Factors associated with private health facilities reporting malaria in the national health management information system in Zambia: a cross sectional study.

INTRODUCTION: Zambia has moved from accelerated malaria burden reduction to malaria elimination which requires the national malaria surveillance system to capture all cases from both the public and private sector. This study investigated challenges and factors associated with private health facilities reporting malaria in the national health management information system (HMIS). METHODS: a structured questionnaire was administered to the heads of 139 private health facilities in three provinces where approximately 85% of private health facilities are found in Zambia. Logistic regression was performed, and the outcome variable was reporting malaria in the HMIS. Epi Info® version 7 was used to conduct multivariable logistic regression to determine factors associated with private facilities reporting malaria in HMIS. RESULTS: private health facilities that had been operating for more than 20 years had three (3) times increased odds of reporting malaria in HMIS (AOR = 3.22, 95% CI: 1.23, 8.42; P-value = 0.02) compared to those that had been operating for less than 20 years. The private facilities that had staff who were aware about malaria surveillance (AOR = 2.06 95% CI: 1.38, 3.99, P-value = 0.01) had two times greater odds to report malaria in HMIS compared to those that were not aware. Lack of information and training in surveillance was identified as the main barrier for private facilities to report malaria in HMIS. CONCLUSION: as Zambia progresses towards malaria elimination, there is need to increase awareness and training of private providers on malaria surveillance to improve reporting in HMIS.

The adult prevalence of HIV in Zambia: results from a population based mobile testing survey conducted in 2013-2014.

OBJECTIVE: To estimate the adult prevalence of HIV among the adult population in Zambia and determine whether demographic characteristics were associated with being HIV positive. METHODS: A cross sectional population based survey to asses HIV status among participants aged 15 years and above in a national tuberculosis prevalence survey. Counselling was offered to participants who tested for HIV. The prevalence was estimated using a logistic regression model. Univariate and multivariate associations of social demographic characteristics with HIV were determined. RESULTS: Of the 46,099 individuals who were eligible to participate in the survey, 44,761 (97.1 %) underwent pre-test counselling for HIV; out of which 30,605 (68.4 %) consented to be tested and 30, 584 (99.9 %) were tested. HIV prevalence was estimated to be 6.6 % (95 % CI 5.8-7.4); with females having a higher prevalence than males 7.7 % (95 % CI 6.8-8.7) versus 5.2 % (95 % CI 4.4-5.9). HIV prevalence was higher among urban (9.8 %; 95 % CI 8.8-10.7) than rural residents (5.0 %; 95 % CI 4.3-5.8). The risk of HIV was double among urban dwellers than among their rural counterparts. Being divorced or widowed was associated with a threefold higher risk of being HIV positive than being never married. The risk of being HIV positive was four times higher among those with tuberculosis than those without tuberculosis. CONCLUSIONS: HIV prevalence was lower than previously estimated in the country. The burden of HIV showed sociodemographic disparities signifying a need to target key populations or epidemic drivers. Mobile testing for HIV on a national scale in the context of TB prevalence surveys could be explored further in other settings.

Implementation of the Community Health Assistant (CHA) Cadre in Zambia: A Process Evaluation to Guide Future Scale-Up Decisions.

Universal health coverage requires an adequate health workforce, including community health workers (CHWs) to reach rural communities. To improve healthcare access in rural areas, in 2010 the Government of Zambia implemented a national CHW strategy that introduced a new cadre of healthcare workers called community health assistants (CHAs). After 1 year of training the pilot class of 307 CHAs deployed in September 2012. This paper presents findings from a process evaluation of the barriers and facilitators of implementation of the CHA pilot, along with how evidence was used to guide ongoing implementation and scale-up decisions. Qualitative inquiry was used to assess implementation during the first 6 months of the program rollout, with 43 in-depth individual and 32 small group interviews across five respondent types: CHAs, supervisors, volunteer CHWs, community members, and district leadership. Potential 'implementation moderators' were explored using deductive coding and thematic analysis of participant perspectives on community acceptance of CHAs, supervision support mechanisms, and coordination with volunteer CHWs, and health system integration of a new cadre. Community acceptance of CHAs was generally high, but coordination between CHAs and existing volunteer CHWs presented some challenges. The supervision support system was found to be inconsistent, limiting assurance of consistent quality care delivered by CHAs. Underlying health system weaknesses regarding drug supply and salary payments furthermore hindered incorporation of a new cadre within the national health system. Recommendations for implementation and future scale based on the process evaluation findings are discussed.