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Food web structure of the pelagic community in Lake Tanganyika was studied using the stable nitrogen and carbon isotopes 15 N and 13 C. Size-fractionated seston, zooplankton, shrimps, medusae and fish were sampled in the northern part of Lake Tanganyika. Picoplankton fractions as well as cyanobacteria-dominated nano/microplankton fractions had very low nitrogen isotope signatures typical for nitrogen-fixing organisms. Fractions containing mainly dead organic matter (and associated bacteria) or nano/microalgae (chlorophytes and diatoms) had δ 15 N 2 to 4‰ higher. The low δ 15 N signatures of small cyclopoids and shrimps suggest they are feeding on nitrogen-fixing cyanobacteria (picoplankton or larger forms), while the higher δ 15 N signature of larger copepods suggest mixed feeding on large algae and small zooplankton and/or cyanobacteria. Medusae were slightly enriched in δ 15 N relative to large copepods. Among fish, the signatures of Stolothrissa and small Lates stappersi suggested feeding on large copepods, while Limnothrissa and larger Lates were slightly more enriched, indicating partial piscivory. The enrichment of 13 C between the putative trophic levels (2 to 3‰) was higher, while that of 15 N (2 to 3‰) was lower, than usual in isotope studies. Our results indicate that picocyanobacteria and possibly also larger cyanobacteria are important producers in the pelagic food web of Tanganyika. [ABSTRACT FROM AUTHOR]

Abstract Background The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period. Aim The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia. Methods A qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively. Findings There are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression. Conclusion Identifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby. Recommendation Strategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia.

Abstract Background Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services. Aims The aim of this paper was to explore health providers' views about mental health integration into primary health care. Methods A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). Results There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems. Recommendations It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. Conclusion Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.

Background: Hypertension is a risk factor for cardiovascular events. Inflammation plays an important role in the development of essential hypertension. Studies assessing the association between complete blood count-based inflammatory scores (CBCIS) and hypertension are scarce. Therefore, this study aimed to determine the relationship between CBCIS and hypertension among individuals with and without human immunodeficiency virus (HIV)., Method: This was a cross-sectional study among 344 participants at Serenje District Hospital and Serenje Urban Clinic. We used structured questionnaires to collect sociodemographic, clinical and laboratory characteristics. CBCIS included lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), derived neutrophil-lymphocyte ratio (d-NLR), and differential white blood cells. The primary outcome variable was hypertension defined as systolic and diastolic blood pressure higher than or equal to 140/90 mmHg. Logistic regression was used to estimate the association between hypertension and CBCIS in statistical package for social science (SPSS) version 22.0., Results: The participants had a median age of 32 years (interquartile range (IQR) 24-42) and 65.1% (n = 224) were female. The prevalence of hypertension was 10.5% (n = 36). Among those with hypertension, 55.6% (n = 20) were female and 44.4% (n = 16) were male. The CBCIS significantly associated with hypertension in people living with HIV (PLWH) was PLR (adjusted odds ratio (AOR) 0.98; 95% confidence interval (CI) 0.97-0.99, p = 0.01) while in people without HIV, AMC (AOR 15.40 95%CI 3.75-63.26), ANC (AOR 1.88 95%CI 1.05-3.36), WBC (AOR 0.52 95%CI 0.31-0.87) and PLR (AOR 0.98 95%CI 0.97-0.99) were the factors associated with hypertension. Compared to people without HIV, only WBC, ANC, NLR, and d-NLR were good predictors of hypertension among PLWH., Conclusion: Our study indicates a notable HIV-status driven association between CBCIS and hypertension, suggesting the use of CBICS as potential biomarkers for hypertension risk with substantial implications for early detection and preventive measures., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mwape 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.)

Background: An increase in the prevalence of HIV drug resistance (HIVDR) has been reported in recent years, especially in persons on non-nucleoside reverse transcriptase inhibitors (NNRTIs) due to their low genetic barrier to mutations. However, there is a paucity of epidemiological data quantifying HIVDR in the era of new drugs like dolutegravir (DTG) in sub-Saharan Africa. We, therefore, sought to determine the prevalence and correlates of viral load (VL) suppression in adult people with HIV (PWH) on a fixed-dose combination of tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD) or tenofovir alafenamide/emtricitabine/dolutegravir (TAFED) and describe patterns of mutations in individuals failing treatment., Methods: We conducted a cross-sectional study among 384 adults living with HIV aged ≥15 years between 5th June 2023 and 10th August 2023. Demographic, laboratory and clinical data were collected from electronic health records using a data collection form. Viral load suppression was defined as plasma HIV-1 RNA VL of <1000 copies/ml after being on ART for ≥ 6 months. SPSS version 22 to analyze the data. Descriptive statistics and logistic regression were the statistical methods used., Results: The median (interquartile range (IQR)) age was 22 (IQR 18, 38) years, and 66.1% (n = 254) were females. VL suppression was 90.4% (n = 347); (95% confidence interval (CI) 87.6%-93.6%) after switching to TLD/TAFED. Among the virally suppressed, the majority (67.1%, n = 233) were female. Those who missed ≥2 doses in the last 30 days prior to the most recent review were less likely to attain viral suppression compared to those who did not miss any dose (adjusted odds ratio (AOR) 0.047; 95% CI 0.016-0.136; p<0.001). Four participants had resistance mutations to lamivudine and tenofovir. The most common NRTI mutations were M184MV and K65R while K101E was the most common NNRTI mutation., Conclusion: Our findings show that viral suppression was high after switching to TLD/TAFED; but lower than the last 95% target of the UNAIDS. Adherence to antiretroviral therapy was a significant correlate of VL suppression. We, therefore, recommend prompt switching of PWH to TLD/TAFED regimen and close monitoring to enhance adherence to therapy., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Luwaya 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.)

Background: The Yathu Yathu ("For Us, By Us") cluster-randomized trial (CRT) evaluated a peer-led community-based sexual and reproductive health(SRH) intervention implemented to address persistent barriers to SRH service use among adolescents and young people (AYP). We report the impact of the intervention on coverage of key SRH services among AYP., Methods: The trial was conducted from Jul 2019-Oct 2021 in two urban communities in Lusaka, Zambia, divided into 20 zones (~ 2350 AYP/zone). Zones were randomly allocated to intervention (N = 10) or control (N = 10) arm. In all zones, a census was conducted and all AYP aged 15-24-years offered participation. The intervention consisted of peer-led community-based hubs providing SRH services; a prevention points card (PPC) system to incentivize and track SRH service use and community engagement. This paper reports on the outcome of coverage (accessing at least one key SRH service), comparing intervention and control arms using PPC data and standard methods of analysis for CRTs., Results: Among enumerated AYP, 93.6% (14,872/15,894) consented to participate from intervention zones and 95.1% (14,500/15,255) from control zones. Among those who accepted a PPC, 63.8% (9,493/14,872) accessed at least one key SRH service during the study period in the intervention arm, compared to 5.4% (776/14,500) in the control arm (adjPR 12.3 95%CI 9.3-16.2, p < 0.001)., Conclusions: The Yathu Yathu intervention increased coverage of key SRH services among AYP and reached two-thirds of AYP. These findings demonstrate the potential of providing peer-led community-based SRH services., Trial Registration: ISRCTN75609016 (11/10/2021), clinicaltrials.gov number NCT04060420 (19/08/2019); retrospectively registered., (© 2024. The Author(s).)

There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hensen 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.)

Introduction: Adolescents and young people (AYP) aged 15-24 years have the least access to facility-based sexual and reproductive health (SRH) services, including HIV services. The Yathu-Yathu cluster-randomized trial (CRT) in Zambia tested whether a novel peer-led community-based approach increased knowledge of HIV status amongst AYP. In this nested case-control study, we aimed to identify factors associated with non-attendance to the Yathu Yathu hubs by adolescent boys and young men (ABYM) aged 18-24-years., Methods: Yathu Yathu was a CRT conducted in two communities in Lusaka, Zambia, with 10 intervention and 10 control zones. AYP in all zones were offered prevention points cards (PPC), which incentivized and tracked service use at the hubs and health facility. In intervention zones, services were provided to AYP through community-based spaces (hubs) led by peer support workers. In these zones, cases were defined as those not having accessed any service at a hub and controls as those that accessed at least one service. Data were collected from October 2020 to January 2021 and analysed using methods appropriate for unmatched case-control studies., Results: 161 cases and 160 controls consented to participate in the study. Participants aged 20-24 years (adjOR 1.99, 95%CI 1.26-3.12, p = 0.003), who were educated up to college level (adjOR 8.47,95%CI 2.08-34.53, p = 0.001) or who reported being employed in the last 12 months (adjOR 2.15, 95%CI 1.31-3.53, p = 0.002) were more likely to not attend the hubs. ABYM who had a friend with a PPC were more likely to attend the hubs (adjOR 0.18 95%CI 0.09-0.35, p<0.001). Most cases reported having their last HIV test at the local government health facility (58%) while most controls reported HIV-testing at a Yathu Yathu hub (82%). Among the controls, 84% (134/160) rated the hub experience as excellent. Among cases, 65% (104/161) stated they didn't visit the hubs "due to employment"., Conclusions: Despite Yathu Yathu services being community-based and more accessible compared to health facilities, we found age, education and employment were associated with not attending hubs. Strategies are needed to reach employed young men who may not have access to SRH/HIV services during conventional working hours and to better utilise peer networks to increase service use., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Phiri 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.)

Background: Globally, millions of adolescent girls and young women (AGYW) who menstruate have limited access to appropriate and comfortable products to manage their menstruation. Yathu Yathu was a cluster randomised trial (CRT) that estimated the impact of community-based, peer-led sexual and reproductive health (SRH) services on knowledge of HIV status among adolescents and young people aged 15-24 (AYP). Among the services offered through Yathu Yathu were free disposable pads and menstrual cups. This study aimed to investigate whether the availability of free menstrual products through Yathu Yathu increased AGYW's use of an appropriate menstrual product at their last menstruation and explored the characteristics of AGYW who accessed menstrual products through Yathu Yathu., Methods: Yathu Yathu was conducted between 2019 and 2021 in 20 zones across two urban communities of Lusaka, Zambia. Zones were randomly allocated to the intervention or standard-of-care arm. In intervention zones, a community-based hub, staffed by peers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15-24 were given a Yathu Yathu Prevention Points Card, which allowed AYP to accrue points for accessing services at the hub and health facility (intervention arm), or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome (knowledge of HIV status) and secondary outcomes. Sampling was stratified by sex and age group; we analysed data from AGYW only to estimate the impact of Yathu Yathu on use of an appropriate menstrual product (disposable or reusable pad, cup, tampon) at last menstruation. We analysed data at zone-level using a two-stage process recommended for CRTs with < 15 clusters/arm., Results: Among 985 AGYW participating in the survey who had experienced menarche, the most commonly used products were disposable pads (88.8%; n = 875/985). At their last menstruation, 93.3% (n = 459/492) of AGYW in the intervention arm used an appropriate menstrual product compared to 85.7% (n = 420/490) in the control arm (adjPR = 1.09 95%CI 1.02, 1.17; p = 0.02). There was no evidence for interaction by age (p = 0.20), but use of appropriate products was higher among adolescents in the intervention arm relative to control (95.5% vs 84.5%, adjPR = 1.14 95%CI 1.04, 1.25; p = 0.006) with no evidence for a difference among young women (91.1% vs 87.0%, adjPR = 1.06 95%CI 0.96, 1.16, p = 0.22)., Conclusions: Delivering community-based peer-led SRH services increased the use of appropriate menstrual products among adolescent girls aged 15-19 at the start of the Yathu Yathu study. With less economic independence, the free provision of appropriate menstrual products is critical for adolescent girls to access materials that allow them to effectively manage their menstruation., (© 2023. The Author(s).)

Background: The growing population of adolescents and young people (AYP) aged 15 to 24 in sub-Saharan Africa face a high burden of HIV in many settings. Unintended pregnancies among adolescent girls in the region remain high. Nonetheless, the sexual and reproductive health (SRH) service needs of AYP have remained underserved. We conducted a cluster-randomised trial (CRT) to estimate the impact of community-based, peer-led SRH service provision on knowledge of HIV status and other SRH outcomes, including met need for contraceptives., Methods and Findings: Yathu Yathu was a cluster-randomised trial (CRT) conducted from 2019 to 2021 in 2 urban communities in Lusaka, Zambia. The communities were divided into 20 zones (approximately 2,350 AYP/zone) that were randomly allocated to the Yathu Yathu intervention or control arm. In each intervention zone, a community-based hub, staffed by peer support workers, was established to provide SRH services. In 2019, a census was conducted in all zones; all consenting AYP aged 15 to 24 were given a Yathu Yathu card, which allowed them to accrue points for accessing SRH services at the hub and health facility (intervention arm) or the health facility only (control arm). Points could be exchanged for rewards, thus acting as an incentive to use SRH services in both arms. We conducted a cross-sectional survey in 2021 to estimate the impact of Yathu Yathu on the primary outcome: knowledge of HIV status (self-reporting living with HIV or HIV testing in the last 12 months) and secondary outcomes, including use of pre-exposure prophylaxis (PrEP) in the last 12 months, current use of antiretroviral therapy (ART), and met need for contraceptive services. The sampling was stratified on sex and age group, and we analysed data at cluster-level using a two-stage process recommended for CRTs with <15 clusters/arm. A total of 1,989 AYP consented to participate in the survey (50% male); consent was similar across arms (63% consent/arm). Across zones, knowledge of HIV status ranged from 63.6% to 81.2% in intervention zones and 35.4% to 63.0% in control zones. Adjusting for age, sex, and community, knowledge of HIV status was higher in the intervention arm compared to control (73.3% versus 48.4%, respectively, adjusted prevalence ratio (PR) 1.53 95% CI 1.36, 1.72; p < 0.001). By age and sex, results were similar. There was no evidence for impact on any secondary outcomes, including current use of ART and met need for contraceptives. There were no adverse events reported in either arm. A key limitation of our trial is that approximately 35% of the AYP randomly selected for participation in the endline survey could not be reached., Conclusions: Delivering community-based, peer-led SRH services increased knowledge of HIV status among AYP, both males and females, compared with the control arm. Scaling up the highly effective Yathu Yathu strategy has the potential to make a substantial contribution to increasing access to HIV prevention and care services for young people. However, additional implementation research is needed to understand how to improve uptake of broader SRH services, beyond uptake of HIV testing., Trial Registration: ISRCTN75609016, clinicaltrials.gov number NCT04060420., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hensen 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.)

Introduction: the World Health Organization (WHO) declared COVID-19 a pandemic in January 2020, which has spread to many countries, including Zambia. Zambia has had challenges in providing personal protective equipment (PPEs) to nurses and midwives. The study's objective was to assess the availability and accessibility of PPEs among nurses and midwives caring for women in the general hospitals in Lusaka, Zambia., Methods: a cross-sectional analytical study design was conducted at five general hospitals in Lusaka on 162 nurses and midwives between February and April 2021, selected by purposive sampling of study sites and simple random sampling to select the participants. Data was collected using a semi-structured self-administered questionnaire and analyzed in STATA version 13. Chi-square and Fisher's exact test were used to test associations between the independent variables and the outcome, and a multivariable logistic regression was used to investigate the predictors of accessing PPEs., Results: out of the 162 who participated in the study, 48.8% were nurses, while 51.2% were midwives. Only 10% (16/160) of the participants reported having enough PPEs at work. Age, marital status, PPE use, employment duration, and protection confidence were associated with accessibility (P<0.05)., Conclusion: overall, there was an inadequate provision of PPEs in the health facilities putting the nurses and midwives at a high risk of acquiring COVID-19. Policymakers need a deliberate move to make the availability and accessibility of PPEs a reality during the pandemic., Competing Interests: The authors declare no competing interests., (Copyright: Sebean Mayimbo et al.)

Background: In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders., Methods: The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL., Results: Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS., Conclusion: The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap., (© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods : Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results : The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion : HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.

This article describes a study that explored the use of instant messaging in continuing education for nurses and midwives using a leadership and management programme designed for rural nurse managers in Zambia. Twenty trainees who were enrolled in a leadership and management course, five supervisors and six course facilitators participated in the discussions over a period of nine months. Each week, a supervisor posted a question to participants regarding content in the curriculum and how the participants were applying this to their daily work. Participants were required to answer the question within a week. Information was free-flowing and participants were encouraged to engage actively, ask questions and share their experiences. Conversations were extracted from mobile devices and data were analysed using thematic analysis. Themes from the messages were identified as social interaction, professional networking and educational interactions. The findings demonstrate that instant messaging can be a useful platform for learners and their facilitators in a blended type of learning and can enhance communication, promote social interaction and professional networking, and support the application of knowledge to practice., Competing Interests: None declared, (©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

With the support of the World Health Organization's Evidence-Informed Policy Network, knowledge translation platforms have been developed throughout Africa, the Americas, Eastern Europe, and Asia to further evidence-informed national health policy. In this commentary, we discuss the approaches, activities and early lessons learned from the development of a Knowledge Translation Platform in Malawi (KTPMalawi). Through ongoing leadership, as well as financial and administrative support, the Malawi Ministry of Health has strongly signalled its intention to utilize a knowledge translation platform methodology to support evidence-informed national health policy. A unique partnership between Dignitas International, a medical and research non-governmental organization, and the Malawi Ministry of Health, has established KTPMalawi to engage national-level policymakers, researchers and implementers in a coordinated approach to the generation and utilization of health-sector research. Utilizing a methodology developed and tested by knowledge translation platforms across Africa, a stakeholder mapping exercise and initial capacity building workshops were undertaken and a multidisciplinary Steering Committee was formed. This Steering Committee prioritized the development of two initial Communities of Practice to (1) improve data utilization in the pharmaceutical supply chain and (2) improve the screening and treatment of hypertension within HIV-infected populations. Each Community of Practice's mandate is to gather and synthesize the best available global and local evidence and produce evidence briefs for policy that have been used as the primary input into structured deliberative dialogues. While a lack of sustained initial funding slowed its early development, KTPMalawi has greatly benefited from extensive technical support and mentorship by an existing network of global knowledge translation platforms. With the continued support of the Malawi Ministry of Health and the Evidence-Informed Policy Network, KTPMalawi can continue to build on its role in facilitating the use of evidence in the development and refinement of health policy in Malawi.

Background: Mental illness constitutes a large proportion of the burden of disease in Zambia. Yet mental health services at the primary care level are either provided in a fragmented manner or are lacking altogether., Methods: A literature review focused on terms including mental health and primary care and strategic options were analyzed., Results: From the analysis, two options were considered for integrating mental health into primary health care. An incremental option would start with a pilot project introducing mental health services into primary care with a well-designed evaluation before scaling up. One key advantage of this option is that it is possible to make improvements in the plan, if needed, before scaling up. A comprehensive option would entail introducing mental health services into primary care in all nine provinces of Zambia. In this option, scaling up could occur more rapidly than an incremental approach., Conclusions: Strategies to implement either option must address several barriers, including insufficient funding for mental health services, inadequate mental health indicators, lack of general public awareness of and social stigma attached to mental illnesses and mental health care not being perceived as cost-effective or affordable.

Background: Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services., Aims: The aim of this paper was to explore health providers' views about mental health integration into primary health care., Methods: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa)., Results: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems., Recommendations: It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level., Conclusion: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.

Human resources for mental health care in low- and middle-income countries are inadequate to meet the growing public health burden of neuropsychiatric disorders. Information on actual numbers is scarce, however. The aim of this study was to analyse the key human resource constraints and challenges facing Zambia's mental health care system, and the possible solutions. This study used both qualitative and quantitative methodologies. The WHO-AIMS Version 2.2 was utilized to ascertain actual figures on human resource availability. Semi-structured interviews and focus group discussions were conducted to assess key stakeholders' perceptions regarding the human resource constraints and challenges. The results revealed an extreme scarcity of human resources dedicated to mental health in Zambia. Respondents highlighted many human resource constraints, including shortages, lack of post-graduate and in-service training, and staff mismanagement. A number of reasons for and consequences of these problems were highlighted. Dedicating more resources to mental health, increasing the output of qualified mental health care professionals, stepping up in-service training, and increasing political will from government were amongst the key solutions highlighted by the respondents. There is an urgent need to scale up human and financial resources for mental health in Zambia.