Browsing by Author "Muttau, Nobutu"

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Availability, cost, and budget impact of lifesaving postpartum hemorrhage interventions in public hospitals in Zambia: A cross-sectional survey.
(2026-Jul) Kapesa, Herbert; Manasyan, Albert; Muttau, Nobutu; Sinkey, Rachel G.; Gallos, Ioannis; Tembo, Tannia
OBJECTIVE: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Most PPH deaths are preventable through evidence-based interventions. This study assessed the availability, direct costs, and economic implications of World Health Organization-recommended PPH interventions in public hospitals in Zambia. METHODS: A cross-sectional survey was conducted in 31 purposively selected public hospitals across seven provinces. Data (June 2019 to May 2020) on PPH prevalence, resource availability, and direct costs of PPH interventions were collected via a structured questionnaire administered to hospital administrators. An ingredients-based costing model compared an ideal pathway (severe PPH managed at a fully equipped primary-level health facility) to a referral pathway (patients unresponsive to early-stage interventions transferred to a tertiary hospital). Data were analyzed using Python. RESULTS: Among 74 238 deliveries, 1957 (2.6%) were PPH cases, resulting in 94 (4.8%) fatalities. Most cases (86.9%) received medical management, primarily by nurse-midwives. Tranexamic acid (TXA) was available in only 58.1% of the hospitals (subsidized cost: US$1.91/dose). Managing a severe PPH case in the ideal pathway cost US$133.46-US$276.22, compared to US$153.34-US$332.53 via the referral pathway , representing an 18.6% increase. Scaled nationally (approximately 672 000 births), this inefficiency translates to an avoidable annual burden of US$133121. CONCLUSION: While oxytocin is universally available, access to critical treatments such as TXA and advanced interventions remains limited. The low cost of preventive interventions contrasts with the high cost of managing severe PPH, which is exacerbated by system fragmentation. Strengthening primary-level facilities with essential commodities, surgical capacity, and training is critical to containing costs and reducing maternal mortality due to PPH.
Strengthening Kangaroo Mother Care at a tertiary level hospital in Zambia: A prospective descriptive study.
(2022) Muttau, Nobutu; Mwendafilumba, Martha; Lewis, Branishka; Kasprzyk, Keilya ; Travers, Colm; Menon, Anitha J.; Mutesu-Kapembwa, Kunda; Mangangu, Aaron ; Kapesa, Herbert ; Manasyan, Albert
BACKGROUND: Globally, complications due to preterm birth are the leading contributor to neonatal mortality, resulting in an estimated one million deaths annually. Kangaroo Mother Care (KMC) has been endorsed by the World Health Organisation as a low cost, safe, and effective intervention in reducing morbidity and mortality among preterm infants. The objective of this study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary level hospital in Lusaka, Zambia. METHODS: We conducted a prospective descriptive study using data collected from the KMC room at the University Teaching Hospital between January 2016 and September 2017. Mothers and government nurses were trained in KMC. We monitored skin-to-skin and breastfeeding practices, weight at admission, discharge, and length of admission. RESULTS: We enrolled 573 neonates into the study. Thirteen extremely low weight infants admitted to the KMC room had graduated to Group A (1,000g-1,499g) at discharge, with a median weight gain of 500g. Of the 419 very low weight neonates at admission, 290 remained in Group A while 129 improved to Group B (1,500g-2,499g), with a median weight gain of 280g. Among the 89 low weight neonates, 1 regressed to Group A, 77 remained in Group B, and 11 improved to Group C (≥2,500g), individually gaining a median of 100g. Of the seven normal weight neonates, 6 remained in Group C individually gaining a median of 100g, and 1 regressed to Group B. Among all infants enrolled, two (0.35%) died in the KMC room. CONCLUSIONS: Based on the RE-AIM metrics, our results show that KMC is a feasible intervention that can improve neonatal outcomes among preterm infants in Zambia. The study findings show a promising, practical approach to scaling up KMC in Zambia. TRIAL REGISTRATION: The trial is registered under ClinicalTrials.gov under the following ID number: NCT03923023.
"Testing Can Be Done Anywhere": A Qualitative Assessment of Targeted Community-Based Point-of-Care Early Infant Diagnosis of HIV in Lusaka, Zambia.
(2022-Jun-29) Tembo, Tannia; Dale, Helen; Muttau, Nobutu ; Itoh, Megumi; Williamson, Dhelia; Mwamba, Chanda; Manasyan, Albert; Beard, Suzanne R.; Cox, Mackenzie H.; Herce, Michael E.
INTRODUCTION: Delayed HIV diagnosis in HIV-exposed infants (HEIs) results in missed opportunities for early antiretroviral therapy (ART), causing significant morbidity and mortality. Early infant diagnosis (EID) depends on the availability of accessible and reliable testing services. We explored the acceptability, appropriateness, and feasibility of deploying a targeted community-based point-of-care (POC) EID testing model (i.e., "community POC model") to reach high-risk mother-infant pairs (MIPs) in Lusaka, Zambia. METHODS: We conducted in-depth interviews with a purposive sample of health care workers, study staff, and caregivers in high-risk MIPs at 6 health facilities included in a larger implementation research study evaluating the community POC model. We defined "high-risk MIPs" as mothers who did not receive antenatal testing or an attended delivery or infants who missed EID testing milestones. Interviews were audio-recorded, translated, and transcribed verbatim in English. Content and thematic analysis were done using NVivo 10 software. RESULTS: Health care workers (n=20) and study staff (n=12) who implemented the community POC model noted that the portability and on-screen prompts of the POC platform made it mobile and easy to use, but maintenance and supply chain management were key to field operations. Respondents also felt that the community POC model reached more infants who had never had EID testing, allowing them to find infants with HIV infection and immediately initiate them on ART. Caregivers (n=22) found the community POC model acceptable, provided that privacy could be ensured because the service was convenient and delivered close to home. CONCLUSION: We demonstrate the acceptability, appropriateness, and feasibility of implementing the community POC model in Zambia, while identifying potential challenges related to client privacy and platform field operations. The community POC model may represent a promising strategy to further facilitate active HIV case finding and linkage to ART for children with undiagnosed HIV infection in the community.
The Impacts of Stigma Against Sexual Minority Men Within and Between Various Socioecological Levels: Breaking the Vicious Cycle in Zambia.
(2023) Qiao, Shan; Garrett, Camryn M.; Addo, Prince N. O.; Adeagbo, Oluwafemi; Moore, Darius M.; Muttau, Nobutu; Sharma, Anjali; Lwatula, Clementina; Ngosa, Levy; Kabwe, McLean; Manasyan, Albert; Menon, Anitha J.; Weissman, Sharon; Li, Xiaoming; Harper, Gary W.
Sexual minority men (SMM) face persistent stigma in Zambia. From a holistic perspective, we aim to explore its impacts within and between multiple socioecological levels, demonstrating how their interactions create a vicious cycle of barriers to the well-being of SMM. In-depth interviews were conducted with 20 purposively recruited SMM from Lusaka, Zambia. All interviews were audio-recorded, after written consent, transcribed verbatim, and iteratively coded employing inductive (i.e., data-driven) approaches for thematic analysis using NVivo. Results suggest three key themes: (1) interpersonal socially perpetuated sexual minority stigma (SMS); (2) multidirectional interactions between psychosocial well-being and risk-taking behaviors; and (3) institutionally perpetuated SMS as a barrier to seeking and receiving health care. SMS permeates across all levels of the socioecological model to negatively impact the psychosocial well-being of SMM while acting also as a barrier to accessing HIV prevention and care. Our study necessitates structural public health intervention to decrease stigma and discrimination against SMM in Zambia, in efforts to increase their psychosocial well-being as well as their access to and utilization of HIV care by breaking the vicious cycle of SMS that pervades through the intrapersonal, interpersonal, and institutional levels of the socioecological model.