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Mukonka V, Sialubanje C, McAuliffe FM, Babaniyi O, Malumo S, Phiri J, Fitzpatrick P. Effect of a mother-baby delivery pack on institutional deliveries: A community intervention trial to address maternal mortality in rural Zambia. PLoS One 2024; 19:e0296001. [PMID: 38466648 PMCID: PMC10927137 DOI: 10.1371/journal.pone.0296001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the effect of providing additional health education during antenatal care (ANC) and a mother-baby delivery pack on institutional deliveries in Monze, Zambia. SETTING 16 primary health facilities conducting deliveries in the district. PARTICIPANT A total of 5000 pregnant women at any gestation and age attending antenatal care (ANC) services in selected health facilities were eligible for enrolment into the study. Out of these, 4,500 (90%) were enrolled into and completed the study. A total of 3,882 (77.6%) were included in the analysis; 12.4% were not included in the analysis due to incomplete data. INTERVENTION A three-year study (2012 to 2014) analysing baseline delivery data for 2012 and 2013 followed by a community intervention trial was conducted from January to December 2014. Health facilities on the western side were assigned to the intervention arm; those on the eastern side were in the control. In addition to the health education provided during routine ANC visits, participants in the intervention arm received health education and a mother-baby delivery pack when they arrived at the health facility for delivery. Participants in the control arm continued with routine ANC services. OUTCOME MEASURES The primary measure was the number of institutional deliveries in both arms over the one-year period. Secondary measures were utilisation of ANC, post-natal care (PNC) and under-five clinic services. Descriptive statistics (frequencies, proportions, means and standard deviation) were computed to summarise participant characteristics. Chi-square and Independent T-tests were used to make comparisons between the two arms. One way analysis of variance (ANOVA) was used to test the effect of the intervention after one year (p-value<0.05). Analysis was conducted using R-studio statistical software version 4.2.1. The p-value<0.05 was considered significant. RESULTS Analysis showed a 15.9% increase in the number of institutional deliveries and a significant difference in the mean number of deliveries between intervention and control arms after one year (F(1,46) = 18.85, p<0.001). Post hoc analysis showed a significant difference in the mean number of deliveries between the intervention and control arms for 2014 (p<0.001). Compared to the control arm, participants in the intervention arm returned earlier for PNC clinic visit, brought their children back and started the under-five clinic visits earlier. CONCLUSION These findings provide evidence for the effectiveness of the mother-baby delivery pack and additional health education sessions on increasing institutional deliveries, PNC and under-five children's clinic utilisation in rural Zambia. TRIAL REGISTRATION ISRCTN Registry (ISRCTN15439813 DOI 10.1186/ISRCTN15439813); Pan African Clinical Trial Registry (PACTR202212611709509).
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Affiliation(s)
- Victor Mukonka
- School of Medicine, Copperbelt University, Ndola, Zambia
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Cephas Sialubanje
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | | - Sarai Malumo
- World Health Organization, Country Office, Lusaka, Zambia
| | - Joseph Phiri
- National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Muliokela R, Uwayezu G, Tran Ngoc C, Barreix M, Tamrat T, Kashoka A, Chizuni C, Nyirenda M, Ratanaprayul N, Malumo S, Mutabazi V, Mehl G, Munyana E, Sayinzoga F, Tunçalp Ö. Integration of new digital antenatal care tools using the WHO SMART guideline approach: Experiences from Rwanda and Zambia. Digit Health 2022; 8:20552076221076256. [PMID: 35127117 PMCID: PMC8814973 DOI: 10.1177/20552076221076256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Digital tools for decision-support and health records can address the protracted
process of guideline adoption at local levels and accelerate countries’ implementation
of new health policies and programmes. World Health Organization (WHO) launched the
SMART Guidelines approach to support the uptake of clinical, public health, and data
recommendations within digital systems. SMART guidelines are a package of tools that
include Digital Adaptation Kits (DAKs), which distill WHO guidelines into a format that
facilitates translation into digital systems. SMART Guidelines also include reference
software applications known as digital modules. Methods This paper details the structured process to inform the adaptation of the WHO antenatal
care (ANC) digital module to align with country-specific ANC packages for Zambia and
Rwanda using the DAK. Digital landscape assessments were conducted to determine
potential integrations between the ANC digital module and existing systems. A
multi-stakeholder team consisting of Ministry of Health technical officers representing
maternal health, HIV, digital health, and monitoring and evaluation at district and
national levels was assembled to review existing guidelines to adapt the DAK. Results The landscape analysis resulted in considerations for integrating the ANC module into
the broader digital ecosystems of both countries. Adaptations to the DAK included adding
national services not reflected in the generic DAK and modification of decision support
logic and indicators. Over 80% of the generic DAK content was consistent with processes
for both countries. The adapted DAK will inform the customization of country-specific
ANC digital modules. Conclusion Both countries found that coordination between maternal and digital health leads was
critical to ensuring requirements were accurately reflected within the ANC digital
module. Additionally, DAKs provided a structured process for gathering requirements,
reviewing and addressing gaps within existing systems, and aligning clinical
content.
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Affiliation(s)
| | | | | | - María Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Andrew Kashoka
- Ministry of Community Development and Social Services—Information, Communication, Technologies (ICT), Zambia, Lusaka, Zambia
| | - Caren Chizuni
- Ministry of Health Zambia, Maternal Health Unit, Lusaka, Zambia
| | | | - Natschja Ratanaprayul
- World Health Organization, Department of Digital Health and Innovations, Geneva, Switzerland
| | - Sarai Malumo
- World Health Organization, Zambia Country Office, Lusaka, Zambia
| | - Vincent Mutabazi
- World Health Organization, Rwanda Country Office, Kigali, Rwanda
| | - Garrett Mehl
- World Health Organization, Department of Digital Health and Innovations, Geneva, Switzerland
| | | | - Felix Sayinzoga
- Ministry of Health Rwanda, Maternal, Child, and Community Health, Kigali, Rwanda
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Ford N, Newman M, Malumo S, Chitembo L, Gaffield ME. Integrating Sexual and Reproductive Health Services Within HIV Services: WHO Guidance. Front Glob Womens Health 2021; 2:735281. [PMID: 34816244 PMCID: PMC8593992 DOI: 10.3389/fgwh.2021.735281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/06/2021] [Indexed: 11/15/2022] Open
Abstract
Among the 1.9 billion women of reproductive age worldwide in 2019, 1.1 billion need family planning and 270 million have an unmet need for contraception. For women and adolescent girls living with human immunodeficiency virus (HIV), using effective contraception reduces the mother-to-child transmission of HIV by preventing unintended pregnancies and enabling the planning and safer conception of desired pregnancies with optimal maternal and child health outcomes. The World Health Organization (WHO) recommends that sexual and reproductive health services, including contraception, may be integrated within HIV services. Integration is associated with increased offers and uptake of sexual and reproductive health services, including contraception, which is likely to result in improved downstream clinical outcomes. Integrating HIV and sexual and reproductive health services has been found to improve access, the quality of antenatal care and nurse productivity while reducing stigma and without compromising uptake of care. Research is encouraged to identify approaches to integration that lead to better uptake of sexual and reproductive health services, including contraception. Implementation research is encouraged to evaluate different strategies of integration in different health systems and social contexts; such research should include providing contraception, including long-acting contraception, in the context of less frequent clinical and ART refill visits.
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Affiliation(s)
- Nathan Ford
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Morkor Newman
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Geneva, Switzerland
| | - Sarai Malumo
- Department of Reproductive and Women's Health, World Health Organization, Lusaka, Zambia
| | - Lastone Chitembo
- Department of HIV, Viral Hepatitis and STIs, World Health Organization, Lusaka, Zambia
| | - Mary E. Gaffield
- Human Reproduction Programme (HRP), World Health Organization, Geneve, Switzerland
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Kasaro MP, Bosomprah S, Taylor MM, Sindano N, Phiri C, Tambatamba B, Malumo S, Freeman B, Chibwe B, Laverty M, Owiredu MN, Newman L, Sikazwe I. Field performance evaluation of dual rapid HIV and syphilis tests in three antenatal care clinics in Zambia. Int J STD AIDS 2018; 30:323-328. [PMID: 30472926 DOI: 10.1177/0956462418800872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cross-sectional study of 3212 pregnant women assessed the field performance, acceptability, and feasibility of two dual HIV/syphilis rapid diagnostic tests, the Chembio DPP HIV-syphilis Assay and the SD Bioline HIV/syphilis Duo in antenatal clinics. Sensitivity and specificity for HIV and syphilis were calculated compared to the rapid Determine HIV-1/2 with Uni-Gold to confirm positive results for HIV and the Treponema pallidum particle agglutination assay for syphilis. RPR titers ≥1:4 were used to define active syphilis detection. Acceptability and feasibility were assessed using self-reported questionnaires. For Chembio, the HIV sensitivity was 90.6% (95%CI = 87.4, 93.0) and specificity was 97.2% (95%CI = 96.2, 97.8); syphilis sensitivity was 68.6% (95%CI = 61.9, 74.6) and specificity was 98.5% (95%CI = 97.8, 98.9). For SD Bioline, HIV sensitivity was 89.4% (95%CI = 86.1, 92.0) and specificity was 96.3% (95%CI = 95.3, 97.1); syphilis sensitivity was 66.2% (95%CI = 59.4, 72.4) and specificity was 97.2% (95%CI = 96.4, 97.9). Using the reference for active syphilis, syphilis sensitivity was 84.7% (95%CI = 76.1, 90.6) for Chembio and 81.6% (95%CI = 72.7, 88.1) for SD Bioline. Both rapid diagnostic tests were assessed as highly acceptable and feasible. In a field setting, the performance of both rapid diagnostic tests was comparable to other published field evaluations and each was rated highly acceptable and feasible. These findings can be used to guide further research and proposed scale up in antenatal clinic settings.
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Affiliation(s)
| | - Samuel Bosomprah
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.,2 Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Melanie M Taylor
- 3 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,4 Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ntazana Sindano
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Caroline Phiri
- 5 Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | | | - Sarai Malumo
- 6 World Health Organization Country Office, Lusaka, Zambia
| | - Bethany Freeman
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bertha Chibwe
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Maura Laverty
- 3 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Morkor N Owiredu
- 7 World Health Organization, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Lori Newman
- 8 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Izukanji Sikazwe
- 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Masaninga F, Katepa Bwalya M, Malumo S, Hamainza B, Songolo P, Kamuliwo M, Meremikwu M, Kazembe L, Mufunda J, Babaniyi OA. Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006–2012): Potential determinants and highlight of lessons learnt. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mukonka VM, McAuliffe FM, Babaniyi O, Malumo S, Sialubanje C, Fitzpatrick P. OP40 Addressing hidden barriers to institutional deliveries – a key intervention for reducing maternal mortality in poor rural Zambia. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mukonka VM, Malumo S, Kalesha P, Nambao M, Mwale R, Mwinga K, Katepa-Bwalya M, Babaniyi O, Mason E, Phiri C, Wamulume PK. Holding a country countdown to 2015 conference on Millennium Development Goals (MDGs) - the Zambian experience. BMC Public Health 2014; 14:60. [PMID: 24447509 PMCID: PMC3909314 DOI: 10.1186/1471-2458-14-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 01/18/2014] [Indexed: 12/05/2022] Open
Abstract
Initiatives such as the Country Countdown to 2015 Conference on Millennium Development Goals (MDGs) have provided countries with high maternal and child deaths like Zambia a platform to assess progress, discuss challenges and share lessons learnt as a conduit for national commitment to reaching and attaining the MDGs four and five. This paper discusses and highlights the process of holding a successful country countdown conference and shares Zambia's experience with other countries planning to organise country countdown to 2015 Conferences on MDGs.
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Affiliation(s)
- Victor M Mukonka
- Copperbelt University, School of Medicine, Ndola Central Hospital, 6th Floor, West wing, P. O. Box 71191, Ndola, Zambia
| | - Sarai Malumo
- United Nations Population Fund, Country Office, Lusaka, Zambia
| | - Penelope Kalesha
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Mary Nambao
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Rodgers Mwale
- United Nations Children’s Fund, Country Office, Lusaka, Zambia
| | - Kasonde Mwinga
- World Health Organisation, Regional Office, Brazzaville, Republic of Congo
| | | | | | - Elizabeth Mason
- World Health Organisation, Headquarters, Geneva, Switzerland
| | - Caroline Phiri
- Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Pauline K Wamulume
- Ministry of Health, National Malaria Control Centre, P. O. Box 32509, Lusaka, Zambia
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