A comprehensive desk review of malaria trends was conducted between 2000-2010 in Zambia to study malaria epidemiology and trends to guide strategies and approaches for effective malaria control.This review considered ...A comprehensive desk review of malaria trends was conducted between 2000-2010 in Zambia to study malaria epidemiology and trends to guide strategies and approaches for effective malaria control.This review considered data from the National Health Information Management System,Malaria Surveys and Programme Review reports and analyzed malaria in-patient cases and deaths in relation to intervention coverage for all ages.Data showed three distinct epidemiological strata after a notable malaria reduction(66%)in in-patient cases and deaths,particularly between 2000-2008.These changes occurred following the(re-)introduction and expansion of indoor residual spraying up to 90%coverage,scale-up of coverage of long-lasting insecticidetreated nets in household from 50%to 70%,and artemisin-based combination therapy nationwide.However,malaria cases and deaths re-surged,increasing in 2009-2010 in the northern-eastern parts of Zambia.Delays in the disbursement of funds affected the implementation of interventions,which resulted in resurgence of cases and deaths.In spite of a decline in malaria disease burden over the past decade in Zambia,a reversal in impact is notable in the year 2009-2010,signifying that control gains are fragile and must be sustained toeliminate malaria.展开更多
Objective:To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.Methods:This study was a retrospective evaluation of the quality of malaria case management at...Objective:To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.Methods:This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage.The review period was from January to December 2008.The sample included twelve lower level health facilities from four districts.The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.Results:Out of 4891 suspected malaria cases recorded at the 12 health facilities,more than 80%of the patients had a temperature taken to establish their fever status.About 67%(CI_(95)66.1-68.7)were tested for parasitemia by either rapid diagnostic test or microscopy,whereas the remaining22.5%(CI_(95)213.1-23.7)were not subjected to any malaria test.Of the 2247 malaria cases reported(complicated and uncomplicated),71%were parasitologicaily confirmed while 29%were clinically diagnosed(unconfirmed).About 56%.(CI_(95)53.9-58.1)of the malaria cases reported were treated with artemether-lumefantrine(AL),35%(CI_(95)33.1-37.0)with sulphadoxine-pyrimethamine,8%(CI_(95)6.9-9.2)with quinine and 1%did not receive any anti-malarial.Approximately 30%of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial,contrary to the guidelines.There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used,and in the choice of anti-malarials for the treatment of malaria confirmed cases.Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not.Gender,in service training on malaria,years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.Conclusions:Malaria case management was characterised by poor adherence to treatment guidelines.The non-adherence was mainly in leans of:inconsistent use of confirmatory tests(rapid diagnostic test or microscopy)for malaria;prescribing anti-malarials which are not recommended(e.g.sulphadoxine-pyrimethamine)and prescribing anti-malarials to cases testing negative.Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.展开更多
Zambia is among the sub-Saharan countries highly burdened with tuberculosis(TB) and has an estimated prevalence rate of 638 per 100 000 population in those aged 15 years and above.The mining industry is the main contr...Zambia is among the sub-Saharan countries highly burdened with tuberculosis(TB) and has an estimated prevalence rate of 638 per 100 000 population in those aged 15 years and above.The mining industry is the main contributor to the country's gross national product,although it is associated with public health challenges,with TB in the mines being among the occupational health diseases having a negative economic impact and threatening to delay the control of TB in the country.We reviewed available evidence on the extent of the burden of TB in the mines so as to inform the development of targeted interventions for the post-2015 End TB Strategy.This was a review of published data from Medline/Pubmed,Cochrane Library and Embase,including unpublished "grey"literature on the burden of TB and the risk factors of TB in the mines of Zambia.There is limited research in Zambia to fully understand the burden of TB and risk factors associated with TB in the mines.However,the few studies and data available have shown that TB is a significant health problem requiring interventions to improve the quality of life of miners,ex-miners and surrounding communities.TB is a potential problem in the mines of Zambia and the actual burden needs to be determined.Exposure to silica as a risk factor needs further investigation.展开更多
Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.Meth...Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.Methods: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis.Results: Out of the 44 791 tuberculosis survey participants, 14 164(31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15-24 years were associated with higher refusal rates.Conclusions: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.展开更多
Insecticide treated nets (ITNs) play a pivotal role in the prevention and control of malaria. Conversely, inadequate levels of ownership, utilization and durability invariably compromise their efficacy. Operational pe...Insecticide treated nets (ITNs) play a pivotal role in the prevention and control of malaria. Conversely, inadequate levels of ownership, utilization and durability invariably compromise their efficacy. Operational performance of the KO-Tab 1-2-3 Long Lasting Insecticidal Nets (LLINs) was assessed using the World Health Organization (WHO) standard entomological and epidemiological procedures, and a pretested structured questionnaire. The median knock down time for Anopheles funestus s.l. was 30 minutes (95% CI 26.3 - 34.0). Post exposure mean mortality rates were 34% at one hour and 80.0% at 24 hours (OR = 0.13, P = 0.00002). Children between the ages of 1 - 4 years old exhibited higher false positives as compared to the 5 - 15 years age groups (OR = 0.10, P = 0.0006). Parasite prevalence varied between rapid diagnostic tests (RDTs) (40.4%) and microscopy (31.3%) (OR = 0.67, P = 0.2825) with 9.2% discordant RDT false positives. All malaria positive children were Plasmodium falciparum mono-infections. Hospital admissions reduced by 28% between 2005 and 2008, with case fatality rates reducing by 19% between 2006 and2007 inchildren under five years. No marked heterogeneity between LLINs ownership (66%) and utilization (48.3%) was observed (OR = 0.49, P = 0.0978). There was complete (100%) community level knowledge of KO-Tab 1-2-3 LLINs. The study provides evidence of potential of KO-Tab 1-2-3 LLINs for operational scale distribution, and substantiates the need for further longitudinal studies to monitor their insecticidal and physical durability.展开更多
基金Supported by the World Health Organization,grant No.:AF/ZAM/BBE/005/XL/10/M
文摘A comprehensive desk review of malaria trends was conducted between 2000-2010 in Zambia to study malaria epidemiology and trends to guide strategies and approaches for effective malaria control.This review considered data from the National Health Information Management System,Malaria Surveys and Programme Review reports and analyzed malaria in-patient cases and deaths in relation to intervention coverage for all ages.Data showed three distinct epidemiological strata after a notable malaria reduction(66%)in in-patient cases and deaths,particularly between 2000-2008.These changes occurred following the(re-)introduction and expansion of indoor residual spraying up to 90%coverage,scale-up of coverage of long-lasting insecticidetreated nets in household from 50%to 70%,and artemisin-based combination therapy nationwide.However,malaria cases and deaths re-surged,increasing in 2009-2010 in the northern-eastern parts of Zambia.Delays in the disbursement of funds affected the implementation of interventions,which resulted in resurgence of cases and deaths.In spite of a decline in malaria disease burden over the past decade in Zambia,a reversal in impact is notable in the year 2009-2010,signifying that control gains are fragile and must be sustained toeliminate malaria.
基金Supported by The Bill and Melinda Gates Foundation support to PATH for the Malaria Control Evaluation Partnership for Africa(MACEPA)project,Grant Number:OPP1013468
文摘Objective:To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.Methods:This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage.The review period was from January to December 2008.The sample included twelve lower level health facilities from four districts.The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.Results:Out of 4891 suspected malaria cases recorded at the 12 health facilities,more than 80%of the patients had a temperature taken to establish their fever status.About 67%(CI_(95)66.1-68.7)were tested for parasitemia by either rapid diagnostic test or microscopy,whereas the remaining22.5%(CI_(95)213.1-23.7)were not subjected to any malaria test.Of the 2247 malaria cases reported(complicated and uncomplicated),71%were parasitologicaily confirmed while 29%were clinically diagnosed(unconfirmed).About 56%.(CI_(95)53.9-58.1)of the malaria cases reported were treated with artemether-lumefantrine(AL),35%(CI_(95)33.1-37.0)with sulphadoxine-pyrimethamine,8%(CI_(95)6.9-9.2)with quinine and 1%did not receive any anti-malarial.Approximately 30%of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial,contrary to the guidelines.There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used,and in the choice of anti-malarials for the treatment of malaria confirmed cases.Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not.Gender,in service training on malaria,years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.Conclusions:Malaria case management was characterised by poor adherence to treatment guidelines.The non-adherence was mainly in leans of:inconsistent use of confirmatory tests(rapid diagnostic test or microscopy)for malaria;prescribing anti-malarials which are not recommended(e.g.sulphadoxine-pyrimethamine)and prescribing anti-malarials to cases testing negative.Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.
文摘Zambia is among the sub-Saharan countries highly burdened with tuberculosis(TB) and has an estimated prevalence rate of 638 per 100 000 population in those aged 15 years and above.The mining industry is the main contributor to the country's gross national product,although it is associated with public health challenges,with TB in the mines being among the occupational health diseases having a negative economic impact and threatening to delay the control of TB in the country.We reviewed available evidence on the extent of the burden of TB in the mines so as to inform the development of targeted interventions for the post-2015 End TB Strategy.This was a review of published data from Medline/Pubmed,Cochrane Library and Embase,including unpublished "grey"literature on the burden of TB and the risk factors of TB in the mines of Zambia.There is limited research in Zambia to fully understand the burden of TB and risk factors associated with TB in the mines.However,the few studies and data available have shown that TB is a significant health problem requiring interventions to improve the quality of life of miners,ex-miners and surrounding communities.TB is a potential problem in the mines of Zambia and the actual burden needs to be determined.Exposure to silica as a risk factor needs further investigation.
基金Supported by the government of the Republic of Zambia(GRZ) through Ministry of Health(budget support)United States Government(USG)through USAID and CDC Zambia,Grant U2GPS001792
文摘Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation.Methods: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis.Results: Out of the 44 791 tuberculosis survey participants, 14 164(31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15-24 years were associated with higher refusal rates.Conclusions: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.
文摘Insecticide treated nets (ITNs) play a pivotal role in the prevention and control of malaria. Conversely, inadequate levels of ownership, utilization and durability invariably compromise their efficacy. Operational performance of the KO-Tab 1-2-3 Long Lasting Insecticidal Nets (LLINs) was assessed using the World Health Organization (WHO) standard entomological and epidemiological procedures, and a pretested structured questionnaire. The median knock down time for Anopheles funestus s.l. was 30 minutes (95% CI 26.3 - 34.0). Post exposure mean mortality rates were 34% at one hour and 80.0% at 24 hours (OR = 0.13, P = 0.00002). Children between the ages of 1 - 4 years old exhibited higher false positives as compared to the 5 - 15 years age groups (OR = 0.10, P = 0.0006). Parasite prevalence varied between rapid diagnostic tests (RDTs) (40.4%) and microscopy (31.3%) (OR = 0.67, P = 0.2825) with 9.2% discordant RDT false positives. All malaria positive children were Plasmodium falciparum mono-infections. Hospital admissions reduced by 28% between 2005 and 2008, with case fatality rates reducing by 19% between 2006 and2007 inchildren under five years. No marked heterogeneity between LLINs ownership (66%) and utilization (48.3%) was observed (OR = 0.49, P = 0.0978). There was complete (100%) community level knowledge of KO-Tab 1-2-3 LLINs. The study provides evidence of potential of KO-Tab 1-2-3 LLINs for operational scale distribution, and substantiates the need for further longitudinal studies to monitor their insecticidal and physical durability.
