Phillimon Ndubani - Academia.edu (original) (raw)

Papers by Phillimon Ndubani

... whilst others are somewhat different as will become evident in the subsequent sections of thi... more ... whilst others are somewhat different as will become evident in the subsequent sections of thispaper. ... increase the likelihood of excessive use of alcohol and practices of unsafe sex (Af-aids list ... place to access ART for people in Kazungula was in Livingstone; by 2007, ART had ...

Scandinavian Journal of Public Health, 2003

Building on the experiences of an initial study in 1993, the current survey was conducted to enha... more Building on the experiences of an initial study in 1993, the current survey was conducted to enhance understanding of men&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s sexual health and prospects for behaviour change in Chiawa, rural Zambia. Seventy-nine randomly selected men in the age range 16-25 years were interviewed using a questionnaire. The obstacles to good sexual health reported were: inadequate access to health facilities (35%); unemployment (24%); diseases in general (20%); and HIV/AIDS (17%). Nineteen (24%) had suffered from an STI in the past. Five (13%) of the married and 16 (33%) of the single men had extra or pre-marital relationships at the time of the interviews. In 1993, 50% of the single men had pre-marital relationships. A real man (murume chaiye) was considered to be married, have children, have a job and sexually satisfy his wife; 97% considered themselves to be real men. Some 91% perceived themselves to be at risk of HIV infection; 76 (96%) were aware that HIV could be passed from mother to child, although 51 (61%) would not think about HIV when making decisions about having children. Sixty-eight (86%) believed that condoms could reduce the risk of HIV and 27% used condoms all the time they had sex. In 1993, 6% used condoms all the time they had sex. There are prospects for behaviour change among the men. Prevention messages need to build on what they already know and practise. The messages must aim to change their local sexual norms, which perpetuate risky practices.

Health Policy and Planning, 2001

... Lusaka: University of Zambia. Mbizvo MT, Kasule J, Gupta V et al. 1995. ... Acknowledgements ... more ... Lusaka: University of Zambia. Mbizvo MT, Kasule J, Gupta V et al. 1995. ... Acknowledgements The authors wish to thank all the young men of Chiawa who willingly participated in this study. Thanks to Mr David Matesamwa and Mr Charles Mandika for their research assistance. ...

BMC Public Health, 2010

Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Afr... more Background: Much of the debate as to whether or not the scaling up of HIV service delivery in Africa benefits non-HIV priority services has focused on the use of nationally aggregated data. This paper analyses and presents routine health facility record data to show trend correlations across priority services.

BMC Health Services Research, 2010

Background: Considerable attention has been given by policy makers and researchers to the human r... more Background: Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods: Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends.

AIDS and Behavior, 2010

Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the ep... more Reaching populations at greatest risk for acquiring HIV is essential for efforts to combat the epidemic. This paper presents, the Priorities for Local AIDS Control Efforts (PLACE) method which focuses on understanding the venues where people are meeting new sexual partners and behaviors which put people at risk. A comparison of data from two PLACE studies in Zambia with a national household survey, the Zambia Sexual Behavior Survey 2005, indicated that the PLACE population was at greater risk of acquiring HIV. Respondents in the two PLACE studies were significantly more likely to report 1+ new partners in the past 4 weeks, 2+ partners in the past 12 months, 1+ new partner in the past 12 months and transactional sex. Data from the PLACE method is important for targeting interventions for those most likely to acquire and transmit HIV.

Human resources for health, 2006

The World Health Organization's World health report 2006: Working together for health undersc... more The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS. We conducted a cross-sectional study in two Zambian urban sites, using structured que...

SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2009

Zambia has over 1 million HIV infections nationwide and an urban prevalence rate of 23%. This stu... more Zambia has over 1 million HIV infections nationwide and an urban prevalence rate of 23%. This study compared the impact of male involvement in multiple and single session risk reduction interventions among inconsistent condom users in Zambia and the role of serostatus among HIV-seropositive and serodiscordant couples. Couples (N=392) were randomised into intervention arms. Among inconsistent condom users at baseline (N=83), condom use increased in both conditions and this increase was maintained over a 12month period. At 12 months, seronegative men in the multiple session condition increased sexual barrier (male and female condoms) use in comparison with those in the single session condition (F=16.13, p=0.001) while seropositive individuals increased sexual barrier use regardless of condition. Results illustrate the importance of both single and multiple session risk reduction counselling among seronegative men in serodiscordant couples in Zambia, and highlight the differing perception of risk between seropositive and serodiscordant persons.

Tropical Medicine and International Health, 1998

We set out to investigate the extent to which cultural constructs might determine treatment-seeki... more We set out to investigate the extent to which cultural constructs might determine treatment-seeking for diarrhoea in the poorer populations of Lusaka, Zambia. This paper describes these concepts and perceptions and outlines a classification of such illnesses, together with an analysis of its implications for understanding treatment choice. Data were derived from focus group discussions, a household survey, a survey of practitioners of traditional medicine and interviews with local residents attending an urban health centre with persistent diarrhoea. The classification is based on symptoms and perceptions of aetiology. While resulting categories convey imperatives for treatment choice, it is clear that individuals with diarrhoeal illnesses seek treatment from multiple sources. This may be because any single illness may fit more than one category, or because unrelenting ill-health engenders desperate behaviour. The cultural constructs do not fully explain treatment choice and attitudes to prevention, but could be used to improve communication regarding public health and treatment strategies.

Social Science & Medicine, 1997

It is increasingly appreciated that health interventions need to be sensitive to cultural percept... more It is increasingly appreciated that health interventions need to be sensitive to cultural perceptions of diseases and local disease terminology. This paper examines linguistic and conceptual problems encountered when researchers in rural Zambia try to develop a glossary which correlates biomedical terms for sexually transmitted diseases (STDs) with local terms for diseases associated with sexual intercourse. Problems arise because it is difficult to establish definite connections between local names and actual biomedical STDs. This paper attempts to draw up a delimited glossary of local terms for diseases associated with sexual intercourse in a rural Zambian community and explore compatibility with the biomedical glossary used in local, formal health facilities. The local terms fall into three broad categories. The first category comprises generic terms, the second symptomalogical terms, and the third category consists of folk concepts associated with moral digression. The concluding analysis speculates on the advantages of health staff being taught the glossary of local terms to use in their consultations with STD patients to facilitate dialogue between health staff and patients, and, perhaps, effective treatment of STDs.

The Lancet, 1998

Whereas much attention has been paid in the past to mortality and morbidity in children, less is ... more Whereas much attention has been paid in the past to mortality and morbidity in children, less is known about adult populations in sub-Saharan Africa, 1 and little community-based information is available about morbidity and mortality in cities. Adults, especially young adults, are the economic force for the whole population, and the HIV pandemic has highlighted the consequences of increased mortality and morbidity in adults. In order to measure adult mortality we carried out surveys of four high-density townships of Lusaka, ...

The Journal of Infectious Diseases, 1997

In Lusaka, where human immunodeficiency virus seroprevalence in young adults is approximately 25%... more In Lusaka, where human immunodeficiency virus seroprevalence in young adults is approximately 25%, four townships were studied to establish the prevalence of persistent diarrhea in adults and the etiologic importance of cryptosporidiosis in adults with persistent diarrhea. Cryptosporidium parvum oocyst contamination of urban water supplies was measured and the results used to categorize these populations into high or low exposure. In total, 506 adults were reported as having had diarrhea in the 2 weeks prior to the survey; 101 of these episodes were persistent. Adults with persistent diarrhea in the high-exposure areas were more likely to have cryptosporidiosis (odds ratio, 5.14; 95% confidence interval, 1.57-17.2; risk ratio, 1.83; 95% confidence interval, 1.04-3.21; P = .003) although overall prevalence of persistent diarrhea was not greater in these areas. This association was not confounded by animal exposure, travel, or boiling water. Within these urban populations, water contamination with C. parvum was a major influence on the prevalence of infection.

Journal of Health Communication, 2012

Journal of Ethnopharmacology, 1999

Lately there has been increasing interest regarding the practice of traditional healers and their... more Lately there has been increasing interest regarding the practice of traditional healers and their use of indigenous plants to treat illnesses. Twenty-three local healers (n'ganga) in Chiawa, rural Zambia, were interviewed about knowledge, practices, and their use of indigenous plants in the diagnosis and treatment of sexually transmitted illnesses (STIs) among male clients. They were also asked about their perceptions of modern medicine. The study revealed that all the n'ganga diagnosed and treated three main types of STIs. They named them as: songeya, doroba and bola-bola. They treated the illnesses with Strychnos cocculoides; Musa species; Solanum delegoense; Ximenia caffra; Diplorynchus condylocarpon; and Croton megalobotrys. Ten of the n'ganga perceived modern medicine to be effective against STIs and five of them sometimes referred some of the clients to the local health centre. It is being argued that a scheme to incorporate the n'ganga into STD control activities in which they can be utilised to refer clients to modern medical facilities can be beneficial. Given the necessary health information and support, the n'ganga may effectively execute this scheme.

Complementary Health Practice Review, 2008

Collaboration between traditional and biomedically trained health workers is regarded as key in H... more Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre-and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community. He is involved in teaching and research on social aspects of HIV and operation research on various aspects of antiretroviral scaling-up processes.

American Journal of Tropical Medicine and Hygiene, 2010

Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a stu... more Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%). Available AEDs were phenobarbitone (21; 18.9%), carbamazepine (27; 24.3%), valproic acid (4; 3.6%), and phenytoin (3; 2.7%). Adult out-of-pocket monthly costs ranged from US 7to7 to 7to30. Pediatric syrups were universally unavailable. Interviews revealed several barriers to AED provision, including that handling phenobarbitone (historically the most affordable AED) has become increasingly difficult because of newly enforced regulatory requirements. Personal communications with epilepsy-care providers in other low income countries suggest that this problem may be widespread. Improved enforcement of existing drug regulations may be contributing to the AED shortage. Social programs aimed at encouraging people with epilepsy to come &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;out of the shadows&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; must be preceded by improved AED access.

AIDS Patient Care and STDs, 2003

The HIV epidemic in sub-Saharan Africa represents an obstacle to productive employment and econom... more The HIV epidemic in sub-Saharan Africa represents an obstacle to productive employment and economic development. Employers in the region are experiencing severe staff shortages, reduced productivity, and increased costs because of protracted ill health and death among their workforce. The scale of the problem has not been fully estimated and the extent to which it could be ameliorated by control measures including effective treatment of opportunistic infections is not well known. Employers and employees (n = 108) in seven Zambian firms were interviewed to assess direct and indirect costs of illness to the firms. Information was collected on diagnosis and treatment received, duration of illness, time off, and strategies adopted to compensate for absent workers using a combination of questionnaires, structured interviews and focus group discussions. The main causes of ill health were tuberculosis (TB) (46.8%), diarrhea (12.9%), and sexually transmitted diseases (STDs; 5.8%). Annual treatment costs to the firm ranged from Zambia Kwacha (K) 60,000 to 405,000 per person treated. Other firm costs included productivity losses because of ill health, paid sick leave, the cost of employee replacement, and funerals. Employees incurred K 67,773 on average per illness episode. The most common causes of ill health were those most frequently associated with HIV. They can be easily but were often ineffectively treated. Improving disease management would thus reduce wastage and costs both to employer and employee. The extent of the impact in these firms shows the need for the private sector to adopt a stronger role in prevention and care. Further research is required to assess what recommended treatment options might be, how they could be financed, and the extent of the economic impact of HIV on firms. This would foster the development of more appropriate responses to the epidemic in Zambia and the region as a whole.

Background: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing polic... more Background: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP).