Poor management of health care waste poses a serious threat to the health of health care workers, patients and communities. In developing countries, adequate health care waste management (HCWM) is often a challenge. To address this, the Zambian Health Services Improvement Project with HCWM as a component, was implemented in five Zambian provinces (Luapula, Muchinga, Northern, North-Western and Western Provinces), under which this cross-sectional study was conducted to identify the knowledge, attitudes, and practices of health care workers on HCWM. Fifty government hospitals and health posts from five provinces in Zambia were included in the study. Data was collected using a mixed-methods approach, which included surveys with health care workers (n = 394), in-depth interviews (n = 47) with health officials at the provincial, district, and facility levels, and observational checklists (n = 86). Overall, knowledge of proper waste segregation was average (mean knowledge score 4.7/ 7). HCWM knowledge varied significantly by job position (p = 0.02) and not by facility level, years of service, nor prior training. Only 37.3% of respondents recalled having received any sort of HCWM training. Poor waste segregation practice was found as only 56.9% of the facilities used an infectious waste bag (yellow, red or orange bin liner) and a black bag for general waste. This study revealed that only 43% of facilities had a functional incinerator on site for infectious waste treatment. Needle sticks were alarmingly high with 31.3% of all respondents reporting a prior needle stick. The system of HCWM remains below national and international standards in health facilities in Zambia. It is imperative that all health care workers undergo comprehensive HCWM training and sufficient health care waste commodities are supplied to all health facility levels in Zambia.

Background Malnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services. Methods This analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes. Results We found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and

Background: Malnutrition continues to take the lives of millions of children every year. Children under the age of five years are especially susceptible to high rates of malnutrition and more than half of the deaths in under five children are caused by undernutrition in low- and middle-income countries. Zambia continues to have one of the highest rates of malnutrition in Southern Africa, specifically Severe Acute Malnutrition (SAM). The country’s prevalence of under-five malnutrition is above the WHO Public Health threshold which may linked to the observed under-mortality. In this study, we assessed the factors associated with under-5 mortality in children with SAM. Methods: This was a cross-sectional study assessing the factors associated with under-5 mortality in children hospitalized with severe acute malnutrition. The study used data from a cross-sectional study which was assessing factors associated with SAM in under-5 children in five underperforming provinces of Zambia. In this study, we reviewed hospital records from 2014 to 2016 and recorded length of hospital stay, co-morbidities, and death among under-5 children presenting with SAM to select level-one hospitals. Stata version 13 was used for analysis. We conducted both descriptive and bivariate logistic regression to assess the association between mortality and select key factors. Results: We found that over half of the records we extracted listed SAM as the main cause of hospital stay. About one-fourth of under-5 children (24%) were recorded as being HIV positive at time of hospital stay. Malnourished under-5 children who were diagnosed as HIV positive were 3.5 times more likely to die than malnourished under-5 children who were HIV negative.Conclusions: Malnutrition continues to be a problem in Zambia. Undernourished children with existing co-morbidities such as HIV are at greater risk for mortality and poor health outcomes. To combat high rates of SAM, continued efforts are needed to provide adequate nutrition services and care especially in rural areas of Zambia.

Knowledge translation is the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems. In Zambia, research evidence is recognized as a critical element for the development of sound policies. This requires deliberate efforts towards generating, harvesting, and utilizing evidence from research and program data to inform decision-making. In response, the National Health Research Authority with support from the Clinton Health Access Initiative adapted a data to policy curriculum for use at sub-national levels and conducted training for 17 healthcare workers. The objectives of the training were to build the capacity of healthcare workers in analyzing research and other data to inform policy and programming as well as to develop six policy briefs for presentation to policymakers. The curriculum combines epidemiology with economic analysis and modeling to develop informative policy briefs. Sixteen modules were covered and delivered during periodic interactive workshops led by facilitators and mentorship was done in-between sessions. This was done within 6 months from February to August 2022. To assess the participants understanding, Kirkpatrick learning evaluation model was adapted upto level 3; we utilized a pre and posttest method of assessment. At pre-test, about 71% of the participants scored below 50 percent, while at posttest, all the participants scored above 50%. Six policy briefs were successfully developed covering Sexual Reproductive Maternal Newborn Child Adolescent Health and Nutrition topics. Implementation of this program provided a lot of learnings for programs aimed at improving uptake of evidence into action. One of the key learnings was that conducting economic evaluations and mathematical modelling of proposed policy interventions was critical in informing the decision-makers of the cost and benefits of the interventions. Policy options proposed in the policy brief were largely accepted by key stakeholders and proposed for piloting.