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Evaluation of Health Facility Performance in Childhood Immunization Services in Selected Facilities of Sikongo District in the Western Province of Zambia
(2026) KANKUNGA, Humphrey
Despite the fact that immunization is an essential component of all countries, there are still gaps in terms of coverage, timeliness and equity in several parts of those countries, especially in low resource settings. The primary aim of this dissertation was to identify the gaps within the immunization programs of Sikongo District in the Western Province of Zambia by assessing various aspects of the immunization records of children within health facilities in the
district. A retrospective cross-sectional study was performed using the child health registers and under 5 cards in five health facilities. Each document was scored for its quality according to the completeness of the documents, availability of the documents, legibility of the documents and accuracy of the information within those documents to create a document quality index (DQI). Based on Zambia’s EPI cycle vaccine specific coverage, the percentage of children who drop
out between doses of the vaccines was calculated, as was the percentage who received each of the three types of doses (early, on time, and late). Tests that did not assume anything about the distribution of variables within the sampling areas were used to compare the facility-level comparisons. Such as the Pearson’s chi-square test. Additionally, logistic regression was used to determine which variables were associated with the likelihood that a child would be late in
receiving the complete immunization series or would be fully immunized. The indicator pathway that linked vaccination documentation to vaccination itself and timeliness in receiving the vaccines was calculated using linear mixed modelling techniques. Spatial autocorrelation analyses (both global and local Moran’s I statistics) were used to determine which geographic areas within the selected catchment areas of Sikongo District in the Western province of Zambia had high vaccine coverage for several antigens and which had lower rates, including any villages that exhibited “cold spots” in relation to vaccination. The documentation quality index (DQI) for all primary vaccination records was
generally high; 80.6% of documentation records had high DQI scores and low instances of missing variables or missing data. Furthermore, vaccination quality was significantly associated with full immunization (95% of the children who were fully immunized had documentation records that reflected high DQI scores). However, this association requires cautious interpretation as both measures were derived from the same documentation. Coverage exceeded 95% for DTP1–3 and IPV with minimal dropout between intermediate doses. Higher dropouts were observed between BCG and OPV0 as well as between IPV and MR1(4.6% and 6.6% respectively). The timeliness of these vaccines was lower than the coverage. While birth doses were generally administered in time with more than 80% of BCG and OPV0 doses administered within the recommended timeliness window, timeliness declined for later doses, with only around one third of DTP3 and IPV doses administered within the recommended age window. Overall, 53.4% of children had at least one late dose. Nyengo and Tuuwa had the highest mean vaccine coverage among the five selected facilities. Mwenyi had the lowest. Spatial analysis identified areas with clustering of fully immunized children and villages with few fully immunized children. Children who lived further from the clinics, who missed more clinic appointments, and who were classified as “defaulter” children had higher odds of being late or not being fully immunized. Higher documentation quality is associated with lower odds of late or incomplete immunization. This relationship is to be interpreted cautiously as the documentation quality and vaccination outcomes were derived from the same routine records. The sex of the child was not associated with the outcomes, as was the number of health workers at the clinics or the number who performed health outreach within the clinics. The five clinics had high vaccine coverage for several antigens and documentation of those vaccinations. However, there were gaps in the rates of success with providing birth doses and MR1 vaccines to the children, and the timeliness with which they received those vaccines. Greater distance to the health facility was associated with poorer immunization outcomes. Most underperforming facilities were in Mwenyi. for the clinics include the administration of catch-up vaccines for MR1 vaccines, strengthening immunization programmes within underperforming clinics, improving the provision of birth doses (especially to Nyengo clinic), improving appointment management and defaulter management within clinics, and performing health outreach to the specific villages with identified gaps in providing vaccines to their populations. Additionally, timeliness within clinics should be more closely monitored, and documentation processes should be strengthened, standardised and streamlined across facilities.
Determinants of Anaemia among Children aged 6–59 Months in Zambia: A Multilevel Analysis of the 2024 ZDHS
(2026) MWILA, Gabriel
Anaemia among children aged 6–59 months remains an important public health problem globally, particularly in low- and middle-income countries. The condition is associated with impaired cognitive and motor development, increased susceptibility to infection and other adverse child health outcomes. In Zambia, nationally representative evidence shows a substantial burden of childhood anaemia. However, determinants operate at individual, household and community levels, and conventional single-level analyses may not adequately account for the hierarchical structure of Demographic and Health Survey data. This study therefore examined the prevalence and factors associated with anaemia among children aged 6–59 months in Zambia using the 2024 Zambia Demographic and Health Survey (ZDHS). This was a quantitative, analytical cross-sectional study based on secondary analysis of the 2024 ZDHS. The study population comprised children aged 6–59 months with available haemoglobin measurements and information on selected explanatory variables. Of 8,673 children initially identified, 3,393 were eligible for the analytical dataset after exclusion of observations with missing or incomplete information; 3,300 children contributed to the final weighted analytical estimates. Descriptive and bivariate analyses were used to estimate prevalence and examine crude associations. A multilevel mixed-effects binary logistic regression model with a random intercept for enumeration areas was fitted to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Statistical significance was assessed at a two-sided alpha level of 0.05. The hierarchical modelling strategy progressed from a null model to child-level, maternal-level, household/community-level and fully adjusted models. Model fit was assessed using AIC, BIC, likelihood-ratio testing, ICC and MOR. In the analytical sample, 52% of children aged 6–59 months were classified as anaemic. Children aged 24–59 months had lower odds of anaemia than children aged 6–23 months (AOR=0.55; 95% CI: 0.43–0.71). Children who had experienced fever in the preceding two weeks had higher odds of anaemia (AOR=1.64; 95% CI: 1.25–2.17), as did underweight children compared with children of normal weight (AOR=1.69; 95% CI: 1.13–2.54). Children who had received deworming medication had lower odds of anaemia (AOR=0.76; 95% CI: 0.58–1.00). Compared with children from the poorest households, those from poorer households had lower odds of anaemia (AOR=0.66; 95% CI: 0.49–0.90), while the association for the richest households was also in the lower-odds direction (AOR=0.53; 95% CI: 0.29–0.97). Rural residence was associated with lower odds of anaemia compared with urban residence (AOR=0.71; 95% CI: 0.52–0.97). The final model retained residual community-level clustering, with an ICC of 6.6% (95% CI: 2.7–15.4) and MOR of 1.59. Childhood anaemia remains common among children aged 6–59 months in Zambia. The findings indicate that age, recent fever, underweight status, deworming, household socioeconomic position and residence are associated with anaemia after adjustment for measured covariates. The persistence of community-level variation supports the use of multilevel approaches and indicates that prevention requires integrated child nutrition, infection prevention and socioeconomic interventions.
Keywords: Anaemia; children aged 6–59 months; Zambia; Zambia Demographic and Health Survey; multilevel analysis; odds ratio; child nutrition; epidemiology.
Prevalence of Urinary Tract Infection Pathogens and Their Antimicrobial Susceptibility Patterns at Choma General Hospital
(2026) MBEWE, Lillian
Urinary tract infections (UTIs) are common bacterial infections that contribute substantially to patient morbidity and are increasingly complicated by antimicrobial resistance. This retrospective cross-sectional study analyzed urine culture and antimicrobial susceptibility data from 386 samples processed at Choma General Hospital between June 2024 and May 2026 using Stata version 14. Culture-confirmed UTIs were detected in 113 samples, giving a culture-confirmed UTI prevalence of 29.27%. Escherichia coli was the predominant uropathogen, accounting for 51.3% of all isolates, followed by Enterobacter agglomerans (15.9%) and Staphylococcus aureus (9.7%). Females had a significantly higher prevalence of culture-confirmed UTIs than males (p = 0.003), while patients aged 65 years and above exhibited the highest burden of infection (p < 0.001). Meropenem, ceftriaxone, nitrofurantoin and piperacillin-tazobactam demonstrated the highest effectiveness against most uropathogens, whereas substantial resistance was observed to ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin and several other commonly used antibiotics. These findings highlight the need for routine surveillance of uropathogens and antimicrobial resistance patterns to guide empirical therapy, improve patient outcomes, and strengthen antimicrobial stewardship efforts at Choma General Hospital.
Keywords: Urinary tract infections, uropathogens, Escherichia coli, antimicrobial susceptibility testing, antimicrobial resistance, Zambia.
Outcomes of the Integrated Community Malaria Case Management (iCCM) Programme by Community Health Workers in Ibenga Catchment Area, Mpongwe District, Zambia: A Cross-Sectional Study
(2026) KAKUBO, Esther
Malaria remains a major cause of morbidity and mortality among children under five years in Zambia, particularly in rural and hard-to-reach communities where access to health facilities is limited. Integrated Community Case Management (iCCM), delivered by trained Community Health Workers (CHWs), and brings malaria diagnosis and treatment closer to communities. This study assessed the coverage, reported adherence to malaria treatment guidelines, and factors influencing utilization of iCCM services in Ibenga Catchment Area, Mpongwe District, Zambia. A quantitative cross-sectional study was conducted among 403 participants comprising 384 caregivers of children under five years and 19 CHWs. Data were collected using structured questionnaires and CHW assessment tools and analysed using IBM SPSS Statistics version 27. Descriptive statistics, chi-square tests and binary logistic regression were performed.
Associations were reported using adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with statistical significance set at p < 0.05. iCCM coverage was high, with 88.0% of households reporting previous use of CHW malaria
services. Among caregivers reporting a child with recent fever, 75.9% first sought care from a CHW. Self-reported adherence to key malaria treatment practices was high, although only 15.8% of CHWs had received refresher training within the previous year. Overall, 88.6% of children recovered. Distance to the nearest CHW was strongly associated with utilization (aOR = 0.13, 95% CI: 0.07–0.25; p < 0.001), while caregiver education was also
independently associated with utilization (aOR = 0.56, 95% CI: 0.32–0.98; p = 0.043). The iCCM programme in Ibenga achieved high coverage and community uptake, with good reported treatment practices and clinical outcomes. However, geographic distance remains an important barrier to equitable utilization, while limited refresher training may affect programme sustainability. Improving the geographic distribution of CHWs and outreach services, strengthening routine refresher training and CHW incentives, and independently verifying CHW adherence are recommended to improve equitable access and sustain the quality of iCCM services.
An Investigation of Maternal Health Factors contributing to Birth Outcomes at Shampande Peri Urban Health Centre in Choma District if Zambia
(2026) NYIRENDA, Taonga Doricah
Adverse birth outcomes (ABOs), including preterm birth (PTB), low birthweight (LBW), and birth asphyxia, remain a leading cause of neonatal morbidity and mortality worldwide, with the highest burden concentrated in sub-Saharan Africa. In Zambia, notwithstanding ongoing maternal health programmes such as Saving Mothers, Giving Life (SMGL) and the progressive shift toward universal health coverage, rates of adverse birth outcomes continue to exceed national targets. Peri-urban settings such as Shampande in Choma District occupy a unique epidemiological space, combining the infrastructural deficits characteristic of rural environments with the population density and rapid demographic growth typical of urban areas. These communities face specific challenges including inequitable access to quality antenatal care (ANC), socioeconomic instability, and a relative absence of locally grounded research examining the determinants of adverse birth outcomes. To date, no study has specifically investigated maternal health factors contributing to birth outcomes in the Choma District community of Shampande, creating a critical evidence gap for district-level health planning and resource allocation. A facility-based, unmatched case-control study was conducted at Shampande PeriUrban Health Centre inChoma District, Zambia. Cases comprised mothers who delivered a live singleton neonate with at least one of the following adverse outcomes: low birth weight (birth weight <2,500 grams), preterm birth (gestational age <37 completed weeks), or birth asphyxia (Apgar score <7 at five minutes). Controls were mothers with normal singleton deliveries (birthweight ≥2,500 grams, gestation ≥37 weeks, Apgar ≧7 at five minutes). Atotal of 400 maternalneonatal records spanning January 2020 to September 2025 were reviewed and included in the final analytical dataset. Data were extracted from ANC booking cards and maternal-newborndelivery registers. Binary logistic regression was performed using Stata version 14.2 to assess bivariate and multivariable associations between maternal sociodemographic, obstetric, nutritional, and ANC utilisation factors and each adverse birth outcome. Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI) are reported. Ethical approval was obtained from the University of Lusaka Research Ethics Committee (UNILUS-REC) prior to data collection. Of 400 records, 170 (42.5%) experienced an adverse birth outcome: 67 (16.8%) had low birth weight, 102 (25.5%) had preterm birth, and 24 (6.0%) had birth asphyxia. These prevalence ratessubstantially exceed Zambia's national estimates of 7% for PTBand 12.4% for LBW. The mean maternal age was 25.4 years (SD ±5.6). Adolescent mothers (aged <20 years) constituted 17.0% of the sample, and 67.1% of all women booked late (at ≥13 weeks of gestation). Anaemia (haemoglobin <11 g/dL) was detected in 29.7% of women with available haemoglobin data (n=350). In the multivariable model for combined adverse outcomes, younger maternal age group was significantly associated with lower odds of adverse birth outcomes (AOR 0.67; 95% CI 0.48–0.93; p=0.018). Peri-urban residence independently doubled the adjusted odds of LBW (AOR 1.89; 95% CI 1.04–3.45; p=0.037). Adequate ANC attendance (≥4 visits) was protective against LBW (AOR 0.53; 95% CI 0.29–1.00; p=0.049). HIV-positive status (9.8%) was not a significant predictor of adverse outcomes in any model, indicating effective PMTCT service delivery at the facility level. This study provides the first context specific quantitative evidence on maternal determinants of adverse birth outcomes in peri-urban Choma District, Zambia. The findings establish a locally grounded evidence base that national survey data cannot supply, and directly inform targeted interventions in ANC quality improvement, anaemia prevention, adolescent reproductive health, and peri-urban health equity. The study contributes to Zambia's progress toward Sustainable Development Goal 3.2.