Browsing by Author "Sindano N"

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A mobile phone-based, community health worker program for referral, follow-up, and service outreach in rural Zambia: outcomes and overview.
(2014-Aug) Schuttner L; Sindano N; Theis M; Zue C; Joseph J; Chilengi R; Chi BH; Stringer JS; Chintu N; 1 Centre for Infectious Disease Research in Zambia , Lusaka, Zambia .; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Mobile health (m-health) utilizes widespread access to mobile phone technologies to expand health services. Community health workers (CHWs) provide first-level contact with health facilities; combining CHW efforts with m-health may be an avenue for improving primary care services. As part of a primary care improvement project, a pilot CHW program was developed using a mobile phone-based application for outreach, referral, and follow-up between the clinic and community in rural Zambia. MATERIALS AND METHODS: The program was implemented at six primary care sites. Computers were installed at clinics for data entry, and data were transmitted to central servers. In the field, using a mobile phone to send data and receive follow-up requests, CHWs conducted household health surveillance visits, referred individuals to clinic, and followed up clinic patients. RESULTS: From January to April 2011, 24 CHWs surveyed 6,197 households with 33,304 inhabitants. Of 15,539 clinic visits, 1,173 (8%) had a follow-up visit indicated and transmitted via a mobile phone to designated CHWs. CHWs performed one or more follow-ups on 74% (n=871) of active requests and obtained outcomes on 63% (n=741). From all community visits combined, CHWs referred 840 individuals to a clinic. CONCLUSIONS: CHWs completed all planned aspects of surveillance and outreach, demonstrating feasibility. Components of this pilot project may aid clinical care in rural settings and have potential for epidemiologic and health system applications. Thus, m-health has the potential to improve service outreach, guide activities, and facilitate data collection in Zambia.
Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia.
(2017-Dec-21) Wagenaar BH; Hirschhorn LR; Henley C; Gremu A; Sindano N; Chilengi R; Health Alliance International, Seattle, WA, USA.; Department of Global Health, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. wagenaarb@gmail.com.; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.; Health Alliance International, Beira, Mozambique.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Partners in Health, Kigali, Rwanda.; Health Alliance International, Seattle, WA, USA. wagenaarb@gmail.com.; Department of Global Health, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation's African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. This paper describes the similar and divergent approaches to increase data-driven quality of care improvements (QI) and implementation challenge and opportunities encountered in these three countries. METHODS: Eight semi-structured in-depth interviews (IDIs) were administered to program staff working in each country. IDIs for this paper included principal investigators of each project, key program implementers (medically-trained support staff, data managers and statisticians, and country directors), as well as Ministry of Health counterparts. IDI data were collected through field notes; interviews were not audio recorded. Data were analyzed using thematic analysis but no systematic coding was conducted. IDIs were supplemented through donor report abstractions, a structured questionnaire, one-on-one phone calls, and email exchanges with country program leaders to clarify and expand on key themes emerging from IDIs. RESULTS: Project successes ranged from over 450 collaborative action-plans developed, implemented, and evaluated in Mozambique, to an increase from <10% to >80% of basic clinical protocols followed in intervention facilities in rural Zambia, and a shift from a lack of awareness of health data among health system staff to collaborative ownership of data and using data to drive change in Rwanda. CONCLUSION: Based on common successes across the country experiences, we recommend future data-driven QI interventions begin with data quality assessments to promote that rapid health system improvement is possible, ensure confidence in available data, serve as the first step in data-driven targeted improvements, and improve staff data analysis and visualization skills. Explicit Ministry of Health collaborative engagement can ensure performance review is collaborative and internally-driven rather than viewed as an external "audit."
Field performance evaluation of dual rapid HIV and syphilis tests in three antenatal care clinics in Zambia.
(2019-Mar) 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; 4 Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.; 7 World Health Organization, Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe.; 1 Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; 6 World Health Organization Country Office, Lusaka, Zambia.; 5 Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.; 8 Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Phnom Penh, Cambodia.; 2 Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.; 3 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
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.
Prevalence of hypertension and its treatment among adults presenting to primary health clinics in rural Zambia: analysis of an observational database.
(2015-Sep-21) Yan LD; Chi BH; Sindano N; Bosomprah S; Stringer JS; Chilengi R; Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana. samuel.bosomprah@cidrz.org.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. jeffrey_stringer@med.unc.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. roma.chilengi@cidrz.org.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. lilyyan@stanford.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. benjamin_chi@med.unc.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. samuel.bosomprah@cidrz.org.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. ntazana.sindano@cidrz.org.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. benjamin_chi@med.unc.edu.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. roma.chilengi@cidrz.org.; Stanford University School of Medicine, Stanford, California, USA. lilyyan@stanford.edu.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Hypertension constitutes a growing burden of illness in developing countries like Zambia. Adequately screening and treating hypertension could greatly reduce the complications of stroke and coronary disease. Our objective was to determine the prevalence of hypertension and identify current treatment practices among adult patients presenting for routine care to rural health facilities in the Better Health Outcomes through Mentoring and Assessments (BHOMA) project. METHODS: We conducted a retrospective analysis of routinely collected clinical data from 46 rural government clinics in Zambia. Our analysis cohort comprised patients ≥ 25 years with recorded blood pressure measurements, who sought care at primary health centers. Consistent with prior research, in our primary analysis, we only included data from first visits. Hypertension was defined as a systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or reported use of antihypertensive medication. A sensitivity analysis was performed using median blood pressure for individuals with multiple visits. RESULTS AND DISCUSSION: From January 2011 to December 2014, 116,130 first visits by adult patients met eligibility criteria. The crude prevalence of hypertension by onsite measurement or reported use of antihypertensive medication was 23.1% [95% CI: 22.8-23.3] (23.6% in females, 22.3% in males). The age standardized prevalence of hypertension across participating sites was 28.0 [95% CI: 27.7-28.3] (29.7% in females, 25.8% in males). Sensitivity analysis revealed a similar prevalence using data from all visits. Only 5.6% of patients had a diagnosis of hypertension documented in their medical record. Among patients with hypertension, only 18.0% had any antihypertensive drug prescribed, with nifedipine (8.9%), furosemide (8.3%), and propranolol (2.4%) as the most common. CONCLUSIONS: Age standardized prevalence of hypertension in rural primary health clinics in Zambia was high compared to other studies in rural Africa; however, we diagnosed hypertension with only one measurement and this may have biased our findings. Future efforts to improve hypertension control should focus on population preventive care and primary healthcare provider education on individual management.