Browsing by Author "Malama, Kennedy"

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    Raising the bar: translating global guidelines to achieve local policy on cholera elimination in Zambia-a qualitative case study.
    (2026-Sep-10) Mwamba, Chanda; Banda, Tikulirekuti ; Mazaba, Mazyanga ; Mukonka, Victor; Malama, Kennedy; Hamweemba, Esther; Syulikwa, Mainza; Chilengi, Roma; Sharma, Anjali; Fahim, Christine; Marten, Robert ; Yangchen, Sonam; Straus, Sharon
    BACKGROUND: The global roadmap to eliminating cholera by 2030 relies on early detection and response, vaccination in hotspots and effective partnerships. In sub-Saharan Africa, where 60% of the 2.8 million annual cases occur, cholera elimination requires a multisectoral response. To accelerate progress, improved understanding of how to translate a multisectoral approach to eliminate cholera is needed. METHODS: We evaluated implementation of Zambia's Multisectoral Cholera Elimination Plan (MCEP) using six phases of Graham's Knowledge-to-Action (KTA) framework (adaption, assessing barriers, implementation, monitoring, evaluation and sustaining knowledge use). We reviewed the MCEP to assess the policy environment for supporting implementation and triangulated information from 24 key informant interviews with policy-makers and implementers, 12 in-depth interviews with cholera survivors and focus group discussions with 28 community-based neighbourhood health committee members. Thematic analysis was used to analyse the data. We present our findings under each KTA phase. RESULTS: The MCEP prioritizes actions in hotspots, and vaccinations through a multisectoral governance and coordination structure. The appointment of a coordinator and formation of multisectoral technical working groups (TWGs) have improved dissemination, coordination and the case for additional investments in laboratory capacity, cholera vaccines and infrastructure for water, sanitation, hygiene and decentralized solid waste management. However, slow institutionalization of plans, weak coordination, inadequate funding, poor infrastructure and the coronavirus disease 2019 (COVID-19) pandemic has led to fragmented implementation. The sustainability of the MCEP is not assured without: (1) comprehensive advocacy; (2) resource mobilization (international and national budget commitment); (3) monitoring and evaluation (M&E) of progress; and (4) information synthesis and dissemination for end users. CONCLUSIONS: A multisectoral approach can help gain adequate momentum and efficiencies to eliminate cholera in Zambia, provided stakeholders are fully committed and funding is allocated to support plans. An adaptive collaborative strategy within national guidelines and policies that includes target communities is needed to support local translation, adaptation and concerted efforts to eliminate cholera.
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    Tuberculosis care cascade in Zambia - identifying the gaps in order to improve outcomes: a population-based analysis.
    (2021-Aug-10) Lungu, Patrick; Kerkhoff, Andrew D.; Kasapo, Clara C.; Mzyece, Judith; Nyimbili, Sulani; Chimzizi, Rhehab ; Silumesii, Andrew; Kagujje, Mary; Subbaraman, Ramnath; Muyoyeta, Monde; Malama, Kennedy
    OBJECTIVE: Tuberculosis (TB) remains a leading cause of morbidity and mortality in Zambia, especially for people living with HIV (PLHIV). We undertook a care cascade analysis to quantify gaps in care and align programme improvement measures with areas of need. DESIGN: Retrospective, population-based analysis. SETTING: We derived national-level estimates for each step of the TB care cascade in Zambia. Estimates were informed by WHO incidence estimates, nationally aggregated laboratory and notification registers, and individual-level programme data from four provinces. PARTICIPANTS: Participants included all individuals with active TB disease in Zambia in 2018. We characterised the overall TB cascade and disaggregated by drug susceptibility results and HIV status. RESULTS: In 2018, the total burden of TB in Zambia was estimated to be 72 495 (range, 40 495-111 495) cases. Of these, 43 387 (59.8%) accessed TB testing, 40 176 (55.4%) were diagnosed with TB, 36 431 (50.3%) were started on treatment and 32 700 (45.1%) completed treatment. Among all persons with TB lost at any step along the care cascade (n=39 795), 29 108 (73.1%) were lost prior to accessing diagnostic services, 3211 (8.1%) prior to diagnosis, 3745 (9.4%) prior to initiating treatment and 3731 (9.4%) prior to treatment completion. PLHIV were less likely than HIV-negative individuals to successfully complete the care cascade (42.8% vs 50.2%, p<0.001). Among those with rifampicin-resistant TB, there was substantial attrition at each step of the cascade and only 22.8% were estimated to have successfully completed treatment. CONCLUSIONS: Losses throughout the care cascade resulted in a large proportion of individuals with TB not completing treatment. Ongoing health systems strengthening and patient-centred engagement strategies are needed at every step of the care cascade; however, scale-up of active case finding strategies is particularly critical to ensure individuals with TB in the population reach initial stages of care. Additionally, a renewed focus on PLHIV and individuals with drug-resistant TB is urgently needed to improve TB-related outcomes in Zambia.