BackgroundUnderstanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.MethodsA systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.ResultsThe main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.ConclusionMass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

BackgroundMalaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014.MethodsThis was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis.ResultsOut of all the enrolled participants (n = 463), 92% women had complete information for analysis. Of these, (n = 426) women, 127 (29.8%, 95% CI: 25.6%–34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%–74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR = 0.31, 95% CI 0.13–0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR = 0.29, 95% CI 0.18–0.48); not taking SP under direct observation therapy (DOT) (AOR = 0.18, 95% CI (0.05–0.63).ConclusionsThere is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1744-y) contains supplementary material, which is available to authorized users.

BackgroundPoisoning remains an important public health problem contributing significantly to the global burden of disease. Evidence on the exact burden and pattern of acute poisoning in Zambia is limited. We aimed to characterise acute poisoning with regard to demographic and epidemiologic factors of cases reported at the University Teaching Hospital and Levy Mwanawasa General Hospital; two large referral hospitals in Lusaka, Zambia.MethodsThis was a cross-sectional study involving retrospective collection of data on all poisoning cases recorded in hospital records from 1 January to 31 December 2012. A pretested data collection form was used to extract demographic and other data such as poisonous agents used, circumstance of poisoning, route and outcome of poisoning. All analyses were performed in STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP).ResultsA total of 873 poisoning cases were reviewed with almost similar proportions of males (52 %) and females (49 %). Poisoning cases were highest in the 0-12 years age category (36 %) followed by the 20-30 years age category (31 %). Accidental poisoning characterised most (65 %) cases in children aged < 13 years. The common route of exposure to poisonous agents was ingestion. Overall, the mortality rate was 2.6 per 100 cases, the majority of deaths were observed in men (78 %). Poisonous agents associated with most cases were pesticides (57 %) and pharmaceuticals (13 %).ConclusionsThe high risk of accidental poisoning observed in children calls for special health education on chemical safety, tailored for mothers and caregivers to prevent chemical exposure in this important age group whose access to toxic agents is mainly in homes or their immediate environment. The results also call for additional regulatory controls on pesticides and pharmaceuticals, which were the most common toxic agents.

Objective: The aim of this study was to evaluate bacterial contamination and the risk factors associated with contamination of poultry during processing. Despite the rapid growth of the poultry industry, the presence of high levels of pathogenic bacteria contaminants, such as Escherichia coli and Salmonella , pose serious public health concerns in dressed chickens. These infections negatively affect the product's shelf life. Methods: A cross sectional design was used to study two main poultry abattoirs in Lusaka. The processing line was used to collect biological samples along with the acquisition of risk-associated data using a structured questionnaire. Data collected both from biological sources and the risk analysis were entered into Excel and analysed in STATA version 14 for windows. Results: Escherichia coli and Salmonella contamination was detected in 70 and 2.5% of the selected dressed chickens ( n = 80), respectively. The number of total coliforms and Escherichia coli were observed to be significantly higher in samples from washed carcasses than pre-washed carcasses (65 and 35%, respectively). In addition, this study revealed that among the anthropogenic and exposure risk factors, bacterial contamination levels resulted mainly from a lack of hygienic practices. This included hand washing and an increased frequency of slaughters per day (>15,000). Conclusion: This study indicates that the water used for dressing chickens is probably the major cause of high levels of cross-contamination. The results also highlight the issues that need to be addressed to improve environmental and carcass hygiene in a poultry abattoir. Significance: Critical findings in this study are that contamination sources may be variable and hygienic practices may play a major role. In this particular study, the reuse of contaminated water was a case in point. Accordingly, there is need for both the water source and the water being used for processing to be tested.

BackgroundCommunity health workers (CHWs) are an important human resource in improving coverage of and success to interventions aimed at reducing malaria incidence. Evidence suggests that the performance of CHWs in malaria programs varies in different contexts. However, comprehensive frameworks, based on systematic reviews, to guide the analysis of determinants of performance of CHWs in malaria prevention and control programs are lacking.MethodsWe systematically searched Google Scholar, Science Direct, and PubMed including reference lists that had English language publications. We included 16 full text articles that evaluated CHW performance in malaria control. Search terms were used and studies that had performance as an outcome of interest attributed to community-based interventions done by CHWs were included.ResultsSixteen studies were included in the final review and were mostly on malaria Rapid Diagnosis and Treatment, as well as adherence to referral guidelines. Factors determining performance and effective implementation of CHW malaria programs included health system factors such as nature of training of CHWs; type of supervision including feedback process; availability of stocks, supplies, and job aids; nature of work environment and reporting systems; availability of financial resources and transport systems; types of remuneration; health staff confidence in CHWs; and workload. In addition, community dynamics such as nature of community connectedness and support from the community and utilization of services by the community also influenced performance. Furthermore, community health worker characteristics such marital status, sex, and CHW confidence levels also shaped CHW performance.ConclusionsEffectively analyzing and promoting the performance of CHWs in malaria prevention and control programs may require adopting a framework that considers health systems and community factors as well as community health worker characteristics.

Background: Soil-transmitted helminths are among the neglected tropical diseases (NTDs) of poverty. They are a common type of parasitic infections in the world, caused by three main species commonly known as roundworms, whipworms, and hookworms. The diseases have major health and socio-economic repercussions and significantly contribute to public health problems in developing countries. Objectives: This study investigated the prevalence, intensity, and factors associated with soil-transmitted helminths among children in Chililabombwe district of Zambia. Methods: A cross-sectional design was used, consisting of 411 guardian – child pairs aged between 17-77 years and 1-15 years, respectively. This was conducted between October and December 2017. Systematic sampling and simple random sampling were used to select the household and 411 participants, respectively. The study used a structured pre-tested questionnaire and stool tests to obtain information on socio-demographic, environmental, behavioral, and service-related factors associated with helminth infection. Stool samples were collected and examined for the presence of parasites using formol-ether concentration and Kato-Katz techniques. Geometric mean was used to report the intensity of infection. An investigator-led stepwise regression was used to identify factors associated with developing Soil-Transmitted Helminth infection and the level of significance was set at 0.05. Results: Prevalence of soil-transmitted helminth infection was 59/411 (14.4%) and the most dominant parasite was roundworms 58/411 (14.1%). The overall intensity of infection was light (<5000epg) with a few heavy infections (>50000epg). Factors independently associated with soil-transmitted helminth infection after adjusting for other variables were residence (AOR=0.26; 95% CI [0.09-0.73]), household income (AOR=2.49; 95% CI [1.01-6.12]), and overcrowding (AOR =1.33; 95% CI [1.09-1.62]). Conclusion: Our findings indicate that STH infections are still prevalent. Low household income, residence, and overcrowding are the factors associated with infection. This indicates that reinfection is common even after deworming.

BackgroundIn 2013, Zambia accepted the immediate operationalization of Option B+, a policy used to try and eliminate mother to child transmission. This policy requires all HIV-positive pregnant and breastfeeding women to initiate antiretroviral treatment for life regardless of CD4 count. However, not all HIV positive women accept treatment for life. This study aimed to investigate acceptability of lifelong ART (Option B+) among HIV positive women receiving antenatal and postnatal services at the university teaching hospital and Lusaka urban city clinics.MethodsThis was a cross sectional study conducted in November, 2016 to March 2017. The study population comprised of HIV positive women in their reproductive age (15–49 years). A Structured questionnaire was used to collect data in a face to face interview with the participants. Data was entered in EpiData version 3.1 and analysed using Stata version 13. Multivariate logistic regression analysis was performed to determine predictors of acceptability.ResultsOverall, 427 women participated in this study. Their mean age was 30 years. Of the 427, over half (54%) had inadequate knowledge and about 30% of the women in the study still experience stigma and discrimination.63.2% of the women had good attitude towards Option B+ and overall, the majority (77.8%) were willing to accept antiretroviral therapy for life. Multivariate analysis showed that only women with good attitude were 9.4 times more likely to accept Option B+ than those with a bad attitude [OR: 9.4: 95%CI, 5.8–15.2)].ConclusionThis study showed that in general, women accepted initiation of Option B+. However, there is still a gap in the level of knowledge of Option B+ as well as stigma and discrimination in some communities, hence there is need to intensify programs that are aimed at educating the community on the importance of ART for life, combat stigma and discrimination and consequently promote acceptability of Option B+.

The global burden of malaria has increased from 227 million cases in 2019 to 247 million cases in 2020. Indoor residual spraying (IRS) remains one of the most effective control strategies for malaria. The current study sought to measure the acceptability level and associated factors of indoor residual spraying. A cross sectional study was conducted from October to November 2020 in sixteen urban and rural communities of Luangwa district using a cluster sampling method, Multilevel analysis was used to account for the hierarchical structure of the data. The acceptability level of indoor residual spraying among household heads was relatively high at 87%. Individuals who felt the timing was not appropriate were associated with decreased odds of accepting IRS (AOR = 0.55, 95% CI: 0.20–0.86). Positive attitude was associated with increased odds of accepting IRS (AOR = 29.34, 95% CI: 11.14–77.30). High acceptability level was associated with unemployment (AOR = 1.92, 95% CI: 1.07–3.44). There were no associations found between acceptability levels and community-level factors such as information, education, communication dissemination, awareness achieved through door-to-door sensitization, and public address system. Acceptability level of indoor residual spraying was relatively high among households of Luangwa District suggesting that the interventions are more acceptable which is essential in reaching malaria elimination by 2030. Finding that community factors known to influence acceptability such as information, education and communication as well as awareness were not important to influencing acceptability suggests need for reinforcing messages related to indoor residual spraying and redefining the community sensitization approaches to make indoor residual spraying more acceptable.