Background Antimicrobial resistance (AMR) of Neisseria gonorrhoeae is a threat to public health as strains have developed resistance to antimicrobials available for the treatment of gonorrhea. Whole genome sequencing (WGS) can detect and predict antimicrobial resistance to enhance the control and prevention of gonorrhea. Data on the molecular epidemiology of N. gonorrhoeae is sparse in Zambia. This study aimed to determine the genetic diversity of N. gonorrhoeae isolated from patients attending sexually transmitted infection (STI) clinics in Lusaka, Zambia. Methods A cross-sectional study that sequenced 38 N. gonorrhoeae isolated from 122 patients with gonorrhea from 2019 to 2020 was conducted. The AMR profiles were determined by the E-test, and the DNA was extracted using the NucliSens easyMaG magnetic device. Whole genome sequencing was performed on the Illumina NextSeq550 platform. The Bacterial analysis pipeline (BAP) that is readily available at: https://cge.cbs.dtu.dk/services/CGEpipeline-1.1 was used for the identification of the species, assembling the genome, multi-locus sequence typing (MLST), detection of plasmids and AMR genes. Phylogeny by single nucleotide polymorphisms (SNPs) was determined with the CCphylo dataset. Results The most frequent STs with 18.4% of isolates each were ST 7363 , ST 1921 and ST 1582 , followed by ST 1583 (13%), novel ST 17026 (7.9%), ST 1588 (7.9%), ST 1596 (5.3%), ST 11181 (5.3%), ST 11750 (2.6/%) and ST 11241 (2.6%) among the 38 genotyped isolates. The blaTeM-1B and tetM (55%) was the most prevalent combination of AMR genes, followed by blaTeM-1B (18.4%), tetM (15.8%), and the combination of blaTeM-1B , ermT , and tetL was 2.6% of the isolates. The AMR phenotypes were predicted in ciprofloxacin, penicillin, tetracycline, azithromycin, and cefixime. The combination of mutations 23.7% was gryA (S91F), parC (E91G), ponA (L421) and rpsJ (V57M), followed by 18.4% in gyrA (S91F), ponA (L421P), rpsJ (V57M), and 18.4% in gyrA (D95G, S91F), ponA (L421P), and rpsJ (V57M). The combinations in gyrA (D95G, S91F) and rpsJ (V57M), and gyrA (D95G, S91F), parC (E91F), ponA (L421P) and rpsJ (V57M) were 13.2% each of the isolates. Plasmid TEM-1 (84.2%), tetM ( 15.8%), and gonococcal genetic island (GGI) was detected in all isolates. Conclusion This study revealed remarkable heterogeneity of N. gonorrhoeae with bla TEM−1 , tetM, ponA, gyrA , and parC genes associated with high resistance to penicillin, tetracycline, and ciprofloxacin demanding revision of the standard treatment guidelines and improved antimicrobial stewardship in Zambia.

Evidence-Based Practice (EBP) in health is important for patient safety and quality care while Critical Thinking (CT) is a vital prerequisite to evidence based nursing. Despite their importance, in some settings neither EBP nor CT is taught assessed or implemented. This scoping review examined literature related to teaching, learning, assessment and implementation of EBP and application of CT by nursing students and graduates. Arksey and O’Malley framework was used to conduct the scoping review. PubMed, CINAHL, EMBASE and Joanna Briggs Institute for EBP data bases were searched for studies conducted between 2000 and 2020. Inclusion criteria were adapted from the -Population, Intervention, Professionals and Patients, Outcomes, Health Care settings (PIPOH) framework. Search terms included; evidence based practice, nursing education, nursing practice, critical thinking, methods, barriers, facilitators to teaching, learning, assessing and implementing EBP and CT. A total of 2,303 articles were retried, eventually 37 met the inclusion criteria. Use of non-traditional instructional methods for teaching EBP and CT were documented including Problem Based Learning, concept mapping, simulation, think aloud, critical incidence technique, debates and role-plays, reflective journaling, article analysis, nursing journal clubs and multidisciplinary clinical rounds. Validated tools for assessing EBP and CT Skills included; California Critical Thinking Skills Test, Upton and Upton 2006 EBP questionnaire and Yoon’s 2004 Critical Thinking Disposition Inventory. Teaching, assessing EBP and applying CT skills is challenging. Therefore innovative teaching methods are required to promote learning while successful implementation require strategies to minimize detractors and sustain enablers of the process. Key words: Evidence-Based Practice nursing, critical thinking, teaching, learning, assessment and implementation.

This scoping review assessed how the term 'self-management' (SM) is used in peer-reviewed literature describing HIV populations in low- and middle-income countries (LMIC). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. OVID Medline, Embase, CAB Abstracts, and EBSCO CINAHL, Scopus, and Cochrane Library were searched up to September 2021 for articles with SM in titles, key words, or abstracts. Two team members independently screened the titles and abstracts, followed by the full-text. A data extraction tool assisted with collecting findings. A total of 103 articles were included. Since 2015, there has been a 74% increase in articles that use SM in relation to HIV in LMIC. Fifty-three articles used the term in the context of chronic disease management and described it as a complex process involving active participation from patients alongside providers. Many of the remaining 50 articles used SM as a strategy for handling one's care by oneself, with or without the help of community or family members. This demonstrates the varied conceptualizations and uses of the term in LMIC, with implications for the management of HIV in these settings. Future research should examine the applicability of SM frameworks developed in high-income settings for LMIC.

Background: There is evidence that multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the “didactic program, community-based experience, and interprofessional-simulation experience” models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

Abstract Background Neisseria gonorrhoeae, the causative agent for sexually transmitted infection (STI) gonorrhoea, has emerged with a significant public health impact on acquiring resistance to antimicrobials available for treatment. The resistance of N. gonorrhoeae limit treatment options and contributed to high morbidity associated with gonorrhoea. Data on antimicrobial resistance (AMR) profiles in N. gonorrhoeae is scares in Zambia. This study aimed to determine the antibiotic susceptibilities in N. gonorrhoeae isolates from Lusaka, Zambia. Methods A prospective cross-sectional study was conducted on 630 STI patients who presented with urethral or vaginal discharge from 2019 to 2020. Urethral and endocervical secretions were cultured on Modified Thayer Martin agar and incubated at 36 °C ± 1 °C in 5% CO2 for 24 h. Identification of N. gonorrhoeae isolates was achieved by Gram stain, oxidase, nitrocefin disk, BactiCard Neisseria, and Viteck® Compact. The AMR profiles were determined using E-test. Statistical significant was determined by Pearson’s Chi-square test, Mann-Whitney U test, or logistic regression with p-values of < 0.05 indicating significance. Results A total of 630 patients were recruited of which 46% (290/630) with the median of 29 years and interquartile range (IQR) of 19–39 years were male. The median of the females was 26 years and IQR of 15–37 years. Neisseria gonorrhoeae was isolated from 19.4% (122/630) patients of which 72.9% (89/122) were male, with highest prevalence of isolation in the age category of 25–34 years. The prevalence of resistance was high to penicillin (85.2%), tetracycline (68.9%) and ciprofloxacin (59.8%) with MIC90 of 32 µg/mL, 8 µg/mL, and 8 µg/mL respectively. The isolates had reduced susceptibility to cefixime (1.6%), spectinomycin (4.9%) and (4.9%) for azithromycin. All isolates were susceptible to ceftriaxone. Risk factors associated with AMR were douching in females (AOR 6.69, 95% CI; 1.11–40.31, p = 0.039), female gender (AOR 7.64, 95% CI; 1.11–52.33, p = 0.048), HIV-positivity (AOR 26.59, 95% CI; 3.67–192.7, p = 0.005), no condom use or unprotected sex (AOR 5.48, 95% CI; 1.17–22.75 p = 0.026), sex trading (AOR 4.19, 95% CI; 1.55–11.33, p = 0.010), and over-counter treatment of ciprofloxacin (AOR 3.44, 95% CI; 1.17–22.75, p = 0.023). Conclusion The N. gonorrhoeae resistance to penicillin, tetracycline and ciprofloxacin was high necessitating revision of the treatment guidelines. However, no resistance to ceftriaxone was detected. Therefore, monitoring of antibiotic resistance remains critical in Zambia.

BACKGROUND:Majority of maternal and new-born deaths occur within 28 hours and one week after birth. These can be prevented by well-educated midwives. Confidence in postnatal and newborn care skills depend on the quality of midwifery education.OBJECTIVE:To assess confidence and its associated factors for basic postnatal and new-born care skills of final year midwifery students , from seven African countries.METHODS:A multi-country cross-sectional study where final year midwifery students answered a questionnaire consisting of basic skills of postnatal and newborn care listed by the International Confederation of Midwives. The postnatal care area had 16 and newborn care area had 19 skill statements. The 16 skills of postnatal care were grouped into three domains through principle component analysis (PCA); Basic postnatal care; postnatal complications and educating parents and documentation. The 19 skills under the newborn care area were grouped into three domains; Basic care and care for newborn complications; Support parents for newborn care; and Care for newborns of HIV positive mothers and documentation.RESULTS:In total 1408 midwifery students from seven Sub-Saharan countries participated in the study namely; Kenya, Malawi, Tanzania, Uganda, Zambia, Zimbabwe, and Somaliland Overall high confidence for all domains under Post Natal Care ranged from 30%-50% and for Newborn care from 39-55%. High confidence for postnatal skills was not found to be associated with any background variables (Age, sex, type and level of educational programme). High confidence for newborn care was associated with being female students, those aged 26-35 years, students from the direct entry programmes and those enrolled in diploma programmes.CONCLUSIONS:Almost half of the study participants expressed lack of confidence for skills under postnatal and newborn care. No association was found between high confidence for domains of postnatal care and background variables. High confidence was associated with being a female, between 26-35 years of age, from direct entry or diploma programmes for newborn care area. The results of the study indicate gaps in midwifery education. Countries could use the ICM list of competencies to develop country specific standards for midwifery education. However, actual competence remains to be measured.

Introduction: To achieve viral suppression and reduce vertical transmission of HIV, more than eighty percent of pregnant or breastfeeding women in Zambia have been started on combined ART using the Test and Treat model. However, Chawama First Level Hospital in Lusaka had records which showed that 32 percent of pregnant or breastfeeding women were non-adherent to combined anti-retroviral therapy (cART). Method: A mixed-method study was conducted to establish predictors of non-adherence to cART by women in the Test and Treat model of care. For the quantitative component, 92 consenting Pregnant and breastfeeding women were randomly drawn from ART defaulter register and a semi-structured questionnaire was administered. Multiple logistic regression was conducted to improve predictive power and control for confounders. Quantitative Results: The mean age was 28years. The study established that housewives were 84 percent less likely to be non-adherent [AOR 0.16; 95% CI 0.12, 0.36] compared to women who were formally employed with a statistically significant P-value of 0.04. Pregnant or breastfeeding women who were several months away from home were 84.9 percent more likely to be non-adherent [AOR 15.11; 95% CI 13.9, 16.4] compared to women who had travelled away from home for several days. The associated P-value was 0.03. The study also established that pregnant and breastfeeding women who were counselled in individually enclosed units were 91 percent less likely to be non-adherent compared to those who were counselled in an open space as a group [AOR 0.09; 95% CI 0.02, 0.53] with an associated P-value of 0.01. Conclusion: The study established that predictors of non-adherence to cART among pregnant and breastfeeding women were: being a working-class client; being away from home or usual clinic for several months; being counselled in open spaces, and negative staff attitude. Therefore, researcher can conclusively say that predictors of non-adherence to cART can be solved by training and re-training of health workers in Patient-Centred Care Model for effective patient engagement. Women should be counselled in private rooms. Furthermore, an improvement in patient’s tracking system by the use of smart-care-cards for pregnant and breastfeeding women countrywide can reduce patient’s non-adherence to cART.

Introduction poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts. Methods a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component. Results the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards. Conclusion based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.

Background/Aims Globally, there are three pathways to become a midwife: midwifery post nursing, direct entry midwifery and integrated nursing and midwifery. There is limited knowledge on the effectiveness of pre-service midwifery education. The aim of this study was to describe and compare midwifery students' confidence in intrapartum skills and associated factors such as type and level of education. Methods A multi-country cross-sectional study was conducted, where midwifery students were approached in the final months of their education programme. Data were collected using a questionnaire, based on the basic skills by the International Confederation of Midwives. Intrapartum care comprised 40 skills. Results In total, 1407 midwifery students from seven sub-Saharan countries responded. The 40 skills were grouped into six domains; three related to care during the first and second stage of labour and three related to care during the third stage of labour. Sex and age were significantly associated with confidence, with female students and those 26–35 years old having higher levels of confidence. Students enrolled in a direct entry programme were more confident than other students in all three domains of care related to the first and second stage of labour. Conclusions Direct entry was found to result in higher confidence for midwifery students than post nursing programmes or integrated programmes. Further research is needed for evaluation of competence.

Background/Aims Obstetric fistula is a serious birthing injury with medicosocial consequences including infertility and marital disharmony. Obstetric fistula has been eliminated in developed countries but remains highly prevalent in Africa and Asia. The aim of this study was to identify and analyse the marital experiences of women with obstetric fistula in order to guide interventions to help women cope with their situation, as well as improving partner support towards women living with this condition. Methods A range of electronic databases were searched for studies conducted worldwide, published between 2003 and 2018. English language publications were searched for using relevant keywords. Three main themes were identified based on the content of the interview questions and the respondents' views and experiences, and how these related to the study objectives. Results A total of 33 studies were included. Three main themes in the marital experiences of women with obstetric fistulas were identified: ‘loss of marriage’ (n=25), ‘marital and sexual life is no longer joyful’ (n=17), and ‘partner support’ (n=22). Conclusions Obstetric fistula can have significant impacts on a woman and her partner. Healthcare professionals should be aware of these concerns and surgical repair should be encouraged. Counselling should be provided for women with obstetric fistula and their partners.

Background: Quality education is one of the important factors in empowering midwives to provide quality health care services to mothers and newborns irrespective of their practice settings.Due to lack of standardization of the duration, content, and structure of midwifery education and different pathways to midwifery across the world, midwives may lack the confidence to deliver quality health care services in the main domain of the ICM competences.Aim: To assess the confidence of final year midwifery students in the domain of new-born care based on the ICM midwifery competencies.Methods: The first phase consisted of a quick situation analysis of midwifery education and regulation in Zambia, followed by a cross-sectional survey through a selfadministered questionnaire to assess the confidence of final year midwifery students.Results: Most (51.9%) of the respondents were aged between 18 and 28 years, and majority of them were placed in Levels 1, 2 and 3 Hospitals and also clinics for their clinical practice, with between one hundred to ten thousand annual births, followed by 16.9% who were placed in Level 3 hospitals only.Most students (38.3%) reported receiving classroom instruction by both Lecture and Demonstration.Few students (22.7%) responded that they were not satisfied with their clinical supervision, while 77.3% were satisfied.There was significant association between confidence to perform skills independently and having enough time to practice on models in the labs (p value = 0.024), confidence when practiced for the first time on mothers (p value = 0.007) and satisfaction with supervision during clinical practice (p value = 0.000).Binary logistic regression of characteristics associated with confidence to perform new-born skills independently revealed significant association between satisfaction with clinical supervision and confidence to perform How to cite this paper:

Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries - Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.

Poor use of fistula repair services has contributed to the continued consequences of obstetric fistula that are physical, psychological, social, financial and economic among the afflicted women. The study was designed to assess views of health care providers on factors hindering women with obstetric fistula in seeking fistula repair services. A descriptive cross sectional design was used. Sixty-five (65) health care providers were selected through convenient sampling method to participate in the study. A structured interview schedule was used to collect data. Reliability was ensured using test retest and alpha value of 0.7 for the views scale Statistical analysis was performed with the IBM SPSS Statistics 20 software. Data was expressed as descriptive summary measures. Factors found to be hindering women in seeking fistula repair services were lack of knowledge that repair services exist, anxiety, loss of dignity, stigma, transportation challenges, financing for the procedure, myths and misconception on obstetric fistula and health systems barriers. Therefore, there is need to engage the individual, communities, organisations and policy makers in order to improve women’s use of fistula repair services. Key words: Health care providers, women with obstetric fistula, fistula repair services, obstetric fistula, Views, Zambia.

Background/Aims Quality midwifery education is important in empowering student midwives with the confidence, knowledge, skills and attitudes relevant to the provision of quality postnatal care. The study aimed to assess confidence in providing postnatal care among midwifery students upon completion of training at selected midwifery schools in Zambia. Methods A cross-sectional survey was conducted in November 2016 at 5 of the 13 midwifery schools in Zambia. The sample comprised 194 finalist midwifery students who were purposively selected. Ethical approval was sort from the University of Zambia Research and Ethics Committee and participants signed informed consent forms. A self-administered questionnaire was used for data collection. Data were analysed using SPSS version 20, and the chi-squared test was used to analyse the significance of the relationship between variables, with significance set at 0.05. Results Almost all (97%) student midwives were confident in their ability to provide postnatal care independently. Most stated that they had enough time to practice in the skills laboratory (63%) and were confident when they practiced on mothers and their babies for the first time (62%). The majority (82.5%) were satisfied with the supervision they received from their mentors. Confidence to provide postnatal care independently was significantly associated with the confidence to practice for the first time on mothers and their newborns (P=0.007) and with satisfaction with clinical supervision (P=0.004). Conclusions Student midwives were confident in their ability to provide postnatal care. Time spent practicing in the skills laboratory and the amount of clinical supervision were two factors that enhanced students' confidence. Midwifery schools must emphasise clinical practice and supervision in order to produce confident midwives.

Rotavirus infection is a highly infectious public health concern among under-five children characterized mainly by diarrhoea, vomiting and fever spread through oral fecal route from contaminated water, food and objects. Diarrhoea ranks third among the common causes of mortality in Zambia among under-fives which accounts for about 9%. Statistics obtained at Ndola District Health Management Office revealed that in spite of high coverage of rotavirus vaccine, diarrhoea incidence had risen over the years from 2011 to 2015 by 32.9/1000. Currently stool is not routinely tested for rotavirus infection, making it difficult to determine its incidence and effectiveness of rotavirus vaccine (RotarixTM), an intervention that was put in place on 27th November 2013 to mitigate diarrhoea disease. The objective of this study is to determine incidence of rotavirus infection among under-fives attending health centres in selected communities of Ndola. Purposive sampling was used to select 380 under-fives aged 3 months - 36 months who presented at health facilities with diarrhoea, vomiting and fever. Stool specimen was tested for rotavirus infection using Combi-Strip Rapid Diagnostic Test. The study was conducted at specified period in time from 1st March 2017 to 28th September 2017 to determine relationships and associations among suspected variables using cross-sectional analytic community based study design. Statistical Package for Social Science software was used for data analysis. Tests used included Pearson’s Chi-square and logistic regression. Results have revealed 11% incidence rate of rotavirus infection and significant statistical association among severity categories of rotavirus infection with uptake of rotavirus vaccine (p ≤ 0.001). Children who took two recommended doses of the vaccine 185 (59.5%) were more likely to have mild category (<7 score) of rotavirus infection. In conclusion, results clearly indicate that rotavirus vaccine reduces incidence and if a child has diarrhoea it is less severe which yields good outcomes.

Admission of a new born to the Neonatal Intensive Care Unit (NICU) is a stressful and unexpected event to most parents. This quantitative study aimed at identifying factors that contribute to stress in mothers nursing babies in the NICU at the Women and New Born Hospital in Zambia. A cross sectional study was conducted among 280 mothers who were randomly selected over a three-month period. Stress levels were assessed using Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) questionnaire. Informed consent was obtained from the mothers for the study. Inclusion criteria for the study were mothers of admitted neonates and their neonates who had to remain in the NICU for at least 24 h. Stata software version 13 was used to analyse data Chi square test to determine association between stress and maternal and infant characteristics. Kruskal wallis test was used to determine association between subscales of the PSS: NICU tool and interquartile and median were calculated since the data was not normally distributed. Results revealed that participants were more stressed by alteration of the parental role and the appearance and behaviour of their neonate. All participants rated admission of the neonate as being stressful. Maternal characteristics that were associated with stress included education level and duration of stay in Kruskal-Wallis test showed a statistical difference between the stress subscales with alteration of parental role being the most stressful subscale. Mothers have different stress levels with most of them experiencing moderate and extreme stress; appropriate counselling targeted towards specific stressors identified is required. The limitation of this study is that it did not monitor levels of stress at different times of admission Future research should monitor how maternal stress changes throughout the neonate’s NICU stay. This information can be used to design effective support programme to help mothers adopt coping strategies during their infant’s hospitalization. Key words: Maternal stressors, neonatal intensive care, Stressor Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU).

HIV is increasingly recognized as a chronic illness which may result in episodic disability related to the effects of the virus, side effects of medication, co-morbidities and consequences of aging. Little is known about the episodic disability experiences of people living long-term with HIV in resource-limited countries, which is best understood by following people over time. This qualitative longitudinal study examined the episodic disability experiences and the applicability of four types of episodic disability among people living with HIV and on anti-retroviral therapy in Zambia. We interviewed 31 men and women living with HIV on 3 occasions at 6-month intervals (total of 93 interviews) examining the processes of change over time. We used disability models to inform the interviews exploring impairments/symptoms, activity limitations and participation restrictions. Longitudinal analyses of transcribed interviews confirmed the applicability of four types over time: stable, increasing disability, decreasing disability and significant fluctuations. Analyses highlighted the extent to which determinants of health contributed to the disability experienced. The use of disability models revealed the importance of environmental and social influences on disability and quality of life. The indicators of the type of episodic disability could be used clinically to help understand the nature and potential triggers of the episodes.

Despite numerous international and national efforts, only 12 countries in the World Health Organization’s African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Our individual case studies suggested that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. To elucidate specific components of national HGL that may have substantially influenced the pace of reductions in child mortality, we conducted a cross-country analysis of national policies and strategies pertaining to maternal, neonatal and child health (MNCH) and qualitative interviews with individuals working in MNCH in each of the four study countries. The three aspects of HGL identified in this study which most consistently contributed to the different progress towards MDG#4 among the four study countries were (1) establishing child survival as a top national priority backed by a comprehensive policy and strategy framework and sufficient human, financial and material resources; (2) bringing together donors, strategic partners, health and non-health stakeholders and beneficiaries to collaborate in strategic planning, decision-making, resource-allocation and coordination of services; and (3) maintaining accountability through a ‘monitor-review-act’ approach to improve MNCH. Although child mortality in sub-Saharan Africa remains high, this comparative study suggests key health leadership and governance factors that can facilitate reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.

Anti-retroviral treatment (ART) has improved the survival of people living with HIV in Africa. Living with chronic HIV comes with new health and functional challenges and the need to manage ART adherence. The Sepo Study applied disability frameworks to better understand living with chronic HIV while using ART. The study followed 35 people (18 women, 17 men) living with HIV and on ART 6 months or longer in private and public health facilities in Lusaka, Zambia over 18-months (2012-2015). A total of 99 in-depth interviews were conducted. Conventional content analysis and NVIVOv10 were applied to analyse the data. Participants were adhering to ART at the times of the interviews and therefore less likely to report major challenges with adherence. Three main themes emerged from the data related to adherence. Firstly, ART was regarded as "giving life", which underscored adherence. Secondly, all participants described strategies for to managehealth and functional limitations, which they attributed as side-effects or chronicity. Thirdly, participants described experiences of uncertainty, including the efficacy of new regimens, potential loss of functioning, risk of new health problems, and death. Long-term ART managment in Africa needs to integrate rehabilitation approaches to address functional limitations, uncertainties, strengthen and support for adherence.

Antenatal care (ANC) has been recommended as a service that can reduce both maternal and newborn mortalities.However, even in areas recording high ANC attendance, there are unevenly high levels of maternal and new born mortalities.Evidence of a weak relationship between ANC use and maternal and newborn survival has motivated recent calls to focus on content and quality of care provided rather than mere ANC attendance.This was a descriptive cross sectional study which was designed to evaluate the quality of antenatal care services in two health facilities in Lusaka and two in Mumbwa districts of Zambia.The health facilities were selected purposively based on poor maternal outcomes such as high maternal mortality ratio.Women attending antenatal clinics were selected using simple random sampling.Data was collected using a client exist interview schedule designed by World Health Organization for assessing quality of antenatal care.Data was analyzed using Statistical Package for Social Scientist (SPSS) version 24.0.The study revealed a lot of variations in the care provided at the four sites.None of the women had all the blood tests for haemoglobin, grouping and X-match, HIV and syphilis conducted from three out of the four health facilities, while at the fourth, only 30% of women had all the blood tests conducted.Furthermore, less than 20% of women had a full head to toe examination.While less than 10% of women from each of the facility reported that the health providers met the requirements for provision of privacy.Despite not meeting the minimum standards of care, only less than 5% of women categorized the care as poor.All the four health facilities recorded low quality of care on all domains of antenatal care.Therefore, if antenatal care has to achieve its intended purpose of reducing adverse maternal and new born outcomes, then quality of care delivered during pregnancy should be the focus as opposed mere attendance.