet to form leaves. The CG had close to 20 leaves and the TBD had almost 15.2 leaves. At the end of 11 weeks, the TBB had the highest number of leaves. Across the grafting methods; the Leaf area exhibited a pattern similar to leaf number; it kept on doubling every 2 weeks to until the 9th week after which the increase was negligible. At 11 weeks, the highest leaf area was in the TBD followed by the STB and lowest in the CG treatment.Int. J. Agril. Res. Innov. & Tech. 7 (1): 64-70, June, 201

Perinatal paracetamol exposure in mice does not affect the development of allergic airways disease in early life

Background Current data concerning maternal paracetamol intake during pregnancy, or intake during infancy and risk of wheezing or asthma in childhood is inconclusive based on epidemiological studies. We have investigated whether there is a causal link between maternal paracetamol intake during pregnancy and lactation and the development of house dust mite (HDM) induced allergic airways disease (AAD) in offspring using a neonatal mouse model. Methods Pregnant mice were administered paracetamol or saline by oral gavage from the day of mating throughout pregnancy and/or lactation. Subsequently, their pups were exposed to intranasal HDM or saline from day 3 of life for up to 6 weeks. Assessments of airway hyper-responsiveness, inflammation and remodelling were made at weaning (3 weeks) and 6 weeks of age. Results Maternal paracetamol exposure either during pregnancy and/or lactation did not affect development of AAD in offspring at weaning or at 6 weeks. There were no effects of maternal paracetamol at any time point on airway remodelling or IgE levels. Conclusions Maternal paracetamol did not enhance HDM induced AAD in offspring. Our mechanistic data do not support the hypothesis that prenatal paracetamol exposure increases the risk of childhood asthma

Evaluation of the Safety of the Taraklamp Male Circumcision Device in Zambia

This paper assesses the safety, duration of procedure, complications, pain and public acceptability of the Taraklamp, male circumcision device, in adolescents and adult male circumcision in Zambia.Male circumcision has been proved to be an effective additional means of preventing transmission of the HIV virus from females to males in heterosexual relationships with efficacy of up to 60%. Many methods and devices for adult male circumcision have now been developed. However, there are still concerns on safety, duration of procedure, and public acceptability of these devices. Objectives: to assess safety, duration of procedure, complications, pain and public acceptability of the Taraklamp, male circumcision device, in adolescents and adult male circumcision in Zambia. Materials and Methods: we conducted a field study with 1,046 male adolescents and adults recruited from five district clinics. Prior to circumcision, participants were educated on benefits of circumcision while undergoing HIV counseling and screening. Duration of procedure was recorded, intra and postoperative pain was assessed and adverse events were documented for each participant. Levels of satisfaction with the procedure both from doctors' and participants' perspectives were also documented. Results: A total of 794 participants were circumcised using the TARAKLAMP device. The median time for circumcision was 4 minutes (IQR: 3-6 minutes; range: 124 minutes). Approximately 5 (0.6%) of the participants experienced postoperative pain and 12 (1.5%) experienced adverse events following the procedure. Despite this all participants found the procedure safe and acceptable, as did the doctors who carried out the procedure. Conclusions: the results from this study showed that the TARAKLAMP device is safe for medical male circumcision. Acceptability of the circumcision using the device was exceptional and it is possible to use the TARAKLAMP to roll out medical male circumcision in Zambia.Office of Global AIDS/US Department of State

Anesthesia capacity of district-level hospitals in Malawi, Tanzania, and Zambia: A mixed-methods study

Background: District-level hospitals (DLHs) are the main providers of surgical services for rural populations in Sub-Saharan Africa (SSA). Skilled teams are essential for surgical care, and gaps in anesthesia impact negatively on surgical capacity and outcomes. This study, from a baseline of a project scaling-up access to safe surgical and anesthesia care in Malawi, Tanzania, and Zambia, illustrates the deficit of anesthesia care in DLHs. Methods: We undertook an in-depth investigation of anesthesia capacity in 76 DLHs across the 3 countries, July to November 2017, using a mixed-methods approach. The quantitative component assessed district-level anesthesia capacity using a standardized scoring system based on an adapted and extended Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) Index. The qualitative component involved semistructured interviews with providers from 33 DLHs, exploring how weaknesses in anesthesia impacted district surgical team practices and quality, volume, and scope of service provision. Results: Anesthesia care at the district level in these countries is provided only by nonphysician anesthetists, some of whom have no formal training. Ketamine anesthesia is widely used in all hospitals, compensating for shortages of other forms of anesthesia. Pediatric size supplies/equipment were frequently missing. Anesthesia PIPES index scores in Malawi (M = 8.0), Zambia (M = 8.3), and Tanzania (M = 8.4) were similar (P = .59), but an analysis of individual PIPES components revealed important cross-country differences. Irregular availability of reliable equipment and supply is a particular priority in Malawi, where only 29% of facilities have uninterrupted access to electricity and 23% have constant access to water, among other challenges. Zambia is mostly affected by staffing shortages, with 30% of surveyed hospitals lacking an anesthesia provider. The challenge that stood out in Tanzania was nonavailability of functioning anesthesia machines among frequent shortages of staff and other equipment. Conclusions: Tanzania, Malawi, and Zambia are falling far short of ensuring universal access to safe and affordable surgical and anesthesia care for district and rural populations. Mixed-methods situation analyses, undertaken in collaboration with anesthesia specialists—measuring and understanding deficits in district hospital anesthetic staff, equipment, and supplies—are needed to address the critical neglect of anesthesia that is essential to providing surgical responses to the needs of rural populations in SSA

HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study

BackgroundGlobally, most countries have implemented a test-and-treat policy to reduce morbidity and mortality associated with HIV infection. However, the impact of this strategy has not been critically appraised in many settings, including Zambia. We evaluated the retention and clinical outcomes of adults enrolled in antiretroviral therapy (ART) and assessed the impact of the test-and-treat policy.MethodsWe conducted a retrospective cohort study among 6,640 individuals who initiated ART between January 1, 2014 and July 31, 2016 [before test-and-treat cohort (BTT), n = 2,991] and between August 1, 2016 and October 1, 2020 [after test-and-treat cohort (ATT), n = 3,649] in 12 districts of the Southern province. To assess factors associated with retention, we used logistic regression (xtlogit model).ResultsThe median age [interquartile range (IQR)] was 34.8 years (28.0, 42.1), and 60.2% (n = 3,995) were women. The overall retention was 83.4% [95% confidence interval (CI) 82.6, 84.4], and it was significantly higher among the ATT cohort, 90.6 vs. 74.8%, p < 0.001. The reasons for attrition were higher in the BTT compared to the ATT cohorts: stopped treatment (0.3 vs. 0.1%), transferred out (9.3 vs. 3.2%), lost to follow-up (13.5 vs. 5.9%), and death (1.4 vs. 0.2%). Retention in care was significantly associated with the ATT cohort, increasing age and baseline body mass index (BMI), rural residence, and WHO stage 2, while non-retention was associated with never being married, divorced, and being in WHO stage 3.ConclusionThe retention rate and attrition factors improved in the ATT compared to the BTT cohorts. Drivers of retention were test-and-treat policy, older age, high BMI, rural residence, marital status, and WHO stage 1. Therefore, there is need for interventions targeting young people, urban residents, non-married people, and those in the symptomatic WHO stages and with low BMI. Our findings highlight improved ART retention after the implementation of the test-and-treat policy

Malaria surveillance in low-transmission areas of Zambia using reactive case detection

BACKGROUND: Repeat national household surveys suggest highly variable malaria transmission and increasing coverage of high-impact malaria interventions throughout Zambia. Many areas of very low malaria transmission, especially across southern and central regions, are driving efforts towards sub-national elimination. CASE DESCRIPTION: Reactive case detection (RCD) is conducted in Southern Province and urban areas of Lusaka in connection with confirmed incident malaria cases presenting to a community health worker (CHW) or clinic and suspected of being the result of local transmission. CHWs travel to the household of the incident malaria case and screen individuals living in adjacent houses in urban Lusaka and within 140 m in Southern Province for malaria infection using a rapid diagnostic test, treating those testing positive with artemether–lumefantrine. DISCUSSION: Reactive case detection improves access to health care and increases the capacity for the health system to identify malaria infections. The system is useful for targeting malaria interventions, and was instrumental for guiding focal indoor residual spraying in Lusaka during the 2014/2015 spray season. Variations to maximize impact of the current RCD protocol are being considered, including the use of anti-malarials with a longer lasting, post-treatment prophylaxis. CONCLUSION: The RCD system in Zambia is one example of a malaria elimination surveillance system which has increased access to health care within rural communities while leveraging community members to build malaria surveillance capacity

Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia

Contains fulltext : 177230.pdf (publisher's version ) (Open Access)BACKGROUND: Most sub-Saharan African countries struggle to make safe surgery accessible to rural populations due to a shortage of qualified surgeons and the unlikelihood of retaining them in district hospitals. In 2002, Zambia introduced a new cadre of non-physician clinicians (NPCs), medical licentiates (MLs), trained initially to the level of a higher diploma and from 2013 up to a BSc degree. MLs have advanced clinical skills, including training in elective and emergency surgery, designed as a sustainable response to the surgical needs of rural populations. METHODS: This qualitative study aimed to describe the role, contributions and challenges surgically active MLs have experienced. Based on 43 interviewees, it includes the perspective of MLs, their district hospital colleagues-medical officers (MOs), nurses and managers; and surgeon-supervisors and national stakeholders. RESULTS: In Zambia, MLs play a crucial role in delivering surgical services at the district level, providing emergency surgery and often increasing the range of elective surgical cases that would otherwise not be available for rural dwellers. They work hand in hand with MOs, often giving them informal surgical training and reducing the need for hospitals to refer surgical cases. However, MLs often face professional recognition problems and tensions around relationships with MOs that impact their ability to utilise their surgical skills. CONCLUSIONS: The paper provides new evidence concerning the benefits of 'task shifting' and identifies challenges that need to be addressed if MLs are to be a sustainable response to the surgical needs of rural populations in Zambia. Policy lessons for other countries in the region that also use NPCs to deliver essential surgery include the need for career paths and opportunities, professional recognition, and suitable employment options for this important cadre of healthcare professionals

Health worker perspectives on user fee removal in Zambia.

UNLABELLED: BACKGROUND: User fees for primary care services were removed in rural districts in Zambia in 2006. Experience from other countries has suggested that health workers play a key role in determining the success of a fee removal policy, but also find the implementation of such a policy challenging. The policy was introduced against a backdrop of a major shortage in qualified health staff. METHODS: As part of a larger study on the experience and effect of user fee removal in Zambia, a number of case studies at the facility level were conducted. As part of these, quantitative and qualitative data were collected to evaluate health workers' satisfaction and experiences in charging and non-charging facilities. RESULTS: Our findings show that health-care workers have mixed feelings about the policy change and its consequences. We found some evidence that personnel motivation was higher in non-charging facilities compared to facilities still charging. Yet it is unclear whether this effect was due to differences in the user fee policy or to the fact that a lot of staff interviewed in non-charging facilities were working in mission facilities, where we found a significantly higher motivation. Health workers expressed satisfaction with an apparent increase in the number of patients visiting the facilities and the removal of a deterring factor for many needy patients, but also complained about an increased workload. Furthermore, working conditions were said to have worsened, which staff felt was linked to the absence of additional resources to deal with the increased demand or replace the loss of revenue generated by fees. CONCLUSION: These findings highlight the need to pay attention to supply-side measures when removing demand-side barriers such as user fees and in particular to be concerned about the burden that increased demand can place on already over-stretched health workers

Banning traditional birth attendants from conducting deliveries: experiences and effects of the ban in a rural district of Kazungula in Zambia

BACKGROUND: In 2010 the government of the republic of Zambia stopped training traditional birth attendants and forbade them from conducting home deliveries as they were viewed as contributing to maternal mortality. This study explored positive and negative maternal health related experiences and effects of the ban in a rural district of Kazungula. METHODS: This was a phenomenological study and data were collected through focus group discussions as well as in-depth interviews with trained traditional birth attendants (tTBAs) and key informant interviews with six female traditional leaders that were selected one from each of the six zones. All 22 trained tTBAs from three clinic catchment areas were included in the study. Content analysis was used to analyse the data after coding it using NVIVO 8 software. RESULTS: Home deliveries have continued despite the community and tTBAs being aware of the ban. The ban has had both negative and positive effects on the community. Positive effects include early detection and management of pregnancy complications, enhanced HIV/AIDS prevention and better management of post-natal conditions, reduced criticisms of tTBAs from the community in case of birth complications, and quick response at health facilities in case of an emergency. Negatives effects of the ban include increased work load on the part of health workers, high cost for lodging at health facilities and traveling to health facilities, as well as tTBAs feeling neglected, loss of respect and recognition by the community. CONCLUSION: Countries should design their approach to banning tTBAs differently depending on contextual factors. Further, it is important to consider adopting a step wise approach when implementing the ban as the process of banning tTBAs may trigger several negative effects