BACKGROUND:In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication. AIM:Investigate factors associated with ART adherence in a clinical setting in Zambia. METHODS:National cross-sectional study involving 193 clinics across all 10 provinces of Zambia. The primary outcomes assessed were ART adherence status, associated behavioral factors, and clinical characteristics. Logistic regression analysis was conducted to evaluate associations between these factors and ART adherence. Both unadjusted odds ratios (UOR) and adjusted odds ratios (AOR) were calculated, with adjustments made for relevant covariates, and all estimates reported with 95% confidence intervals. RESULTS:Of the 5,204 PLWH, 7.1% were non-adherent to ART (9.7% males vs 5.9% females). Of those who were non adherent, 60% and 22% consumed alcohol and smoked tobacco respectively. In adjusted analysis, age; 45-59 (AOR: 0.5, 95% CI:0.32-0.79), 60+ (AOR: 0.26, 95% CI: 0.12-0.59) and education; Primary (AOR: 0.6, 95% CI: 0.4-0.9), secondary (AOR: 0.57, 95% CI: 0.4-0.82), college/university (AOR: 0.5, 95% CI: 0.29-0.89) were associated with decreased odds of being non-adherence to ART. In contrast, being male (AOR: 1.45, 95% CI:1.07-1.98), being in informal employment (AOR:1.65, 95% CI:1.15-2.36), having average yearly income; > $160 (AOR: 1.55, 95% CI: 1.16-2.06), Alcohol consumption; healthy consumption (AOR: 2.72, 95% CI: 1.9-3.89), unhealthy consumption (AOR: 2.76, 95% CI: 1.8-4.22), indeterminant consumption (AOR: 3.03, 95% CI: 2.04-4.5) and tobacco smoking (AOR: 95% CI: 2.03 1.42-2.9) were associated with increased odds of being non-adherence to ART. CONCLUSIONS:ART non-adherence among PLWH in Zambia is 7.1%, with higher rates in males. Substance use especially alcohol and tobacco are common among the non-adherent. The associations between alcohol consumption, tobacco smoking, and ART adherence highlight the potential value of targeted support strategies. These results can inform future longitudinal research and contribute to the development of evidence-based interventions.

The problem of obesity among People Living with HIV (PLHIV) receiving Antiretroviral therapy (ART) is not yet explained with regard to gender, rural or urban location. This study assessed the prevalence of obesity and intake of fruits and vegetables to explain the problem within the Zambian context. Participants above 18 years old from health facilities with a minimum of 300 registered HIV patients were recruited and interviewed. Stata 18 SE (Stata Corp, College Station, TX, USA) was used for analysis. Participants’ characteristics were summarized using frequency and proportion for categorical variables while continuous variables were firstly checked for normality, if normally distributed then means and standard deviation were reported. The prevalence and corresponding 95% confidence intervals of risk factors were estimated. Over one tenth (10.8%) of the participants were obese. Women had a higher prevalence of overweight (26.4%) compared to men (15.2%) and more females (13.9%) were obese than males (4.5%). BMI was lower in rural (23.6 kg/m2) than in urban areas (24.2 kg/m2). Overweight was slightly lower in rural (21.3%) than urban communities (23.2%). Similarly, obesity was higher in urban (12.4%) than in rural areas (9.2%). The majority (74.8%) of respondents were not consuming enough fruits and vegetables with little difference between males (76.9%) and females (73.8%). The limited fruit and vegetable consumption and high salt intake indicates a dietary challenge in the management of obese HIV positive patients. It is recommended that health promotion should be incorporated in routine screening for overweight and obese individuals receiving ART. Individuals found with BMI above normal should be advised on lifestyle changes in relation to medication and diet.

Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to lack of awareness of both diseases and absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.

INTRODUCTION:Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia. METHODS:We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR). RESULTS:In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3-23.6), 26.7% (CI: 25.5-27.9) and 12.5% (CI: 11.6-13.4), respectively. In the multivariable model, being 30-44 (PR = 2.1; CI: 1.5-2.9), 45-49 (PR = 3.3; CI: 2.4-4.7) and 60 years or older (PR = 4.7; CI: 3.3-6.8) compared to those aged 18-29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2-1.5) and obese (PR = 1.9; CI: 1.6-2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3-3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4-3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1-1.6) and obese (PR = 1.6; CI: 1.3-2.0), compared to those with normal weight, showed a significant association with diabetes mellitus. CONCLUSIONS:The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate the high prevalence of hypertension and diabetes mellitus, along with their associated risk factors, particularly within this vulnerable demographic.

BACKGROUND:People living with HIV (PLWH) who use tobacco face significant public health risks compared to non-users, including an average loss of 12.3 years of life expectancy. Tobacco use increases the likelihood of non-communicable diseases (NCDs), such as cardiovascular diseases, hypertension, diabetes mellitus, and non-AIDS-related cancers. AIM:This study investigated factors associated with tobacco smoking and smokeless tobacco (SLT) use among PLWH in Zambia. METHODS:Data were obtained from a national cross-sectional survey involving 5,204 PLWH from 193 clinics across Zambia's 10 provinces. Tobacco smoking, SLT use, behavioral patterns, and clinical characteristics were assessed. Logistic regression was used to determine unadjusted (UOR) and adjusted odds ratios (AOR) at a 95% confidence interval (CI). RESULTS:Among the 5,204 PLWH surveyed, 9.7% were current tobacco smokers (21.9% men, 3.7% women), while 1.4% used smokeless tobacco (1.81% men, 1.26% women). In the multivariable analysis, several factors were identified as predictors of tobacco smoking. Male individuals had significantly higher odds of smoking (AOR: 4.81, 95% CI: 3.36-6.90). In contrast, higher educational attainment was associated with lower odds of smoking (AOR: 0.29, 95% CI: 0.16-0.52). Alcohol consumption was associated with an increased likelihood of smoking (AOR: 4.97, 95% CI: 2.93-8.44). Additionally, overweight or obese individuals were less likely to smoke, with adjusted odds ratios of 0.55 (95% CI: 0.35-0.85) and 0.36 (95% CI: 0.17-0.79), respectively. Non-adherence to antiretroviral therapy (ART) was also associated with higher smoking rates (AOR: 1.75, 95% CI: 1.14-2.67). Similarly, several factors were identified as predictors of smokeless tobacco (SLT) use. Individuals with an annual income exceeding 4,000 ZMW had lower odds of using SLT (AOR: 0.31, 95% CI: 0.14-0.73). In contrast, alcohol users exhibited significantly higher odds of SLT use (AOR: 14.74, 95% CI: 1.99-109.02). Furthermore, non-adherence to ART was associated with an increased likelihood of SLT use (AOR: 3.32, 95% CI: 1.54-7.17). CONCLUSIONS:Our findings highlight the urgent need for targeted interventions to reduce tobacco use among PLWH in Zambia. Integrating these measures within the existing healthcare framework can maximize impact. Gender-specific programs addressing unique risk factors, alongside economic empowerment initiatives for low-income females, could help curb SLT use. Additionally, reinforcing ART adherence through tobacco cessation counseling within HIV care settings may lower smoking rates. Given the strong association between alcohol consumption and tobacco use, structured behavioral interventions and support programs should also be prioritized. Strengthening collaborations between health authorities and community organizations can further enhance accessibility and outreach. By embedding these strategies within primary care and ART clinics, Zambia can effectively reduce tobacco use among PLWH, ultimately improving overall health outcomes and strengthening HIV management efforts.

BACKGROUND:Trachoma is responsible for the blindness or visual impairment of about 1.9 million people and causes about 1.4% of all blindness worldwide. In Zambia, trachoma is endemic and Western Province is one of the most affected provinces. The SAFE (surgery, antibiotics, facial cleanliness and environmental improvement) strategy is recommended for elimination of trachoma. In many settings, interventions particularly for facial cleanliness and environmental improvement are sub-optimally adopted due to lack of prioritization and inadequate funding of intervention activities. This study sought to establish the level of, and factors associated with adoption of facial and environmental hygiene promotion in the SAFE strategy among health workers in Western Province, Zambia. METHODOLOGY/PRINCIPAL FINDINGS:This was a cross-sectional study involving 24 health facilities selected from three districts using stratified random sampling. A total of 388 health workers comprising environmental health officers, community health assistants and community health workers were randomly selected. Adoption of facial and environmental hygiene promotion was self-reported, defined as participation in community distribution of information, education and communication (IEC) materials or community demonstrations of correct hand and face washing methods or both, within the past six months. Multiple logistic regression was used to identify the factors associated with adoption using STATA Version 15. The study was conducted in March and April 2023. Adoption of facial and environmental hygiene promotion was low at 47.68%. Having readily available transport (AOR = 3.06. 95% CI = [1.38, 6.80]), perceiving the intervention as relevant for trachoma prevention (AOR = 7.78, 95% CI = [4.38, 13.82]), having been trained in F and E (AOR = 2.17, 95% CI = [1.24, 3.78]) and availability of information, education and communication materials (AOR = 3.04, 95% CI = [1.69, 5.46]) were associated with higher odds of adoption of facial and environmental hygiene promotion among health workers. CONCLUSION/SIGNIFICANCE:There was low adoption of facial and environmental hygiene promotion among health workers influenced by training, transport availability, IEC material availability and perceived relevance and complexity of the intervention. To increase adoption of facial and environmental hygiene promotion, program implementers must ensure that they consider the identified factors in the planning of the intervention activities.

Female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS) are gender-specific manifestations of urogenital schistosomiasis. Morbidity is a consequence of prolonged inflammation in the human genital tract caused by the entrapped eggs of the waterborne parasite, Schistosoma (S.) haematobium. Both diseases affect the sexual and reproductive health (SRH) of millions of people globally, especially in sub-Sahara Africa (SSA). Awareness and knowledge of these diseases is largely absent among affected communities and healthcare workers in endemic countries. Accurate burden of FGS and MGS disease estimates, single and combined, are absent, mostly due to lack of awareness of both diseases and absence of standardized methods for individual or population-based screening and diagnosis. In addition, there are disparities in country-specific FGS and MGS knowledge, research and implementation approaches, and diagnosis and treatment. There are currently no WHO guidelines to inform practice. The BILGENSA (Genital Bilharzia in Southern Africa) Research Network aimed to create a collaborative multidisciplinary network to advance clinical research of FGS and MGS across Southern African endemic countries. The workshop was held in Lusaka, Zambia over two days in November 2022. Over 150 researchers and stakeholders from different schistosomiasis endemic settings attended. Attendees identified challenges and research priorities around FGS and MGS from their respective countries. Key research themes identified across settings included: 1) To increase the knowledge about the local burden of FGS and MGS; 2) To raise awareness among local communities and healthcare workers; 3) To develop effective and scalable guidelines for disease diagnosis and management; 4) To understand the effect of treatment interventions on disease progression, and 5) To integrate FGS and MGS within other existing sexual and reproductive health (SRH) services. In its first meeting, the BILGENSA Network set forth a common research agenda across S. haematobium endemic countries for the control of FGS and MGS.

Implementation science, although promising to bridge the know-do gap in global health, has inadvertently created new forms of epistemic exclusion in African health systems. In this Viewpoint, we present an empirical critique of how widely used implementation frameworks, rooted in Eurocentric and North American epistemologies, systematically fail to recognise the mechanisms through which successful implementation occurs in African contexts. Drawing on case studies across diverse African settings, we reveal how this epistemological mismatch undermines both the science and practice of implementation in African health systems. Using epistemic injustice theory, we show how frameworks operationalise constructs in ways that treat traditional governance, community legitimacy, and relational authority as peripheral variables rather than generative mechanisms of change. We propose concrete transformations to implementation science that centre African epistemological traditions and require genuine power-sharing in knowledge production to support health system improvement across all contexts.

While the impact of the pandemic has varied between and within countries, there are few published data on the relationship between social determinants of health (SDoH) and COVID-19 in Africa. This ecological cross-sectional study examines the relationship between COVID-19 risk and SDoH among 28 African countries. Included were countries with a recent demographic and health survey (years 2010 to 2018). The response variables were COVID-19 case rates and death rates (reported as of 15 August 2020); and the covariates comprised eight broad topics common to multiple SDoH frameworks aggregated to the country level: geography (urban residence), wealth index, education, employment, crowding, and access to information. A negative binomial regression was used to assess the association between aspects of SDoH and COVID-19 outcomes. Our analysis indicated that 1 in 4 (25.1%) households in study countries are without safe and clean water and a space for handwashing. The odds of COVID-19 morbidity and deaths were higher in countries with a high proportion of households without access to safe and clean water. Having a high proportional of educated women (1.003: 95% CI, 1.001–1.005) and living in a less crowded home (0.959: 95% CI, 0.920–1.000) were negatively associated with COVID-19 deaths, while being insured and owning a mobile phone predicted illness. Overall, aspects of SDoH contribute either negatively or positively to COVID-19 outcomes. Thus, addressing economic and environmental SDoH is critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent.

BACKGROUND:As the field of implementation science continues to grow, its key concepts are being transferred into new contexts globally, such as Low and Middle Income Countries (LMICs), and its use is constantly being reexamined and expanded. Theoretical and methodological positions commonly used in implementation research and practice have great utility in our work but in many cases are at odds with LMIC contexts. As a team of implementation scientists based in Zambia, we offer this commentary as a critical self-reflection on what has worked and what could limit us from fully utilizing the field's promise for addressing health problems with contextual understanding. MAIN BODY:We used a 'premortem,' an approach used to generate potential alternatives from failed assumptions about a particular phenomenon, as a way to reflect on our experiences conducting implementation research and practice. By utilizing prospectively imagined hindsights, we were able to reflect on the past, present and possible future of the field in Zambia. Six key challenges identified were: (i) epistemic injustices; (ii) simplified conceptualizations of evidence-informed interventions; (iii) limited theorization of the complexity of low-resource contexts and it impacts on implementation; (iv) persistent lags in transforming research into practice; (v) limited focus on strategic dissemination of implementation science knowledge and (vi) existing training and capacity building initiatives' failure to engage a broad range of actors including practitioners through diverse learning models. CONCLUSION:Implementation science offers great promise in addressing many health problems in Zambia. Through this commentary, we hope to spur discussions on how implementation scientists can reimagine the future of the field by contemplating on lessons from our experiences in LMIC settings.

BackgroundThere is persistent pressure on countries with a high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from the “one-size-fits-all” model to differentiated service delivery (DSD) models, which are meant to be more patient-centered and efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess the availability of HIV service indicators and the readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia.MethodsWe conducted a nationwide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess the availability of HIV service indicators and the readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered latent constructs, and therefore, we used structural equation modeling (SEM) to determine the correlations between them and their respective indicators.ResultsOf 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60), and readiness to provide the DSD models was 81.7% (48/60). However, only 48 and 39% of the facilities had all indicators of availability and readiness, respectively. Retention in care for HIV multidisciplinary teams was more likely to occur in urban areas than in rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated (r = 0.73, p < 0.0001). In addition, both availability and readiness were significantly and positively correlated with most of their respective indicators.ConclusionAlthough most facilities had available HIV service indicators and were ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban facilities in some indicators. There is a need for persistent and heightened efforts meant to implement DSD in HIV treatment, especially in rural areas to accelerate reaching the desired HIV treatment outcomes.

The burden of disease due to neglected tropical diseases in tropical and sub-tropical regions of the world still remains enormous. The diseases are prevalent in poor and marginalized communities where water and sanitation are a challenge and these communities are still grappling with other challenges like unemployment and other diseases. Africa shares the greatest burden of these diseases with women and children being the worst hit. In an effort to reduce the impact that these diseases have had on humans, global commitments and targets have been set to collectively deal with these diseases. Crucial to these global calls is epidemiological data showing exactly where these diseases occur so that the limited resources for control which is common in these poorer communities are targeted to areas where they will achieve maximum impact. Spatial epidemiology tools such as geographic information systems and remote sensing are therefore needed.

Background Although COVID-19 outcomes vary between and within countries, there is little published data on how aspects of social determinants of health (SDoH) affect COVID-19 outcomes in the African context. Objective The current study set to examine COVID-19 case and death rates and their correlates among African countries using data from different sources. Methods An ecological cross-sectional study comprising 28 African countries with a recent Demographic and Health Survey, DHS (2010-2018). Response variables were COVID-19 case and death rates (as of August 15, 2020). Covariates comprised three healthcare systems measures; rates of hospital beds (2005-2017), ventilators (2020) and doctors (2010-2018) per 10,000 population, and 9 broad topics common to multiple SDoH frameworks aggregated to the country level; geography (urban residence), wealth index, education, employment, crowding, and access to information. Rates per 10,000 population were calculated for healthcare measures and mapped for visualization. A Negative Binomial regression was used to assess whether aspects of SDoH are correlated with COVID-19. Results Our analysis indicated that 1 in 4 (25.1%) households in study countries are without clean water and handwashing access. Country-level health system capacity (hospital beds, ventilators, and medical doctors) varied considerably between the countries. Negative Binomial regression showed that the odds of COVID-19 morbidity and death was higher in countries with a high proportion of households without access to quality water and doctors per 10,000 people. Having a high proportional of educated women (1.003: 95% CI, 1.001 – 1.005), hospital beds per population and less people per room (0.959: 95% CI, 0.920 – 1.000) was negatively correlated with COVID-19 deaths while being insured and owning a mobile phone was correlated with illness. Conclusion Both aspects of SDoH and healthcare system contribute either negatively or positively to COVID-19 outcomes. Addressing healthcare system capacity and economic and environmental SDoH will be critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent.

The World Health Organization has promoted a shift towards the test-and-treat-all strategy to accelerate the elimination of HIV/AIDS. Zambia was one of the early African countries to adopt this strategy as the policy change was officially announced on national television by the republican president on 15th August 2017. This study explored the communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia. A qualitative case study design was employed with a purposeful sample of policy makers, international partners, National AIDS Council representatives, health facility managers, and frontline health providers in selected tertiary, secondary and primary health facilities in the Lusaka District, Zambia. Thematic data analysis was performed using NVivo 12 Pro software. In total, 22 key informant interviews and 3 focus group discussions were conducted. The government relied on formal and informal channels to communicate the test-and-treat-all policy change to health providers. Whilst HIV policy changes were reflected in the National HIV/AIDS Strategic Framework, there was little awareness of this policy by the frontline providers. The use of informal communication channels such as verbal and text instructions affected health providers’ implementation of the test-and-treat-all. Electronic and print media were ineffective in communicating the test-and-treat-all policy change to some sections of the public. Top-down stakeholder engagement, limited health worker training, and poor financing negatively affected the implementation of the test-and-treat-all policy change. Acceptability of the test-and-treat-all policy change was shaped by positive provider perceptions of its benefits, limited sense of policy ownership, and resistance by the non-treatment-ready patients. Furthermore, unintended consequences of the test-and-treat-all policy change on human resources for health and facility infrastructure were reported. Effective test-and-treat-all policy change communication is vital for successful policy implementation as it enhances interpretation and adoption among health providers and patients. There is a need to enhance collaboration among policy makers, implementers and the public to develop and apply communication strategies that facilitate the adoption of the test-and-treat-all policy changes to sustain gains in the fight against HIV/AIDS.

Background Timely access to essential obstetric and gynecologic healthcare is an effective method for improving maternal and neonatal outcomes; however, the COVID-19 pandemic impacted pregnancy care globally. In this global scoping review, we select and investigate peer-reviewed empirical studies related to mHealth and telehealth implemented during the pandemic to support pregnancy care and to improve birth outcomes. Methods We searched MEDLINE and PubMed, Scopus, CINAHL and Web of Science for this Review because they include peer-reviewed literature in the disciplines of behavioral sciences, medicine, clinical sciences, health-care systems, and psychology. Because our investigative searches reviewed that there is considerable ‘grey literature’ in this area; we did not restrict our review to any study design, methods, or place of publication. In this Review, peer-reviewed preprints were comparable to published peer-reviewed articles, with relevant articles screened accordingly. Results The search identified 1851 peer reviewed articles, and after removal of duplicates, using inclusion and exclusion criteria, only 22 studies were eligible for inclusion in the review published from January 2020 to May 2022. mHealth interventions accounted for 72.7% (16 of 22 studies) and only 27.3% (6 of 22 studies) were telehealth studies. There were only 3 example studies that integrated digital technologies into healthcare systems and only 3 studies that developed and evaluated the feasibility of mobile apps. Experimental studies accounted 68.8% of mHealth studies and only 33.3% studies of telehealth studies. Key functionalities of the pregnancy apps and telehealth platforms focused on mental and physical wellness, health promotion, patient tracking, health education, and parenting support. Implemented interventions ranged from breastfeeding and selfcare to behavioral health. Facilitators of uptake included perceived benefits, user satisfaction and convenience. Mobile apps and short messaging services were the primary technologies employed in the implemented mHealth interventions. Conclusion Although our Review emphasizes a lack of studies on mHealth interventions and data from pregnant women during the COVID-19 crisis, the review shows that implementation of digital health interventions during emergencies are inevitable given their potential for supporting pregnancy care. There is also a need for more randomized clinical trials and longitudinal studies to better understand the effectiveness and feasibility of implementing such interventions during disease outbreaks and emergencies.

Background Schistosomiasis or bilharzia is one of the neglected tropical diseases affecting over 230 million people globally. In Zambia, the infection poses as one of the major public health burdens among parasitic infections. The diagnosis of schistosomiasis in endemic countries is still a challenge. The aim of this study was to evaluate the diagnostic performance of the Schistosoma immunochromatographic (ICT) IgG–IgM rapid diagnostic test in the detection of schistosome infections from Schistosoma haematobium and mansoni in Siavonga district in Zambia. Results The diagnostic performance of Schistosoma ICT IgG–IgM test was evaluated using 430 of the 440 participants’ samples which had complete data. The prevalence of S. haematobium and S. mansoni was 4.4% and 6%, respectively, while seroprevalence was 71.4%. The sensitivity and specificity of the Schistosoma ICT IgG–IgM test was found to be 100% and 32.2%, respectively. The associated positive predictive value was 13.8% and 100% for negative predictive value. Diagnostic accuracy [area under the curve (AUC)] was 0.57 [95% confidence interval (CI) 0.52, 0.62]. Conclusions The Schistosoma ICT IgG–IgM proved to have remarkably high sensitivity with a fairly good specificity and diagnostic accuracy for the detection of both urinary and intestinal schistosomiasis. We therefore recommend the test as it is ideal for screening in the light of current focus of disease elimination in endemic countries.

Background The World Health Organisation has promoted a shift towards the test and treat strategy to accelerate elimination of HIV/AIDS. Zambia adopted this policy change in 2017. However, communication of this policy change and its effect on policy implementation has not been documented. This study sought to explore the communication of the HIV/AIDS test and treat health policy change and how this affects practice in selected public health facilities in Lusaka district. Methods A qualitative case study was employed with purposeful sampling of policy makers, partners, National AIDS Council managers and frontline health providers in selected tertiary, secondary and primary-level health facilities in Lusaka District of Zambia. In total, 22 key informant interviews and 3 focus group discussion were conducted. Thematic inductive – deductive approach coding and data analysis were performed using NVivo pro 12 software. Results The results revealed that to communicate test and treat policy change; government relied on print media such as newspapers, IEC materials and electronic media through radios and television. The official channels of communication and feedback mechanisms for test and treat HIV health policy change were not clearly stipulated in the health facilities for reference. This created a lapse in communication which resulted in policy misinterpretation and resistance from both implementers and clients. The HIV policy changes reshaped health systems negatively as infrastructure was altered to accommodate increased service demand workload for HIV services and operational hours for HCWs. Further, policy makers seemed to be unprepared for the policy changes. Conclusion Effective health policy change communication with clear channels and open feedback mechanisms is vital for successful policy change implementation as it enhances understanding and subsequently adoption of the policy. Further, there is a need to enhance collaboration amongst policy makers, partners, implementers and the public in developing and applying communication strategies that facilitate quick adoption of health policy changes.

This research article was part of a dissertation that explored overweight and obesity: prevalence, level of awareness and associated risk-factors among adolescents in selected secondary schools in Monze, Zambia.A total of 358 respondents participated in the cross-sectional study.Risk-factors identified included: inadequate time in physical activity, consumption of sugar-sweetened beverages, eating fast foods, snacking, irregularity in fruits and vegetables intake, insufficient sleeping hours, skipping breakfast, lack of school-policy to regulated sale and consumption of energy-dense foods and drinks in and around school premises as well as insufficient awareness about overweight and obesity risk-factors among the studied population.It was recommended that schools, parents and other education stakeholders should among other interventions develop and enforce the implementation of a national policy that require schools to create a conducive environment for the prevention and control of overweight and obesity such as Nourishing: based on the understanding that food policies to prevent obesity should aim to improve dietary behaviours by improving the availability, affordability and acceptability of healthy diets and decreasing the availability, affordability and acceptability of unhealthy diets or food and beverage dietary guidelines respectively.

Substantial efforts have seen the reduction in malaria prevalence from 33% in 2006 to 19.4% in 2015 in Zambia. Many studies have used effect measures, such as odds ratios, of malaria interventions without combining this information with coverage levels of the interventions to assess how malaria prevalence would change if these interventions were scaled up. We contribute to filling this gap by combining intervention coverage information with marginal predictions to model the extent to which key interventions can bring down malaria in Zambia. We used logistic regression models and derived marginal effects using repeated cross-sectional survey data from the Malaria Indicator Survey (MIS) datasets for Zambia collected in 2010, 2012 and 2015. Average monthly temperature and rainfall data were obtained from climate explorer a satellite-generated database. We then conducted a counterfactual analysis using the estimated marginal effects and various hypothetical levels of intervention coverage to assess how different levels of coverage would affect malaria prevalence. Increasing IRS and ITNs from the 2015 levels of coverage of 28.9% and 58.9% respectively to at least 80% and rising standard housing to 20% from the 13.4% in 2015 may bring malaria prevalence down to below 15%. If the percentage of modern houses were increased further to 90%, malaria prevalence might decrease to 10%. Other than ITN and IRS, streamlining and increasing of the percentage of standard houses in malaria fight would augment and bring malaria down to the levels needed for focal malaria elimination. The effects of ITNs, IRS and Standard housing were pronounced in high than low epidemiological areas.

Background: The SAFE strategy (surgery for trichiasis, antibiotics for active infection, facial cleanliness and environmental improvement) is the World Health Organization (WHO) recommended guideline for the elimination of blindness by trachoma by the year 2020. Objective: While evaluations on the implementation of the SAFE strategy have been done, systematic reviews on the factors that have shaped implementation are lacking. This review sought to identify these factors. Methods: We searched PUBMED, Google Scholar, CINAHL and Cochrane Collaboration to identify studies that had implemented SAFE interventions. The Consolidated Framework for Implementation Research (CFIR) guided development of the data extraction guide and data analysis. Results: One hundred and thirty-seven studies were identified and only 10 papers fulfilled the eligibility criteria. Characteristics of the innovation - such as adaptation of the SAFE interventions to suit the setting and observability of positive health outcomes from pilots - increased local adoption. Characteristics of outer setting - which included strong multisectoral collaboration - were found to enhance implementation through the provision of resources necessary for programme activities. When community needs and resources were unaccounted for there was poor compatibility with local settings. Characteristics of the inner setting - such as poor staffing, high labour turnovers and lack of ongoing training - affected health workers' implementation behaviour. Implementation climate within provider organisations was shaped by availability of resources. Characteristics of individuals - which included low knowledge levels - affected the acceptability of SAFE programmes; however, early adopters could be used as change agents. Finally, the use of engagement strategies tailored towards promoting community participation and stakeholder involvement during the implementation process facilitated adoption process. Conclusion: We found CFIR to be a robust framework capable of identifying different implementation determinants in low resource settings. However, there is a need for more research on the organisational, provider and implementation process related factors for trachoma as most studies focused on the outer setting.