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Mwanza J, Kawonga M, Kumwenda A, Gray GE, Mutale W, Doherty T. Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities. Glob Health Action 2022; 15:2126269. [PMID: 36239946 PMCID: PMC9578454 DOI: 10.1080/16549716.2022.2126269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers’ experience with the policy changes and the readiness of different health system elements to contribute to this goal. Objective To understand frontline healthcare workers’ experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework. Method We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework. Results Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites. Conclusion The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems.
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Affiliation(s)
- Jonathan Mwanza
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Kawonga
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Community Health, Charlotte Maxeke Johannesburg Academic Hospital Johannesburg, Johannesburg, South Africa
| | - Andrew Kumwenda
- Department of Obstetrics and Gynaecology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Glenda E Gray
- Office of the President, South Africa Medical Research Council, Cape Town, South Africa
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Tanya Doherty
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa
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Mpabalwani EM, Lukwesa-Musyani C, Imamba A, Nakazwe R, Matapo B, Muzongwe CM, Mufune T, Soda E, Mwenda JM, Lutz CS, Pondo T, Lessa FC. Declines in Pneumonia and Meningitis Hospitalizations in Children Under 5 Years of Age After Introduction of 10-Valent Pneumococcal Conjugate Vaccine in Zambia, 2010-2016. Clin Infect Dis 2020; 69:S58-S65. [PMID: 31505628 PMCID: PMC6761309 DOI: 10.1093/cid/ciz456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. Methods Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010–December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1–4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010–June 2013 and July 2014–December 2016, respectively. Results At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4–50.3%) and 28.8% (95% CI 17.7–38.7%) among children aged <1 year and 1–4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2–79.0%) and 61.6% (95% CI 50.4–70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1–4 years (39.3%, 95% CI 16.2–57.5%). Conclusions PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.
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Affiliation(s)
- Evans M Mpabalwani
- University of Zambia, School of Medicine, Department of Pediatrics & Child Health Unit, Ministry of Health, Ndeke House, Lusaka, Zambia.,Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Chileshe Lukwesa-Musyani
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Akakambama Imamba
- Lusaka Children's Hospital Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; and
| | - Ruth Nakazwe
- Microbiology Laboratory Unit, Ministry of Health, Ndeke House, Lusaka, Zambia; University Teaching Hospitals
| | - Belem Matapo
- World Health Organization Zambia Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Chilweza M Muzongwe
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Trust Mufune
- Department of Monitoring and Evaluation, Public Health & Research, Health Management Information System Unit, Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Elizabeth Soda
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Chelsea S Lutz
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, United States Department of Energy, Washington, DC
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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