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The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: The Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up., Methods and Analysis: Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews., Ethics and Dissemination: This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project's course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The University of Zambia (UNZA) Mentor Training Program is conducted annually to strengthen the mentorship capacity of postgraduate programs for the health professions. This intensive five-session course trains faculty members in the mentorship of students. Established by senior UNZA leaders and US-based collaborators, this program was designed to address gaps in mentorship identified at the institutional level. Faculty facilitators developed the course curriculum and used a train-the-trainer model to ensure program sustainability. Participants were faculty members who mentor PhD and Master of Medicine students. To assess the program's impact, mentors and their mentees completed questionnaires on the mentor's mentoring competencies at the end of the course and 1 year later. Competency scores were compared longitudinally to quantify potential changes in mentoring behaviors. Mentors and mentees alike noted mentor growth in all competency domains from postcourse to 1 year later, providing evidence of a trend toward improvement in mentorship and that the program may have sustainable and positive effects on mentoring behaviors over time. Salient areas of growth corresponded to emphasized topics and discussions, including addressing diversity, aligning expectations, assessing capacities, motivating mentees, and fostering independence. These findings suggest that mentors internalized this content and transferred it to behavior change. The behavior changes may reveal a larger change in the institutional environment around the mentoring of students. The UNZA Mentor Training Program appears to have sustained impact after a year and should bode well for future benefits to students, faculty, and the institution.

Strong cultures of mentorship and research remain underdeveloped at many African universities, threatening future knowledge generation essential for health and development on the continent. To address these challenges, a mentorship program was developed in 2018 at the University of Zambia with an aim to enhance the institutional culture of mentorship and to build institutional capacity through an innovative 'train the trainer' faculty development model. In this study, we documented perceptions of lived experiences related to mentorship culture by following trainers and trainees and their mentees over two years. We analyzed these perceptions to assess changes in institutional attributes regarding mentorship. We identified positive change in institutional culture towards mentorship, and this change appeared sustainable over time. However, a slight decrease in indicators for year two emphasizes the need for a continued culture of learning rather than assuming that one-off training will be sufficient to change culture., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Objective: To explore the health professionals' and community members' perspectives on the factors influencing transmission of the novel COVID-19 in Zambia., Design: An exploratory qualitative study using in-depth interviews as data collection technique., Setting: Four primary healthcare facilities and local communities of Lusaka city and Chirundu international border town under Lusaka province, Zambia., Participants: Purposive sampling of 60 study participants comprising health professionals (n=15) and community members (n=45). Health staff were health inspectors and surveillance officers. Community members included public market traders, civic and religious leaders, immigration officers, bus and international truck drivers., Results: Both health professionals and community members were aware of the COVID-19 pandemic, the preventive and control measures. Nevertheless, stark differences were observed on the two groups' perspectives on COVID-19 and the factors influencing its transmission. Most health staff expressed high personal risk and susceptibility to the disease and a positive attitude towards the prevention and control measures. Conversely, myths and misconceptions influenced most community members' perspectives on the disease and their attitude towards the COVID-19 guidelines. Participants were unanimous on the low levels of adherence to the COVID-19 preventive and control measures in the community. Reasons for non-adherence included limited information on COVID-19, negative attitude towards COVID-19 guidelines, social movement and travel patterns, networks and interactions, living and work conditions, water and sanitation facilities, and observation of behaviours of important role models such as politicians and other community leaders. These factors were perceived to increase the risk of COVID-19 transmission., Conclusion: These findings highlight important factors influencing transmission of COVID-19 in Zambia. Future interventions should focus on providing information to mitigate myths and misconceptions, increasing people's risk perception to the disease, and improving attitude towards the prevention and control interventions and mitigating structural and socioeconomic barriers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Country-specific estimates of tobacco use among people living with HIV (PLWH) are lacking for much of sub-Saharan Africa. We aim to evaluate the association between the HIV status and tobacco product use status, frequency, and intensity, using nationally representative data from Zambia. We analyzed data from the 2018 Demographic and Health Survey conducted in Zambia among women aged 15-49 years and men aged 15-59 years. We performed logistic regression to assess the associations of HIV status, selected sociodemographic, and other characteristics with indicators of tobacco use (i.e., status, frequency, and intensity). Among women, 14.3% tested positive for HIV and 2.7% reported current smoking or tobacco use; women living with HIV were more likely to report currently smoking or using tobacco than women living without HIV (4.4% vs. 2.4%; aPR: 1.46). Among men, 8.4% tested positive for HIV and 19.5% reported current smoking; men living with HIV were more likely than men living without HIV to report current smoking (27.8% vs. 18.7%; aPR: 1.22). Several sociodemographic characteristics were associated with tobacco use, including age, residence (urban/rural), education level, employment status, and wealth index. The frequency and intensity of smoking among men who currently smoked did not differ by HIV status. Tobacco use was more likely in PLWH than those without HIV in Zambia. Our findings highlight the need to encourage and support tobacco cessation among PLWH, possibly by offering cessation services at existing intersections with health care or integrating cessation support into mHealth and other alternative models of care.

Background: There is evidence that multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia., Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed., Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students., Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients., Competing Interests: CONFLICT OF INTEREST The authors declare that they have no competing interests.

Aims: This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing., Design, Setting, Participants and Measurements: A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily)., Findings: NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries., Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. Prevalence of hypertension is reported to reach 34% in some areas of Zambia but public awareness is reportedly low. A majority of individuals do not know that they have high BP and others do not take any medication. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Measurement sites were set-up at shopping malls, markets, sports facilities, churches, higher institutions of learning, and urban clinics. A total of 9607 individuals were screened during MMM17. After multiple imputation, 2438 (25.9%) had hypertension. Of individuals not receiving anti-hypertensive medication, 1706 (19.6%) were hypertensive. Of individuals receiving anti-hypertensive medication, 438 (62%) had uncontrolled BP. The MMM for 2017 was the largest BP screening campaign undertaken in Zambia. The campaign identified 2438 individuals with hypertension who were given heart health advice and/or referred to the local clinic for treatment. These results suggest that a large BP screening campaign based on convenience sampling could be a useful and reasonably inexpensive tool to help raise awareness in the general population and thereby help address the burden of disease caused by hypertension.

Introduction: Hypertension is a longstanding problem in Zambia, yet little is known about its prevalence and risk factors, particularly in rural and urban settings. Identifying geographical variations in hypertension is important to enhance the health of adult Zambians regardless of where they live. Therefore, the purpose of this study was to compare the prevalence of hypertension and related risk factors between rural (n = 130) and urban (n = 131) communities in Western Province, Zambia., Methods: This cross-sectional study included urban and rural adult Zambians attending health checks who completed a modified World Health Organization (WHO) survey, and had blood pressure and anthropometric measurements completed. Descriptive statistics were used to summarize demographic and risk factor variables. Chi-square tests of association were used to analyze relationships between categorical variables, t-tests to analyze relationships between continuous variables and logistic regression to examine associations of hypertension with selected risk factors., Results: The prevalence of hypertension in rural Zambians was double (46.9%) that of urban Zambians (22.9%). Increasing age, not engaging in walking/biking, and alcohol intake within the last 30 days were associated with an increased likelihood of hypertension in rural Zambians while eating vegetables more days during the week was associated with a decreased likelihood of hypertension in rural Zambians. Body Mass Index (BMI) was significantly associated with an increased likelihood of hypertension in urban Zambians., Conclusion: Modifiable risk factors (such as BMI, dietary intake, and physical activity) are associated with hypertension prevalence in this population, indicating opportunities for screening and other prevention measures., Competing Interests: The authors declare no competing interests.

Background: Tobacco production is said to be an important contributor to Zambia's economy in terms of labour and revenue generation. In light of Zambia's obligations under the WHO Framework Convention of Tobacco Control (FCTC) we examined the institutional actors in Zambia's tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia., Methods: Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature., Results: Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country's weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country's economy and ensuring employment for its citizens are the government's top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed., Conclusions: As with other low-income countries involved in tobacco production, there is inconsistency between Zambia's economic policy to strengthen the country's economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.

Background: Data from 2006 show that the practice of anesthesia at the University Teaching Hospital in Lusaka, Zambia was underdeveloped by international standards. Not only was there inadequate provision of resources related to environment, equipment, and drugs, but also a severe shortage of staff, with no local capability to train future physician anesthetic providers. There was also no research base on which to develop the specialty. This study aimed to evaluate patient care, education and research to determine whether conditions had changed a decade later., Methods: A mix of qualitative data and quantitative data was gathered to inform the current state of anesthesia at the University Teaching Hospital, Lusaka, Zambia. Semistructured interviews were conducted with key staff identified by purposive sampling, including staff who had worked at the hospital throughout 2006 to 2015. Further data detailing conditions in the environment were collected by reviewing relevant departmental and hospital records spanning the study period. All data were analyzed thematically, using the framework described in the 2006 study, which described patient care, education, and research related to anesthetic practice at the hospital., Results: There have been positive developments in most areas of anesthetic practice, with the most striking being implementation of a postgraduate training program for physician anesthesiologists. This has increased physician anesthesia staff in Zambia 6-fold within 4 years, and created an active research stream as part of the program. Standards of monitoring and availability of drugs have improved, and anesthetic activity has expanded out of operating theaters into the rest of the hospital. A considerable increase in the number of cesarean deliveries performed under spinal anesthetic may be a marker for safer anesthetic practice. Anesthesiologists have yet to take responsibility for the management of pain., Conclusions: The establishment of international partnerships to support postgraduate training of physician anesthetists in Zambia has created a significant increase in the number of anesthesia providers and has further developed nearly all aspects of anesthetic practice. The facilitation of the training program by a global health partnership has leveraged high-level support for the project and provided opportunities for North-South and international learning.

This paper discusses the processes of harmonization of various approaches by partners that have been implemented in Zambia, in an attempt to overcome the fragmented implementation of Community based primary healthcare (CBPHC) systems strengthening, facilitated by multiple non-governmental organizations (NGOs) and donors, impeding country ownership and nationalization. To achieve equitable and sustained improvements in health, social and economic development outcomes for all, there is evidence that governments should consider building CBPHC systems based on three legs namely: 1. Front-line health workers trained, supervised and able to deliver services; 2. Community engagement through interactions to enhance community participation and Social Accountability for delivery of healthcare services; 3. Enabling environments through strengthening of community health systems. To realize a harmonized approach and alignments, the government and key stakeholders must uphold a common vision ensuring that all the three legs of CBPHC systems are implemented to scale. In evaluating the health system in Zambia and the related healthcare provision at community level, gaps were identified in the available mechanisms for the provision of quality CBPHC thus necessitating processes of harmonization, that include capacity building and orientations at all levels on importance of taking to scale the three legs of CBPHC systems, revision of the Community Health Strategy, and elaboration of Operational Guide for Neighbourhood Health Committees, clarifying the role of NHC as platform for community engagement and Community-Based Volunteers (CBVs). There is need for harmonization of health systems at national, provincial, district, zonal and communal levels to ensure the delivery of quality, cost-effective healthcare as close to the family as possible.

Background: Despite its achievements in decreasing HIV prevalence and under-five mortality, Zambia still faces high maternal and neonatal mortality, particularly in the rural and remote areas where almost 60% of the population resides. After significant investments in developing its community health system, the Zambian Ministry of Health was interested to understand how to leverage the role of nurses to sustain achievements made and further improve the quality of care in rural communities. The Ministry joined research partners in an assessment into the role and leadership capacity of nurses heading rural health facilities., Methods: A seven-member research team conducted 30 in-depth interviews and 10 focus group discussions in four provinces with four categories of respondents: national decision-makers, provincial and district managers, rural facility staff and community respondents (neighborhood health committee members and volunteers). An initial scoping visit and literature review informed the development of specific interview guides for each category of respondent. After audio-recording and transcription, research team members identified and reached consensus on key themes, and presented and validated the findings at a national stakeholder workshop., Results: Zambia's front-line health teams are a complex mixture of professional facility staff, community providers, community-based volunteers and neighborhood health committees. Nurses and nurse-midwives head over half the rural facilities in Zambia, where they are expected to lead the delivery of safe, high-quality care with staff and volunteers who often operate beyond their level of training. Nurses and midwives who are assigned to head rural facilities are not adequately prepared or recognized for the leadership responsibilities they are expected to fulfill., Conclusions: This paper highlights opportunities to support rural facility heads in effectively leading front-line health teams to deliver primary healthcare to rural communities. Front-line teams require a leader to coordinate and motivate seamless and sustainable quality services that are accessible to all. Zambia has the potential to support integrated, responsive quality care and advance toward universal health coverage if nurses are adequately prepared and recognized with job descriptions that reflect their responsibilities and opportunities for career advancement.

Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants. A mixed methods approach was used; 203 adults completed surveys including demographics, anthropometric measures, blood pressure (BP), physicial activity, diet, and salt intake at five health check stations. Two focus groups were conducted with rural and urban community members to better understand their perspectives on hypertension. The prevalence of hypertension was 32.8% for survey participants. A further 24.6% had pre-hypertension. The mean total weight of salt added to food was nearly double the WHO recommendation with women adding significantly more salt to food than men. Significant differences in waist circumference were observed between men and women with men at low risk and women at substantialy high risk. In focus groups, participants cited westernized diets, lack of physical activity, stress, psychological factors, and urbanization as causative factors for hypertension. Participants lacked understanding of BP medications, healthy lifestyles, adherence to treatment, and ongoing monitoring. Focus group participants mentioned challenges in obtaining treatment for hypertension and desired to be active contributors in creating solutions. They recommended that government priorize hypertension initiatives that increase access to health education to reduce risk, enhance early detection, and support lifestyle changes and medication adherence. Our findings suggest that policy-makers need to engage communities more effectively to develop successful public health strategies to prevent, detect, and manage hypertension in Western Province, Zambia, particularly in rural areas.

Background: Tobacco smoke causes changes in the levels of catecholamines in the blood. This leads to an increase in blood pressure and heart rate. This is due to nicotine which has also been noted to cause a decrease in vasodilatory activities leading to an increase in both the blood pressure and heart rate., Aim: To determine the acute effects of tobacco smoke on haemodynamics in black male adolescents in Lusaka, Zambia., Study Design: This was an observational study done at the University of Zambia School of Medicine Cardiovascular Research Laboratory in the month of December, 2014., Methodology: Twenty-two (22) black, male-adolescent (age range 19-25 years), active-smokers, consented to participate in the study. The Diasys Ambulatory Blood Pressure Monitoring system (Novacor, France) was used to obtain the Systolic and Diastolic blood pressures (SBP and DBP) and the heart rate. These were obtained 15 minutes before smoking at 5 minute intervals and averaged to obtain the baseline, during the 15 minutes of smoking and on immediate cessation of smoking and thereafter every 15 minutes up to an hour after smoking., Results: There was a significant rise in SBP (mmHg) during smoking (127.9 ± 13.80 mmHg) from baseline values (113.5 ± 13.15 mmHg) ( P = .00). It took 30 minutes for the SBP to return to baseline after cessation of smoking. DBP (mmHg) also increased from baseline (79.5 ± 8.79 mmHg) to 85.6 ± 10.92 mmHg during smoking ( P = .01). It returned to baseline values immediately after cessation of smoking. The heart rate (bpm) was also noted to significantly increase during smoking (95.2 ± 16.72 bpm) from the values noted before smoking (74.3 ± 13.75 bpm) ( P = .05). The mean value for heart rate returned to baseline value by the 15 th minute of recovery., Conclusion: The present study demonstrates that smoking may be the cause for the acute increases in SBP, DBP and heart rate in smokers. The smoking caused significant increases in all the haemodynamic indices considered in this study within 15 minutes. Both SBP and DBP increase are indices for stroke and coronary heart disease respectively. The effect of increased SBP was noted to last for 30 minutes while DBP returned to baseline immediately after smoking. A significant increase in heart rate was also noted in the study.

We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4(+) T cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia. We compared baseline characteristics of patients by sex and age at ART initiation [categorized as 16-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years and older]. We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4(+) T cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable. Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ≥50 years. Compared with 16-29 year olds, 40-49 year olds (-46 cells/mm(3)), 50-59 year olds (-53 cells/mm(3)), and 60+ year olds (-60 cells/mm(3)) had reduced CD4(+) T cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ≥40 years (AHR 1.25 for 40-49 year olds, 1.56 for 50-59 year olds, and 2.97 for 60+ year olds). Adherence and retention in care were poorest among 16-29 year olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4(+) T cell count recovery and increased risk of death. Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with a higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations.

Background: Human resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo., Methods: The health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district's health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies., Results: The primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient's medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment., Conclusions: Although active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country's ability to align the training, management, and deployment of its health workforce to meet the needs of its people.

Background: In response to Zambia's critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia., Methods: Using a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers' self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district., Results: Nineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers' job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions., Conclusions: Although somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.

Background: Hypertension is a leading cause for ill-health, premature mortality and disability. The objective of the study was to determine the prevalence and associated factors for hypertension in Lusaka, Zambia., Methods: A cross sectional study was conducted. Odds ratios and their 95% confidence intervals were calculated to assess relationships between hypertension and explanatory variables., Results: A total of 1928 individuals participated in the survey, of which 33.0% were males. About a third of the respondents had attained secondary level education (35.8%), and 20.6% of males and 48.6% of females were overweight or obese. The prevalence for hypertension was 34.8% (38.0% of males and 33.3% of females). In multivariate analysis, factors independently associated with hypertension were: age, sex, body mass index, alcohol consumption, sedentary lifestyle, and fasting blood glucose level., Conclusions: Health education and structural interventions to promote healthier lifestyles should be encouraged taking into account the observed associations of the modifiable risk factors.

Background: Developing countries are undergoing an epidemiological transition, from Communicable or Infectious to 'Non-Communicable' diseases (NCDs), such that cardiovascular disease, chronic respiratory diseases, cancer, and diabetes were responsible for 60% of all deaths globally in 2005, with more than 75% of these deaths occurring in developing countries. A survey was conducted to determine among other objectives the prevalence of diabetes and its association with physical fitness and biological factors., Methods: A cross sectional study utilizing a modified World Health Organization's STEPwise approach to surveillance of NCDs was conducted in Lusaka district, Zambia. A multi-stage cluster sampling technique was used to select study participants of age 25 years or older. All eligible members of a household that was selected were invited to participate in the study. Unadjusted odds ratios (OR), and adjusted odds ratios (AOR) together with their 95% Confidence Intervals (CI) were obtained using Complex samples logistic regression, Results: A total of 1928 individuals participated in the survey, of which 33.0% were males. About half of the participants were of age 25-34 years (53.2%), and about a third of the respondents had attained secondary level of education (35.8%). The combined prevalence for impaired glucose level or diabetes was 4.0%. Age and mild hypertension were significantly associated with impaired levels of glucose or diabetes. Compared to participants in the age group 25-34 years, older participants were more likely to have impaired glucose level or diabetes (AOR = 2.49 (95%CI [1.35, 2.92]) for 35-44 years age group, and AOR = 3.80 (95%CI [2.00, 7.23]) for 45 + years age group). Mild hypertension was associated with impaired glucose level or diabetes (AOR = 2.57) (95%CI [1.44, 4.57]))., Conclusions: The prevalence of diabetes in Lusaka district has not reached an alarming level and it is now that interventions targeting the younger age group 25-34 years should be put in place to curtail the spread of diabetes.

In 2004, we created HIVCorps, an international volunteer program to involve pre-medical, medical, and public health students in the scale-up of HIV care and prevention services in Zambia. In our first year, we used 27 American and Zambian volunteers to assist with the administrative and logistical aspects of program implementation. Ten volunteers were based in the capital Lusaka; the remaining 17 were stationed across five rural districts. Supervision was provided by local health care providers, district officials, and hospital administrators. In our setting, the use of volunteers has proven feasible and effective for program support. Depending on a program's immediate needs, use of many basic field personnel may be more beneficial than employment of one to two trained clinicians. Formal volunteer programs like HIVCorps should be developed alongside initiatives focused on deploying more specialized, experienced healthcare workers aboard.

The delayed phase ('second window') of protection induced by ischemic preconditioning in rabbit heart is observed as enhanced resilience to infarction 24 hours after repetitive brief cycles of ischemia. Here we provide a fuller physiological characterisation of this phenomenon in the open-chest rabbit model, examining temporal characteristics and dose-dependency of this adaptation. For examination of the timecourse of delayed protection, rabbits were pretreated with four 5 minute coronary artery occlusions (PC) or sham operation (SHAM). Twenty four, 48, 72 or 96 hours later, infarct size after 30 min coronary occlusion and 120 minutes reperfusion was assessed with TTC staining and expressed as a percentage of myocardial risk volume (I/R). I/R was reduced at 24 hours (SHAM 48.1 +/- 3.9% v PC 31.4 +/- 3.0%, P < 0.01), 48 hours (SHAM 41.9 +/- 3.0% v PC 19.6 +/- 6.3%, P < 0.01), and 72 hours (SHAM 39.8 +/- 3.4% v PC 17.2 +/- 2.5%, P < 0.01). No protection was observed 96 hours after preconditioning (SHAM 35.0 +/- 4.8% v PC 36.9 +/- 3.8%). In a further study, animals were pretreated with one, two or four 5 minute coronary occlusions (1 x 5 PC, 2 x 5 PC, 4 x 5 PC) and subjected to the infarction protocol 48 hours later. I/R was 44.5 +/- 4.3% in SHAM, 24.8 +/- 4.4% in 1 x 5 PC (P < 0.01), 27.4 +/- 2.9% in 2 x 5 PC (P < 0.05) and 24.4 +/- 4.8 in 4 x 5 PC (P < 0.01). Delayed protection in this rabbit model is prolonged, extending between 24 and 72 hours after the preconditioning stimulus. The threshold for eliciting the second window of protection in this model is as low as one 5 minute coronary occlusion.

Rabbit hearts were preconditioned with four 5 min coronary artery occlusions 24 h before 30 min coronary occlusion with 120 min reperfusion. Preconditioning significantly reduced the percentage of myocardium infarcting within the risk zone from 49.1 +/- 4.3% to 31.8 +/- 3.5% (P < 0.05). When the protein kinase C (PKC) inhibitor, chelerythrine, was administered just before preconditioning, the delayed protection against infarction 24 h later was abolished. We conclude that the delayed cytoprotective response associated with ischaemic preconditioning of myocardium is likely to involve the early activation of one or more PKC subtypes.