Browsing by Author "Zulu JM"

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Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.
(2024-May-03) Mulubwa C; Zulu JM; Hurtig AK; Goicolea I; Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden. cmulubwa@hotmail.com.; School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia. cmulubwa@hotmail.com.; Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden.; School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O Box 34681, Lusaka, Zambia. cmulubwa@hotmail.com.
INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.
Lost in translation: key lessons from conducting dissemination and implementation science in Zambia.
(2024-Oct-29) Maritim P; Munakampe MN; Nglazi M; Mweemba C; Sikombe K; Mbewe W; Silumbwe A; Jacobs C; Zulu JM; Herce M; Mutale W; Halwindi H; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia. triciamarie20@gmail.com.; Implementation Science Centre for Advancing Practice and Training (IMPACT), University of Zambia, Lusaka, Zambia. triciamarie20@gmail.com.; Implementation Science Centre for Advancing Practice and Training (IMPACT), University of Zambia, Lusaka, Zambia.; Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.; Ministry of Health, Lusaka, Zambia.; Implementation Science Department, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
BACKGROUND: As the field of implementation science continues to grow, its key concepts are being transferred into new contexts globally, such as Low and Middle Income Countries (LMICs), and its use is constantly being reexamined and expanded. Theoretical and methodological positions commonly used in implementation research and practice have great utility in our work but in many cases are at odds with LMIC contexts. As a team of implementation scientists based in Zambia, we offer this commentary as a critical self-reflection on what has worked and what could limit us from fully utilizing the field's promise for addressing health problems with contextual understanding. MAIN BODY: We used a 'premortem,' an approach used to generate potential alternatives from failed assumptions about a particular phenomenon, as a way to reflect on our experiences conducting implementation research and practice. By utilizing prospectively imagined hindsights, we were able to reflect on the past, present and possible future of the field in Zambia. Six key challenges identified were: (i) epistemic injustices; (ii) simplified conceptualizations of evidence-informed interventions; (iii) limited theorization of the complexity of low-resource contexts and it impacts on implementation; (iv) persistent lags in transforming research into practice; (v) limited focus on strategic dissemination of implementation science knowledge and (vi) existing training and capacity building initiatives' failure to engage a broad range of actors including practitioners through diverse learning models. CONCLUSION: Implementation science offers great promise in addressing many health problems in Zambia. Through this commentary, we hope to spur discussions on how implementation scientists can reimagine the future of the field by contemplating on lessons from our experiences in LMIC settings.
"They say that I have lost my integrity by breaking my virginity": experiences of teen school going mothers in two schools in Lusaka Zambia.
(2019-Jan-14) Nkwemu S; Jacobs CN; Mweemba O; Sharma A; Zulu JM; Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia. sharonnkwemu@yahoo.com.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia.; Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia. sharonnkwemu@yahoo.com.; Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Adolescent school-going mothers return to school in the rekindled hope of obtaining an education. However, their re-introduction into the school environment requires adequate support from teachers, fellow pupils, and the community. The purpose of this study was to explore the experiences of school-going mothers in Lusaka to understand their coping mechanism in the process of re-integration. METHOD: This is a qualitative case study. We conducted in-depth interviews with 24 school going mothers between the ages of 16-19, purposively selected from 2 schools in Lusaka district. Audio-recorded interviews were transcribed, coded using Nvivo 10 software and analysed using thematic analysis. RESULTS: The girls reported experiencing stigmatization, discrimination, mockery and abuse from their teachers. Some community members labelled, humiliated, gossiped about and isolated the girls from their friends and classmates because of fear of 'contamination'. Families forced some girls into early marriages making them feel rejected. These experiences resulted in low self-esteem, inferiority complex, poor performance in their academic work and identity crises in the young mothers. Therefore, because of the experiences the girls faced, they developed certain behaviours such as beer drinking, truancy and running away from home. They found it difficult to adjust to motherhood while doing their schoolwork. CONCLUSION: There is a need for the teachers to undergo training on how to handle young mothers and have a flexible time-table to accommodate adolescent school going mothers when they miss lessons to attend to their babies. Non-parenting school girls should be counseled so that they do not stigmatize adolescent mothers. Parents need to be educated on how to deal with adolescent mothers in the community. The guidance office should have a qualified psychosocial counselor to help create a conducive learning environment for adolescent mothers, by helping them with missed lessons and seeing to it that they are not stigmatized.