46 results on '"Kachimba J"'
Search Results
2. A EU-Africa partnership to co-design a training intervention to scale-up access to surgery in Africa
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Pittalis, C, primary, Drury, G, additional, Mwapasa, G, additional, Borgstein, E, additional, Cheelo, M, additional, Kachimba, J, additional, Chilonga, K, additional, Brugha, R, additional, Lavy, C, additional, and Gajewski, J, additional
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- 2023
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- View/download PDF
3. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study
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Zhang, Mengyang, Gajewski, J., Pittalis, C., Shrime, M., Broekhuizen, H., Ifeanyichi, M.I., Clarke, M., Borgstein, E., Lavy, C., Drury, G., Juma, A., Mkandawire, N., Mwapasa, G., Kachimba, J., Mbambiko, M., Chilonga, K., Bijlmakers, L.A., Brugha, R., Zhang, Mengyang, Gajewski, J., Pittalis, C., Shrime, M., Broekhuizen, H., Ifeanyichi, M.I., Clarke, M., Borgstein, E., Lavy, C., Drury, G., Juma, A., Mkandawire, N., Mwapasa, G., Kachimba, J., Mbambiko, M., Chilonga, K., Bijlmakers, L.A., and Brugha, R.
- Abstract
Contains fulltext : 287910.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries. METHODS: Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency. RESULTS: Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score<1). Hospitals that scored high on the most commonly utilised surgical capacity index were not the ones with high surgical volumes or high efficiency. The number of surgical team members, which was lowest in Zambia, was strongly, positively correlated with surgical productivity and efficiency. CONCLUSION: Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency.
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- 2022
4. Barriers and enablers to utilisation of the WHO surgical safety checklist at the university teaching hospital in Lusaka, Zambia: a qualitative study
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Munthali, Judith, Pittalis, C., Bijlmakers, L.A., Kachimba, J., Cheelo, M., Brugha, R., Gajewski, J., Munthali, Judith, Pittalis, C., Bijlmakers, L.A., Kachimba, J., Cheelo, M., Brugha, R., and Gajewski, J.
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Contains fulltext : 252238.pdf (Publisher’s version ) (Open Access)
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- 2022
5. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study
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Zhang, M, Gajewski, J, Pittalis, C, Shrime, M, Broekhuizen, H, Ifeanyichi, M, Clarke, M, Borgstein, E, Lavy, C, Drury, G, Juma, A, Mkandawire, N, Mwapasa, G, Kachimba, J, Mbambiko, M, Chilonga, K, Bijlmakers, L, and Brugha, R
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Data Analysis ,Malawi ,Multidisciplinary ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Humans ,Investments ,Hospitals, District ,Tanzania - Abstract
Introduction Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries. Methods Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency. Results Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score Conclusion Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency.
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- 2022
6. The pattern of urological cancers in Zambia
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Bowa, K., Kachimba, J. S., Labib, M. A., Mudenda, V., and Chikwenya, M.
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- 2009
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7. COVID-19 pandemic: Revisiting the case for a dedicated financing mechanism for surgical care in resource-poor countries
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Ifeanyichi, M.I., Gajewski, J., Baltussen, R.M.P.M., Borgstein, E., Kachimba, J., Brugha, R., Bijlmakers, L.A., Ifeanyichi, M.I., Gajewski, J., Baltussen, R.M.P.M., Borgstein, E., Kachimba, J., Brugha, R., and Bijlmakers, L.A.
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Contains fulltext : 237137.pdf (Publisher’s version ) (Open Access)
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- 2021
8. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia
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Gajewski, J., Monzer, Nasser, Pittalis, C., Bijlmakers, L.A., Cheelo, M., Kachimba, J., Brugha, R., Gajewski, J., Monzer, Nasser, Pittalis, C., Bijlmakers, L.A., Cheelo, M., Kachimba, J., and Brugha, R.
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Contains fulltext : 217773.pdf (publisher's version ) (Open Access)
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- 2020
9. The contribution of non-physician clinicians to the provision of surgery in rural Zambia-a randomised controlled trial
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Gajewski, J., Cheelo, M., Bijlmakers, L.A., Kachimba, J., Pittalis, C., Brugha, R., Gajewski, J., Cheelo, M., Bijlmakers, L.A., Kachimba, J., Pittalis, C., and Brugha, R.
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Contains fulltext : 206270.pdf (publisher's version ) (Open Access)
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- 2019
10. Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial
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Pittalis, C., Brugha, R., Crispino, G., Bijlmakers, L.A., Mwapasa, G., Lavy, C., Le, G., Cheelo, M., Kachimba, J., Borgstein, E., Mkandawire, N., Juma, A., Marealle, P., Chilonga, K., Gajewski, J., Pittalis, C., Brugha, R., Crispino, G., Bijlmakers, L.A., Mwapasa, G., Lavy, C., Le, G., Cheelo, M., Kachimba, J., Borgstein, E., Mkandawire, N., Juma, A., Marealle, P., Chilonga, K., and Gajewski, J.
- Abstract
Contains fulltext : 203337.pdf (publisher's version ) (Open Access), Background: District-level hospitals (DLHs) can play an important role in the delivery of essential surgical services for rural populations in sub-Saharan Africa if adequately prepared and supported. This article describes the protocol for the evaluation of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project which aims to strengthen the capacity in district-level hospitals (DLHs) in Malawi, Tanzania and Zambia to deliver safe, quality surgery. The intervention comprises a programme of quarterly supervisory visits to surgically active district-level hospitals by specialists from referral hospitals and the establishment of a mobile phone-based consultation network. The overall objective is to test and refine the model with a view to scaling up to national level. Methods: This mixed-methods controlled pilot trial will test the feasibility of the proposed supervision model in making quality-assured surgery available at DLHs. Firstly, the study will conduct a quantitative assessment of surgical service delivery at district facilities, looking at hospital preparedness, capacity and productivity, and how these are affected by the intervention. Secondly, the study will monitor changes in referral patterns from DLHs to a higher level of care as a result of the intervention. Data on utilisation of the mobile based-support network will also be collected. The analysis will compare changes over time and between intervention and control hospitals. The third element of the study will involve a qualitative assessment to obtain a better understanding of the functionality of DLH surgical systems and how these have been influenced by the intervention. It will also provide further information on feasibility, impact and sustainability of the supervision model. Discussion: We seek to test a model of district-level capacity building through regular supervision by specialists and mobile phone technology-supported consultations to make safe surgica
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- 2019
11. The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia
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Bijlmakers, L.A., Cornelissen, Dennis, Cheelo, M., Nthele, Mzaza, Kachimba, J., Broekhuizen, H., Gajewski, J., Brugha, R., Bijlmakers, L.A., Cornelissen, Dennis, Cheelo, M., Nthele, Mzaza, Kachimba, J., Broekhuizen, H., Gajewski, J., and Brugha, R.
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Item does not contain fulltext
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- 2018
12. Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016
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Cheelo, M., Brugha, R., Bijlmakers, L.A., Kachimba, J., McCauley, T., Gajewski, J., Cheelo, M., Brugha, R., Bijlmakers, L.A., Kachimba, J., McCauley, T., and Gajewski, J.
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Item does not contain fulltext
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- 2018
13. A review of bladder cancer in Sub-Saharan Africa: A different disease, with a distinct presentation, assessment, and treatment
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Bowa, K, primary, Mulele, C, additional, Kachimba, J, additional, Manda, E, additional, Mapulanga, V, additional, and Mukosai, S, additional
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- 2018
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14. Evaluation of the Safety of the Taraklamp Male Circumcision Device in Zambia
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Kachimba, J S, primary, Chibwili, E, primary, Munthali, J, primary, and Cheelo, M, primary
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- 2017
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15. Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia
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Gajewski, J., Mweemba, C., Cheelo, M., McCauley, T., Kachimba, J., Borgstein, E., Bijlmakers, L.A., Brugha, R., Gajewski, J., Mweemba, C., Cheelo, M., McCauley, T., Kachimba, J., Borgstein, E., Bijlmakers, L.A., and Brugha, R.
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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.
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- 2017
16. Who accesses surgery at district level in sub-Saharan Africa? Evidence from Malawi and Zambia
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Gajewski, J., Dharamshi, Rachel, Strader, Michael, Kachimba, J., Borgstein, E., Mwapasa, Gerald, Bijlmakers, L.A., Brugha, R., Gajewski, J., Dharamshi, Rachel, Strader, Michael, Kachimba, J., Borgstein, E., Mwapasa, Gerald, Bijlmakers, L.A., and Brugha, R.
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Item does not contain fulltext
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- 2017
17. The evidence needed to make surgery a global health priority
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Brugha, R., Bijlmakers, L.A., Borgstein, E., Kachimba, J., Brugha, R., Bijlmakers, L.A., Borgstein, E., and Kachimba, J.
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Contains fulltext : 152833.pdf (publisher's version ) (Open Access)
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- 2015
18. Evaluation of transurethral ethanol ablation of the prostate (TEAP) as a treatment option for prostatic obstruction
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Chituwo, O, Kachimba, J, and Labib, M
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ethanol ablation ,prostatic obstraction ,benign enlargement of the prostate (BEP) - Abstract
No Abstract. African Journal of Urology Vol. 12(2) 2006: 60-64
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- 2006
19. Evaluation of the Implementation of the Reaching Every District Approach in Routine Immunisation in Lusaka District, Zambia.
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Mwanamwenge, A., Masumbu, P., Mwansa, F. D., Masaninga, F., Mazaba, M. L., Songolo, P., Kachimba, J. S., Vwalika, B., and Mufunda, J.
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IMMUNIZATION ,HEALTH programs ,COMMUNITY health services ,PUBLIC health - Abstract
Background: In 2003, the Government of Zambia in collaboration with implementing partners in immunisation introduced the Reaching Every District (RED) strategy to improve immunization coverage. The aim of this study is to evaluate the implementation of the RED strategy in Lusaka district. Methods: A questionnaire was administered among health centres in charge of all governmental health clinics in Lusaka districts (N = 27). RED implementation was quantified by calculating a RED implementation score (IS) for each of the RED components on a scale of 0 (low implementation score) to 5 (high implementation score). Results: The mean overall RED implementation score was 3.5. The RED component of linking services with community and re-establishing outreach were the two weakest components. Conclusions and recommendations: This evaluation showed that there are a number of elements of the RED strategy which are well implemented; however, some elements need further improvements. There is need for more research on the implementation of the RED strategy in Zambia in order to identify bottlenecks for improving immunization coverage at larger scale and a wider participation. [ABSTRACT FROM AUTHOR]
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- 2016
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20. Prescribing Patterns and Medicine Use at the University Teaching Hospital, Lusaka, Zambia.
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Mudenda, W., Chikatula, E., Chambula, E., Mwanashimbala, B., Chikuta, M., Masaninga, F., Songolo, P., Vwalika, B., Kachimba, J. S., Mufunda, J., and Mweetwa, B.
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DRUG prescribing ,DRUG utilization ,UNIVERSITY hospitals ,OUTPATIENT medical care - Abstract
Background: There is paucity of data on rational drug use studies at tertiary hospitals in Zambia. The aim of this study was to assess the extent of rational drug use at the adults and paediatrics outpatient departments of the University Teaching Hospital (UTH) using World Health Organization (WHO) standardized drug-use indicators. Methods: Cross-sectional, descriptive, retrospective study of prescription encounters, selected using systematic random sampling methods was conducted at the adult and paediatric outpatient departments of UTH. WHO format of core and complimentary drug use indicators were used to collect prescribing indicators, patient care data which included consultation time, dispensing time and knowledge of correct dosage. Results: A total of 1486 drugs encounters were prescribed from both adult and paediatric outpatient wings in 2015. The average number of drugs per prescription was 2.5(SD±1.58), with a range of 1 to 7 drugs per prescription. The antibiotic and injection-prescribing rate was 53.7% and 11.8%respectively. Generic prescribing was at 56.1%. Percentage of drugs prescribed from the Zambia Essential Medicines List (ZEML) was 98.1%. Average consulting and dispensing time was 9.5 minutes and 1.3 minutes respectively. Percentage of patients with knowledge of correct dosing schedule was 78.9%. Labelling of medicines was adequate. All consultation rooms did not have Standard Treatment Guidelines (STG's) or any reference literature and were not connected to the internet. Conclusion: Low rate of injection prescribing was rational but consultation times were shorter than recommended and therefore irrational. High rate of antibiotic prescribing was irrational going by WHO standards for health facilities and this could lead to microbial resistance. Brand name prescribing was also irrational and common. Prescribing outside the ZEML was minimal and rational. [ABSTRACT FROM AUTHOR]
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- 2016
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21. Leveraging Existing Laboratory Capacity towards Universal Health Coverage: A Case of Zambian Laboratory Services.
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Mazaba, M. L., Mwaba, P., Droti, B., Kagulura, S., Makasa, C., Masaninga, F., Kachimba, J. S., Vwalika, B., and Mufunda, J.
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NATIONAL health insurance ,MEDICAL laboratories ,MEDICAL quality control ,CLINICAL pathology ,PUBLIC health - Abstract
Background: The provision of quality health care is influenced by the availability and capacity of the support systems such as the laboratory. The Service Availability and Readiness Assessment (SARA) by the Ministry of Health with support from WHO Zambia aimed to establish the availability levels of basic amenities required for quality health care including selected diagnostic tests that normally should be conducted at general hospitals and most health facilities. Adequately equipped clinical laboratories should provide early warning signals of health risks. The Assessment categorized the laboratories at three levels relating to the type of facility, these being hospital, health center and health post. This study used results from the SARA to determine the ability to make timely diagnosis, towards the Universal Health Coverage goals. Methods: The general service readiness, the service specific readiness and diagnostic capacity were measured to determine overall capacity, ability of facilities to offer specific services and the mean availability of 8 basic lab tests respectively according to the guidelines in the SARA reference manual, version 2.1. Single stage stratified random sampling method was used to select facilities. A total of 234 health facilities were randomly sampled from 86 districts with 231 visited for assessment. In each stratum, a proportionate of health facilities was selected. Sample was weighted against all facilities. Analysis of data was done using STATA version 13.0. Descriptive analysis was done and data presented as percentages. Results: A total of 231 (99%) out of 234 health facilities took part in the study. Most health facilities had the capacity to diagnose malaria (99%) and HIV (94%). A third (33%) of the facilities had capacity to diagnose blood glucose. The mean of tracer items was 66%. Compared across provinces, the Central (71%), Luapula (73%), and Southern (74%) provinces had higher mean availability of diagnostic capacity tracer items (ADCTI), while North-western province (48%) had the least mean ADCTI. Among the health type, hospitals had the highest mean ADCTI (87%); followed by health centres (70%) and health posts (46%). Private health facilities had a mean ADCTI of 76% compared to those of public health facilities of 63%. With regard to residence, the mean ADCTI for facilities in urban areas was 71% compared to that of facilities in rural areas of 63%. Overall, 12% of the facilities reported all the 8 tracer items for diagnosis. Discussion: Although the mean availability of tracer items was found to be 66%, very few facilities (12%) had full diagnostic capacity. This status limits the ability to carry out the objective of Universal Health Coverage which is aimed at providing basic services for all at minimal cost. Only about a third of facilities had the capacity to diagnose blood glucose and yet Zambia has a high prevalence of diabetes. The capacity for health facilities to conduct essential tests in Zambia is low. Laboratory support is urgently needed to enhance service delivery in the country especially with regards to timely diagnosis of diseases of public health significance. Conclusion: Although Zambia has not attained the ideal height of providing the basic diagnostic services to all as per aim of the Universal Health coverage, the capacity according to the SARA 2015 report has improved from 45% in 2010 to 66% in 2015. [ABSTRACT FROM AUTHOR]
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- 2016
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22. Lessons Learnt From the Implementation of Mass Drug Administration for Schistosomiasis and Soil-Transmitted Helminths in Lusaka Province, Zambia.
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Sokesi, T., Malama, K ., Masaninga, F., Vwalika, B., Kachimba, J. S., Mufunda, J., and Songolo, P.
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DRUG administration ,SCHISTOSOMIASIS treatment ,HELMINTHIASIS ,DRUG therapy ,PUBLIC health ,FILARIASIS prevention ,THERAPEUTICS - Abstract
Background: Zambia is endemic for four of the global Preventive Chemotherapy Neglected Tropical Diseases (PC-NTD) targeted for elimination and control, namely schistosomiasis, trachoma, lymphatic filariasis (LF) and soil transmitted helminths (STH). These diseases are associated with disfigurement, reduced productivity, reduced cognitive potential and hence affect the economic development of the households, communities and the country. They largely affect communities with socioeconomic challenges, limited access to safe and clean water and lacking sanitary facilities. These diseases are preventable with chemotherapy being amenable to integrated community and school based mass drug administration coupled with PHASE strategies. This study explores lessons learnt from the implementation of mass drug administration for Schistosomiasis and Soiltransmitted helminths in Lusaka, Zambia. Methodology: Lusaka province was targeted by Ministry of Community development, Mother and Child Health as the area for implementation of mass drug administration for Schistosomiasis and Soil-transmitted helminths using identified 666 health service delivery posts as drug distribution points in selected districts. A total of 2,208,617 people were targeted to be dispensed with Praziquantel, while 773,016 were targeted to be dispensed with Mebendazole in Lusaka only. These medicines were given to all children and adults considered to be at high risk of Schistosomiasis and Soil Transmitted Helminths respectively. Specific targets to be met were set. Results: Luangwa, Chongwe and Shibuyunji districts surpassed their targets beyond 100%. Chirundu, Kafue and Rufunsa districts surpassed the 75% target. Lusaka district managed a coverage of 24% and this brought the overall provincial coverage to 41%. This was below the set target of 75%. Conclusion: The exercise revealed that implementation of MDA with high coverage is feasible. This needs to be improved in areas not meeting the set targets. [ABSTRACT FROM AUTHOR]
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- 2016
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23. Impact of the WHO Technical Support Towards Malaria Elimination in Zambia.
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Masaninga, F., Mwendaweli, M., Mweetwa, B., Mweemba, N., Songolo, P., Kagulula, S., Kachimba, J. S., Vwalika, B., and Mufunda, J.
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MALARIA prevention ,EPIDEMIOLOGY ,PUBLIC health ,MALARIA diagnosis ,MALARIA treatment - Abstract
Background: Zambia's National Malaria Strategic Plan (NMSP) 2011-2016 aims to eliminate malaria by the year 2020. The WHO Country Office is supporting Zambia in its goal to attain this national target earlier than the global goal contained in Global Technical Strategy (GTS) 2016-2030. WHO's focus is to accelerate coverage of proven interventions and strategies, and promote their effective use. This study documents impact of the WHO technical support in Zambia to accelerate efforts towards elimination of malaria. Methods: This study involved a desk review of relevant documents and literature to obtain in-depth information on WHO technical support on malaria. Key documents included: malaria strategic plans, World Malaria Reports (WMR), WHO Annual Reports; Country Cooperation Strategy, for WHO in Zambia; and Health Bulletins and Health Management Information System (HMIS). Results: WHO contributed effectively to monitoring malaria trends. Malaria deaths reduced from 6000 in 2010 to 3,200 in 2014. In 2015, ownership of long lasting insecticide treated nets (LLINs) increased from 38% in 2006 to 77% in 2015; to be among the highest in Africa. Similarly, utilization of LLINs increased from 19% in 2006 to 55% in 2015 and use of Intermittent Preventive Therapy in pregnancy (IPTp) increased from 61.2% in 2006 to 77% in 2015. In 2014, WHO contributed to the revision of the national malaria diagnosis and treatment guidelines that included: Dihydroartemisinin piperaquine (DHA-PQ) as first line, an alternative to Artemether lumefantrine (AL); injectable Artesunate for treatment of severe malaria and the adoption of the new WHO guidelines on IPTp. In 2016, WHO contributed to epidemiological profile leading to the development of the novel Malaria Elimination Strategy 2017-2020. Discussion: WHO support has led to the determination of epidemiological profile and contributed to the improved focusing of interventions and surveillance activities for greater impact. These have been supported by clear guidelines on proven and evidenced-based prevention, diagnosis and treatment strategies. Conclusion: WHO's technical assistance to priority areas in Zambia remains pivotal for the accelerated health gains countrywide. The importance of this technical support is evidenced in the malaria elimination strategy within an environment of changing epidemiological malaria profile, insecticide and drug resistance. [ABSTRACT FROM AUTHOR]
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- 2016
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24. Increased Sensitization of Health Workers Leading to Detection of Unintended Cases of Acute Flaccid Paralysis: A Case of a "Konzo" Outbreak in Western Zambia.
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Mtonga, A., Mwaba, P., Mazaba, M. L. M., Chizema, E., Kapina, M., Mwangala, S., Silumesi, A., Masaninga, F., Masuka, T., Hachambwa, L., Siddiqi, O., Mweene-Ndumba, I., Kachimba, J. S., Vwalika, B., Kagulura, S., Songolo, P., and Mufunda, J.
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SENSITIZATION (Neuropsychology) ,HEALTH of medical personnel ,ACUTE flaccid paralysis ,DISEASE outbreaks ,PARAPARESIS ,PUBLIC health ,PREVENTION - Abstract
Background: The threat of high profile diseases causing outbreaks has drawn attention to public health surveillance systems, much needed for the timely detection of outbreaks. A disease characterized by weakness of the lower limbs in Luatembo rural health facility was reported to the province in 2013. Through the Acute Flaccid Paralysis surveillance (AFP) program the Western Province in Zambia recorded an increase in the numbers of people affected with spastic paraparesis. The disease affected clusters of families, especially women and children. The disease was found to be in specific geographic areas, with the initial cases being identified in Mongu district followed by Luampa and Senanga districts. Surveillance for a particular disease condition may sometimes lead to detection of a related or unrelated condition. This study aims to assess the sensitivity of the Acute Flaccid Paralysis surveillance program surveillance program to detect other diseases of public health importance using the suspected 'Konzo' outbreak in Western Province as a case study. Methods: Through the surveillance system and medical records review, patients with spastic paraparesis were identified and brought for clinical examination to selected health facilities. A team of specialists comprising of an infectious disease specialist and neurologist, supported by physiotherapists, epidemiologist, surveillance officers and laboratory scientists comprehensively investigated the cases. To improve the diagnosis a detailed case investigation form and checklist were used to capture clinical data and socio demographic information. Laboratory investigations included routine urine microscopy and full blood count. Further analysis included viral analysis for enteroviruses, cytomegalovirus among others, copper levels and thiocyanate levels. Results: Preliminary laboratory results indicated no viral infections. Thiocyanate and copper levels are yet to be analysed. Discussion: As a result of the increased sensitization of health workers and communities, more cases were reported in other parts of Western Province, namely Luampa and Senanga districts. All the cases were detected through active surveillance for AFP. This study indicates a potential role for integrating AFP surveillance with other notifiable diseases within the integrated disease surveillance and response for early notification of unusual events in the community and community involvement to foster health seeking behaviors. Conclusion: This paper reflects on the role of AFP surveillance in integrated disease surveillance and response that resulted in the detection of an uncommon spastic paralysis 'Konzo' disease in Mongu, Western Province. [ABSTRACT FROM AUTHOR]
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- 2016
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25. Preparedness of Response to Deadly Outbreaks: Lessons Learnt From Zambia's Deployment to the 2014 African Ebola Outbreak.
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Zulu, A., Sipangule, C., Siboonde, M., Musumali, M., Chituta, F., Kagulula, S., Mazaba, M. L., Masaninga, F., Vwalika, B., Kachimba, J. S., and Mufunda, J.
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EBOLA viral disease transmission ,DISEASE outbreaks ,HUMAN resources personnel ,PUBLIC health ,PREVENTION - Abstract
Background: West Africa experienced the largest outbreak of Ebola in 2014 in history involving three Mano River States of Sierra Leone, Liberia and Guinea. The World Health Organization (WHO) coordinated an emergency response from WHO Country Offices in many areas, including human resources for health services. WHO Zambia deployed human resources (HR) focal persons to Sierra Leone and Liberia to strengthen operations. The purpose of this paper is to document the contributions made by WHO Zambia human resources staff that were deployed for more than six weeks during this outbreak and areas of value of this exposure experience. Methods: A review of standard operating procedures (SOPs) in an Ebola setting and experiences gained during the deployment of staff in Sierra Leone and Liberia were recorded systematically. Comparisons were made between experiences gained in the WHO offices situated in the Ebola outbreak setting and one outside such a setting. Lessons learned from this deployment were documented and where appropriate documentation adapted by staff upon return from the Ebola setting. The staffs were in an emergency setting for over six weeks in either Sierra Leone or Liberia. Results: There were major similarities in settings affected by Ebola. Both the local and international staff members that visited the Ebola affected areas worked as a team towards the goal of ending the epidemic quickly. At these sites, staff members discharged a variety of duties which involved facilitating recruitment, deployment, appointments, Special Service Agreements (SSA), Consultancies and Agreements of Performance of Work (APW). The HR staffs were also responsible for travel and logistics of international staff and consultants on duty travel and entitled for rest and recuperation. Recruitment processes were shorter with HR waivers being applied where necessary unlike in a WHO country non-Ebola office setting. Working hours were longer including weekends and it was normal for staff to be found working at the WHO office after office working hours, weekends and official holidays. People working at WHO compound avoided bodily contact, including a specified contact distance, to minimize the risk of exposure. Discussion: The participation or exposure of staff to an Ebola setting during an outbreak built a strong culture of staff enabling them to work under harsh conditions which were characterized by long hours and constant recognition of the threat of disease enabling a quick adaptation to different culture and lifestyle which had a positive impact. Some of the lessons learnt included improved work efficiency, built staff resilience to work long hours under stressful conditions and consciously managing aseptic techniques. Conclusion: Exposure to some adverse conditions such as managing work operations in the midst of a deadly outbreak such as Ebola may have a positive impact on the work culture of the individual exposed to this setting and the organization as a whole. [ABSTRACT FROM AUTHOR]
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- 2016
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26. Using E-Learning for Skills Transfer, Motivation and Retention of Health Workers in Zambia.
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Chime, J. K., Munyati, P., Katepa-Bwalya, M., Musumali, M., Mweetwa, B., Kagulura, S., Kachimba, J. S., Vwalika, B., and Mufunda, J.
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DISTANCE education ,KNOWLEDGE transfer ,MEDICAL personnel training ,EMPLOYEE motivation ,EMPLOYEE retention ,PERSONNEL management - Abstract
Background: Health system strengthening continues to be a moving target for developing countries with the human resource factor the most critical bottleneck towards universal health coverage. The human resource management cycle revolves around three interdependent factors: production, recruitment, deployment and retention. The most elusive is retention where both monetary and non-monetary reward systems are equally important. The purpose of this is to document establishment of e-learning as a tool for online skills transfer to address retention of health workers in a cost-effectively. Methods: This prospective study analyses the process of establishing an e-learning facility in Central Province of Zambia. Visitations of the site in the PEPFAR (US President Emergency Plan for Aids Relief in Africa) sponsored Chainama College of Health Sciences, Kabwe Campus premises and technical inputs and specifications were documented. Results: The Ministry of Health maximized the prevailing thriving partnership in the health sector by allocating accommodation to e-learning using resources from RMNCH Trust Fund with the WHO dedicating technical support for this concept in close liaison with Ministry of Health officials in Central Province. The facility can accommodate 36 students and is earmarked to be a training facility equipped with appropriate equipment and software to cater for the entire spectrum of diseases and conditions in Zambia. This is an institution which can support the human resource cycle of production, recruitment, deployment and retention, an innovation that be scaled up to address national retention needs. Discussion: E-learning has ushered a sustainable modality of skills transfer to many areas including human resources for health. The government has successfully engaged cooperating partners in Zambia to implement this improvision in the health sector. The WHO has played its part in ensuring that the critical health resource for health pillar of health systems is addressed. Conclusion: Zambia health sector is instituting an intervention that can improve retention of health workers using non-financial motivation through sustainable elearning. [ABSTRACT FROM AUTHOR]
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- 2016
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27. Epidemiology of the 2016 Cholera Outbreak of Chibombo District, Central Zambia.
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Chirambo, R. M., Mufunda, J., Songolo, P., Kachimba, J. S., and Vwalika, B.
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EPIDEMIOLOGY ,CHOLERA ,DISEASE outbreaks ,PREVENTION of cholera ,PUBLIC health ,INFECTIOUS disease transmission ,PREVENTION - Abstract
Background: The first outbreak of cholera in Zambia was reported in 1977/1978, and then cases appeared again in 1982/1983. The first major outbreak occurred in 1990 and lasted until 1993. Since then, cholera cases have been registered every year except in 1994 and 1995. Generally most cases were recorded in the fishing camps of the rural areas and in the peri-urban areas of Lusaka and Copperbelt provinces. There is no documented evidence of previous cholera outbreaks in Chibombo district. An outbreak of cholera occurred in this area in 2016. The aim of the study was to document the epidemiological features of this outbreak Methods: We used routine data of suspected and confirmed cholera cases in this area which covered the period from 09th February to 20th March 2016. Available information on the patients included stool culture results, household, sex, and age. Descriptive analysis involved the frequency of the various variables as percentages. Results: A total of 23 suspected and confirmed cases were seen at the district health facility. Thirteen of the cases (57%) were from the same catchment area of which 4 (31%) were from the same household. Of these 10 were female. Of these 20 (87%) were adults and 3(13%) were children. Stool culture results were available for 18 (78%) of which 8 (45%) were positive for vibrio cholera. Of the cases that tested positive the index case was identified as a 62 year old woman who had travelled from an area experiencing an outbreak in Lusaka. On the other hand, of the 11 water samples available 2 (18%) were found to have faeces coliforms contamination. All patients were treated with ciprofloxacin and intravenous fluids. There was no related mortality. Discussion: This was an imported outbreak with the index coming from an area experiencing an epidemic in Lusaka. Possible sources could have included water contaminated with faeces matter. There is need to raise awareness of cholera transmission whenever the country is experiencing outbreaks of cholera. Conclusion: Even areas that have never experienced cholera outbreaks are at risk and there is need to raise awareness. [ABSTRACT FROM AUTHOR]
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- 2016
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28. Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania.
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Pittalis C, Drury G, Mwapasa G, Borgstein E, Cheelo M, Kachimba J, Juma A, Chilonga K, Cahill N, Brugha R, Lavy C, and Gajewski J
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- Pregnancy, Female, Humans, Zambia, Tanzania, Malawi, Health Services Research, Hospitals, District, Rural Population
- Abstract
Background: In 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach., Methods: Participatory Action Research workshops were held in the 3 countries in July-October 2017 and in October 2018-July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants' perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres., Results: All groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site., Conclusion: The inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Pittalis, Drury, Mwapasa, Borgstein, Cheelo, Kachimba, Juma, Chilonga, Cahill, Brugha, Lavy and Gajewski.)
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- 2023
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29. Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia.
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Simushi P, Kalunga MN, Mwakyoma T, Mwewa M, Muchaili L, Hazeemba N, Mulenga C, Mwewa P, Chiyenu KOR, Kachimba J, Choonga P, Shibemba A, Hamooya BM, Zambwe M, Chipimo PJ, and Kasonka L
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- Humans, Infant, Viral Load, Zambia, Cross-Sectional Studies, Sensitivity and Specificity, RNA, Viral, HIV Infections
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Objective: Zambia has embarked on improving the diagnostic capacity by setting up high throughput and accurate machines in the testing process and introduction of dried blood spot (DBS) as a sample type. This was a cross sectional study to verify dried blood spot as a sample type for HIV viral load and early infant diagnosis (EID) on Hologic Panther platform and Evaluate the analytical performance (precision, linearity and measurement of uncertainty) of the Hologic Panther., Results: The specificity and sensitivity of EID performance of Aptima Quant Dx assay on Hologic panther machine against the gold standard machine COBAS Taqman (CAP/CTM) was 100% with an overall agreement of 100%. The quantitative HIV Viral Load (VL) accuracy had a positive correlation of (0.96) obtained against the gold standard (plasma samples) run on COBAS4800 platform. Analytical performance of the Hologic panther machine was evaluated; Precision low positive repeatability 3.50154 and within lab 2.268915 at mean 2.88 concentration and precision high positive repeatability 1.116955 and within lab 2.010677 at mean 5.09 concentration were obtained confirming manufacturers claims. Uncertainty of measurement for this study was found to be ± 71 copies/ml. Linearity studies were determined and all points were within acceptable limits. We therefore recommend DBS as a sample type alternative to plasma for the estimation of HIV-1 viral load and EID diagnosis on the Hologic panther machine., (© 2023. The Author(s).)
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- 2023
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30. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study.
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Zhang M, Gajewski J, Pittalis C, Shrime M, Broekhuizen H, Ifeanyichi M, Clarke M, Borgstein E, Lavy C, Drury G, Juma A, Mkandawire N, Mwapasa G, Kachimba J, Mbambiko M, Chilonga K, Bijlmakers L, and Brugha R
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- Humans, Hospitals, District, Malawi, Tanzania, Investments, Data Analysis
- Abstract
Introduction: Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries., Methods: Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency., Results: Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score<1). Hospitals that scored high on the most commonly utilised surgical capacity index were not the ones with high surgical volumes or high efficiency. The number of surgical team members, which was lowest in Zambia, was strongly, positively correlated with surgical productivity and efficiency., Conclusion: Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Zhang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2022
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31. Barriers and enablers to utilisation of the WHO surgical safety checklist at the university teaching hospital in Lusaka, Zambia: a qualitative study.
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Munthali J, Pittalis C, Bijlmakers L, Kachimba J, Cheelo M, Brugha R, and Gajewski J
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- Humans, Patient Safety, Universities, World Health Organization, Zambia, Checklist, Hospitals, Teaching
- Abstract
Background: Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia., Methods: A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis., Results: Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams., Conclusion: The SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives., (© 2022. The Author(s).)
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- 2022
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32. Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study.
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Clarke M, Pittalis C, Borgstein E, Bijlmakers L, Cheelo M, Ifeanyichi M, Mwapasa G, Juma A, Broekhuizen H, Drury G, Lavy C, Kachimba J, Mkandawire N, Chilonga K, Brugha R, and Gajewski J
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- Cross-Sectional Studies, Humans, Malawi, Quality Control, Tanzania, Zambia, Hospitals, District
- Abstract
Background: In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems., Aim: To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia., Methods: A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers., Results: 53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms., Conclusions: Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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33. Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review.
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Ifeanyichi M, Aune E, Shrime M, Gajewski J, Pittalis C, Kachimba J, Borgstein E, Brugha R, Baltussen R, and Bijlmakers L
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- Africa South of the Sahara, Health Expenditures, Humans, Anesthesia
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Objective: This study aimed to provide an overview of current knowledge and situational analysis of financing of surgery and anaesthesia across sub-Saharan Africa (SSA)., Setting: Surgical and anaesthesia services across all levels of care-primary, secondary and tertiary., Design: We performed a scoping review of scientific databases (PubMed, EMBASE, Global Health and African Index Medicus), grey literature and websites of development organisations. Screening and data extraction were conducted by two independent reviewers and abstracted data were summarised using thematic narrative synthesis per the financing domains: mobilisation, pooling and purchasing., Results: The search resulted in 5533 unique articles among which 149 met the inclusion criteria: 132 were related to mobilisation, 17 to pooling and 5 to purchasing. Neglect of surgery in national health priorities is widespread in SSA, and no report was found on national level surgical expenditures or budgetary allocations. Financial protection mechanisms are weak or non-existent; poor patients often forego care or face financial catastrophes in seeking care, even in the context of universal public financing (free care) initiatives., Conclusion: Financing of surgical and anaesthesia care in SSA is as poor as it is underinvestigated, calling for increased national prioritisation and tracking of surgical funding. Improving availability, accessibility and affordability of surgical and anaesthesia care require comprehensive and inclusive policy formulations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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34. Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science.
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Broekhuizen H, Ifeanyichi M, Cheelo M, Drury G, Pittalis C, Rouwette E, Mbambiko M, Kachimba J, Brugha R, Gajewski J, and Bijlmakers L
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- Administrative Personnel psychology, Hospitals, District, Humans, Mentoring organization & administration, Referral and Consultation, Zambia, Mentoring methods, Policy, Surgical Procedures, Operative education
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Background: Supervision by surgical specialists is beneficial because they can impart skills to district hospital-level surgical teams. The SURG-Africa project in Zambia comprises a mentoring trial in selected districts, involving two provincial-level mentoring teams. The aim of this paper is to explore policy options for embedding such surgical mentoring in existing policy structures through a participatory modeling approach., Methods: Four group model building workshops were held, two each in district and central hospitals. Participants worked in a variety of institutions and had clinical and/or administrative backgrounds. Two independent reviewers compared the causal loop diagrams (CLDs) that resulted from these workshops in a pairwise fashion to construct an integrated CLD. Graph theory was used to analyze the integrated CLD, and dynamic system behavior was explored using the Method to Analyse Relations between Variables using Enriched Loops (MARVEL) method., Results: The establishment of a provincial mentoring faculty, in collaboration with key stakeholders, would be a necessary step to coordinate and sustain surgical mentoring and to monitor district-level surgical performance. Quarterly surgical mentoring reviews at the provincial level are recommended to evaluate and, if needed, adapt mentoring. District hospital administrators need to closely monitor mentee motivation., Conclusions: Surgical mentoring can play a key role in scaling up district-level surgery but its implementation is complex and requires designated provincial level coordination and regular contact with relevant stakeholders., Competing Interests: The authors have declared that no competing interests exist.
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- 2021
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35. COVID-19 pandemic: Revisiting the case for a dedicated financing mechanism for surgical care in resource-poor countries.
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Ifeanyichi M, Gajewski J, Baltussen R, Borgstein E, Kachimba J, Brugha R, and Bijlmakers L
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- Delivery of Health Care, Developing Countries, Humans, SARS-CoV-2, COVID-19, Pandemics
- Abstract
Competing Interests: Competing interests: The authors have completed the ICMJE conflict of interest form (available upon request from the corresponding author) and declare no conflicts of interest.
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- 2021
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36. Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia.
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Ifeanyichi M, Broekhuizen H, Cheelo M, Juma A, Mwapasa G, Borgstein E, Kachimba J, Gajewski J, Brugha R, Pittalis C, and Bijlmakers L
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- Adaptation, Psychological, Humans, Malawi, Referral and Consultation, Tanzania, Zambia, Ambulances, Hospitals, District
- Abstract
Background: An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges., Methods: We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016., Results: At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year., Conclusion: Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening., (© 2021. The Author(s).)
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- 2021
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37. Anesthesia Capacity of District-Level Hospitals in Malawi, Tanzania, and Zambia: A Mixed-Methods Study.
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Gajewski J, Pittalis C, Lavy C, Borgstein E, Bijlmakers L, Mwapasa G, Cheelo M, Le G, Juma A, Kachimba J, Marealle P, Mkandawire N, Chilonga K, and Brugha R
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- Adult, Anesthesia standards, Anesthetics, Dissociative, Child, Clinical Competence, Electrical Equipment and Supplies, Hospitals, District standards, Hospitals, District statistics & numerical data, Humans, Ketamine, Malawi, Nurse Anesthetists, Patient Care Team, Perioperative Care standards, Tanzania, Zambia, Anesthesia statistics & numerical data, Hospitals, District organization & administration
- Abstract
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.
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- 2020
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38. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia.
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Gajewski J, Monzer N, Pittalis C, Bijlmakers L, Cheelo M, Kachimba J, and Brugha R
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- Clinical Competence, Communication, Electric Power Supplies supply & distribution, Equipment and Supplies supply & distribution, Hospitals, District standards, Humans, Interviews as Topic, Qualitative Research, Rural Health Services standards, Surgical Procedures, Operative standards, Telemedicine organization & administration, Zambia, Capacity Building organization & administration, Health Personnel organization & administration, Hospitals, District organization & administration, Rural Health Services organization & administration, Surgical Procedures, Operative methods
- Abstract
Introduction: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals., Methods: Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding., Results: Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision., Conclusion: This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.
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- 2020
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39. The contribution of non-physician clinicians to the provision of surgery in rural Zambia-a randomised controlled trial.
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Gajewski J, Cheelo M, Bijlmakers L, Kachimba J, Pittalis C, and Brugha R
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- Clinical Competence, Developing Countries, Humans, Rural Population, Zambia, Allied Health Personnel supply & distribution, Delegation, Professional statistics & numerical data, Health Workforce statistics & numerical data, Surgical Procedures, Operative statistics & numerical data
- Abstract
Background: The global shortage of surgeons disproportionately impacts low- and middle-income countries. To mitigate this, Zambia introduced a 'task-shifting' solution and started to train non-physician clinicians (NPCs) called medical licentiates (ML) to perform surgery. The aim of this randomised controlled trial was to assess their contribution to the delivery of surgical care in rural hospitals in Zambia., Methods: Sixteen hospitals were randomly assigned to intervention and control arms of the study. Nine MLs were deployed to eight intervention sites. Crude numbers of selected major surgical procedures between intervention and control sites were compared before and after the intervention. Volume and outcomes of surgery were compared within intervention hospitals, between NPCs and surgically active medical doctors (MDs)., Results: There was a significant increase in the numbers of caesarean sections (CS) in the intervention hospitals (+ 15.2%) and a drop by almost half in the control group (- 47%) (P = 0.015), between the two time periods. There were marginal shifts in the numbers of index procedures: a small drop in the intervention group (- 4.9%) and slight increase in the control arm (+ 4.8%) (P = 0.505). In all pairs, MLs had higher mean number of CS and other major surgical cases done in the intervention period compared with MDs. There was no significant difference in postoperative wound infection rates for CS (P = 0.884) and other major surgical cases (P = 0.33) at intervention hospitals between MLs and MDs., Conclusion: This study provided evidence that the ML training programme in Zambia is an effective and safe way to bridge the gap in rural hospitals between the demand and the limited availability of surgically trained workforce in the country. Such evidence is greatly needed as more developing countries are developing national surgical plans., Trial Registration: ISRCTN66099597 Registered: 07/01/2014.
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- 2019
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40. Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial.
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Pittalis C, Brugha R, Crispino G, Bijlmakers L, Mwapasa G, Lavy C, Le G, Cheelo M, Kachimba J, Borgstein E, Mkandawire N, Juma A, Marealle P, Chilonga K, and Gajewski J
- Abstract
Background: District-level hospitals (DLHs) can play an important role in the delivery of essential surgical services for rural populations in sub-Saharan Africa if adequately prepared and supported. This article describes the protocol for the evaluation of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project which aims to strengthen the capacity in district-level hospitals (DLHs) in Malawi, Tanzania and Zambia to deliver safe, quality surgery. The intervention comprises a programme of quarterly supervisory visits to surgically active district-level hospitals by specialists from referral hospitals and the establishment of a mobile phone-based consultation network. The overall objective is to test and refine the model with a view to scaling up to national level., Methods: This mixed-methods controlled pilot trial will test the feasibility of the proposed supervision model in making quality-assured surgery available at DLHs. Firstly, the study will conduct a quantitative assessment of surgical service delivery at district facilities, looking at hospital preparedness, capacity and productivity, and how these are affected by the intervention. Secondly, the study will monitor changes in referral patterns from DLHs to a higher level of care as a result of the intervention. Data on utilisation of the mobile based-support network will also be collected. The analysis will compare changes over time and between intervention and control hospitals. The third element of the study will involve a qualitative assessment to obtain a better understanding of the functionality of DLH surgical systems and how these have been influenced by the intervention. It will also provide further information on feasibility, impact and sustainability of the supervision model., Discussion: We seek to test a model of district-level capacity building through regular supervision by specialists and mobile phone technology-supported consultations to make safe surgical services more accessible, equitable and sustainable for rural populations in the target countries. The results of this study will provide robust evidence to inform and guide local actors in the national scale-up of the supervision model. Lessons learned will be transferred to the wider region., Competing Interests: Ethical approval for this study was granted by the Research Ethics Committee (REC) of the Royal College of Surgeons in Ireland, the project consortium lead, under approval no. REC 1417. In the implementation countries, ethical approval was received from the College of Medicine Research Ethics Committee in Malawi (approval no. P.05/17/2179), the University of Zambia Biomedical Research Ethics Committee (approval no. 005-05-17), the Kilimanjaro Christian Medical College Research Ethics and Review Committee (approval no. CRERC 2026) and the National Institute for Medical Research in Tanzania (approval no. NIMR/HQ/R.8a/Vol. IX/2600).Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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- 2019
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41. The cost of providing and scaling up surgery: a comparison of a district hospital and a referral hospital in Zambia.
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Bijlmakers L, Cornelissen D, Cheelo M, Nthele M, Kachimba J, Broekhuizen H, Gajewski J, and Brugha R
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- Bed Occupancy statistics & numerical data, Hospital Costs statistics & numerical data, Humans, Referral and Consultation, Rural Population, Zambia, Hospitals, District economics, Hospitals, Public economics, Surgical Procedures, Operative economics
- Abstract
The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. We identified the resources used in delivering surgery at a rural district-level hospital and an urban based referral hospital in Zambia and calculated their cost through a combination of bottom-up costing and step-down accounting. Surgery performed at the referral hospital is ∼50% more expensive compared with the district hospital, mostly because of the higher cost of hospital stay. The low bed occupancy rates at the two hospitals suggest underutilization of the capacity, and/or missing elements of needed capacity, to conduct surgery. Nevertheless, our study confirms that scaling up district-level surgery makes sense, through bringing economies of scale, while acknowledging the need for more comprehensive assessments and costing of capacity constraints. We quantified the economies of scale under different scaling scenarios. If surgery at the district hospital was scaled up by 10, 20 or 50%, the total cost of surgery would increase proportionately less than that, i.e. by 6, 12 and 30%, respectively. If this were to lead to less demand for surgery at the referral hospital, say 10% less surgery, it would result in a reduction of 2.7% in the total cost. Although the health system as a whole would benefit, the referring hospitals would not derive the full economic benefit, unless Government increased resources for district-level surgery., (© The Author(s) 2018. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2018
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42. Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016.
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Cheelo M, Brugha R, Bijlmakers L, Kachimba J, McCauley T, and Gajewski J
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- Cesarean Section statistics & numerical data, Cross-Sectional Studies, Female, Health Resources supply & distribution, Hospitals, District statistics & numerical data, Humans, Pregnancy, Zambia epidemiology, Surgical Procedures, Operative statistics & numerical data
- Abstract
Background: Sub-Saharan Africa has one of the highest burdens of surgically treatable conditions in the world and the highest unmet need, especially in rural areas. Zambia is one of the countries in the region taking steps to improve surgical care for its rural populations., Aim: To demonstrate changes in surgical capacity in Zambia's district hospitals over a 3-year period and to provide a baseline from which future interventions in surgical care can be assessed., Methods: A cross-sectional assessment of surgical capacity, using a modified WHO questionnaire, was administered in first-level hospitals in nine of Zambia's ten provinces between November 2012 and February 2013 and again between February and April 2016. The two assessments allowed measurement of changes in surgical workforce, infrastructure, equipment, drugs and consumables; and numbers of major surgical procedures performed over two 12-month periods prior to the assessments., Results: There was a significant increase, 2013-2016, in number of theatre staff, from 174 (mean 4.4; SD 1.7) to 235 (mean 6; SD 2.9), P = 0.02. However, the percentage of hospitals with functioning anaesthetic machines dropped from 64 to 41%. There was also a drop in hospitals reporting availability of instruments, drugs and consumables from 38 to 24 (97-62%) and from 28 to 24 (72-62%), respectively. The median number of caesarean sections in 2012 was 99 [interquartile range (IQR) 42-187] and 100 (IQR 42-126) in 2015 (P value =0.53). The median number of major surgical procedures in 2012 was 54 (IQR 10-113) and 66 (IQR 18-168) in 2015 (P = 0.45)., Conclusion: An increase in the first-level hospital surgical workforce between 2013 and 2016 was accompanied by reductions in essential equipment and consumables for surgery, and no changes in surgical output. Periodic monitoring of resource availability is needed to address shortages and make safe surgery available to rural populations.
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- 2018
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43. Who accesses surgery at district level in sub-Saharan Africa? Evidence from Malawi and Zambia.
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Gajewski J, Dharamshi R, Strader M, Kachimba J, Borgstein E, Mwapasa G, Cheelo M, McCauley T, Bijlmakers L, and Brugha R
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Malawi, Male, Middle Aged, Young Adult, Zambia, Hospitals, District, Patient Acceptance of Health Care, Surgery Department, Hospital
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Objectives: To examine age and gender distribution for the most common types of surgery in Malawi and Zambia., Methods: Data were collected from major operating theatres in eight district hospitals in Malawi and nine in Zambia. Raw data on surgical procedures were coded by specialist surgeons for frequency analyses., Results: In Malawi female surgical patients had a mean age of 25 years, with 91% aged 16-40 years. Females accounted for 85%, and obstetric cases for 75%, of all surgical patients. In Zambia, female surgical patients had a mean age of 26, with 75% aged 16-40 years. They accounted for 55% of all cases, 34% being obstetric. Male surgical patients in Malawi were on average older (33 years) than in Zambia (23 years). General surgical cases in men and women, respectively, had a median age of 42 and 32 in Malawi and 26 and 30 in Zambia. The median age of trauma patients was 12 in males and 10 in females in both countries. Children aged 0-15 years accounted for 64-65% of all trauma cases in Malawi and 57-58% in Zambia, with peak incidences in 6- to 10-year-olds., Conclusions: Women of reproductive (16-45 years) mainly undergoing Caesarean sections and children aged 0-15 years who accounted for two-thirds of trauma cases are the main patient populations undergoing surgery at district hospitals in Zambia and Malawi. Verification and analysis of routine hospital data, across 10-30% of districts countrywide, demonstrated the need to prioritise quality assurance in surgery and anaesthesia, and preventive interventions in children., (© 2017 John Wiley & Sons Ltd.)
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- 2017
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44. Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia.
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Gajewski J, Mweemba C, Cheelo M, McCauley T, Kachimba J, Borgstein E, Bijlmakers L, and Brugha R
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- Female, Humans, Male, Qualitative Research, Rural Population, Zambia, Allied Health Personnel, Clinical Competence standards, Health Personnel organization & administration, Licensure, Medical standards, Rural Health Services standards
- Abstract
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.
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- 2017
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45. Implementing World Health Assembly Resolution 68.15: National surgical, obstetric, and anesthesia strategic plan development--the Zambian experience.
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Mukhopadhyay S, Lin Y, Mwaba P, Kachimba J, Makasa E, Lishimpi K, Silverstein A, Afshar S, and Meara JG
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- Developing Countries, Global Health, Health Services Accessibility, Health Services Needs and Demand, Humans, Internationality, Organizational Objectives, Public Health, Societies, Medical, Zambia, Anesthesiology organization & administration, Delivery of Health Care organization & administration, National Health Programs organization & administration, Obstetrics organization & administration, Surgical Procedures, Operative
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- 2017
46. The evidence needed to make surgery a global health priority.
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Brugha R, Bijlmakers L, Borgstein E, and Kachimba J
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- Humans, Attitude of Health Personnel, Global Health, Health Policy, Health Priorities, Health Services Accessibility statistics & numerical data, Surgical Procedures, Operative statistics & numerical data
- Published
- 2015
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