Front Line Health Workers’ COVID-19 Lived Experiences: A Case of Levy Mwanawasa Hospital in Lusaka, Zambia

Introduction: Frontline health workers who work in COVID-19 isolation treatment centers are susceptible to developing mental health issues due to the overwhelming workload and stress associated with their job. Thus understanding their lived experiences provides insights that helps alleviate health worker burnout and improving their quality of life thereby leading to an efficient delivery of health care services during a pandemic. Aim: To understand the lived experiences of front line health workers during the COVID-19 pandemics at Levy Mwanawasa Teaching University Hospital. Design and Methods: A qualitative interpretative phenomenological study design was used. Purposive sampling method was adopted to select the 14 participants who took part in the study. The data were collected through face-to-face, audio-taped interviews using an in-depth interview guide, after which the responses were transcribed verbatim before using NVIVO to generate codes. The data were analyzed using thematic method. Results: The lived experiences of the participants were found to be mainly negative with few positive experiences. Their lived experiences were mainly negative emotional and psychological experiences including fear, anger, depression, frustration, anxiety and sadness. The thoughts that were identified included thoughts of surviving through the pandemic, thoughts of getting infected, and dying. The frontline health workers also experienced some personal and professional changes as they offered health services in the COVID-19 wards. The personal changes reported included;social limitations and collapse of extra income business while the professional changes included a change in the way health services were delivered, a gain in knowledge and skills and shaping of a career path. The main challenges experienced were limited resources (man power, resuscitation equipment, drugs, personal protective equipment), limited literature on the disease and limited social interactions. Conclusion and Recommendations: Relevant stakeholders should come on board in order to offer support during a pandemic or a similar situation so as to better the experience of frontline health workers with particular attention directed towards the provision of adequate resources to enable them deliver their services effectively. Frontline health workers perspectives and opinions should be taken into account by the institution’s administrators and policymakers when planning for and managing a pandemic.

COVID-19 Pandemic through the Lenses of Nurses and Midwives in Zambia: Exploring Depression, Anxiety and Stress

Following the declaration of COVID-19 as an international health emergency, Zambia like many other countries implemented measures to limit human interaction and curb the spread of the disease. In the midst of these measures, nurses and midwives continue to provide care to suspected and confirmed cases of COVID-19, which puts them at risk of contracting the disease and compromising their psychological wellbeing. The aim of this study was to assess the levels of depression, anxiety, and stress experienced by nurses and midwives working in health facilities in two districts of Zambia during the COVID-19 pandemic. This descriptive cross-sectional study involving 187 nurses and midwives was conducted between July and December 2020 in selected health facilities in Lusaka and Chilanga Districts. The Depression Anxiety and Stress Scale (DASS) 21 was used to collect the data which was analysed using univariate analysis. Majority of the respondents were female (84%) and mean age at 30.1 (SD 9.05) years, 58.3 percent were married, and 50.84 percent had children. The mean work experience was 6.63 (SD 4.75) years, and 54 percent had worked for less than five years. Overall, 22.5 percent of nurses and midwives reported depression, 52.4 percent had anxiety and almost half (42.2%) had varying levels of stress. Anxiety and stress correlated significantly with working in COVID Isolation departments (P = 0.001). Strategies such as strict adherence to infection prevention measures, seeking help from family and friends and recognition by hospital management were a significant supportive measure (P < 0.001). Nurses and Midwives working directly with COVID-19 patients reported greater incidence of depression, anxiety and stress, similar to findings from previous research around the world. Therefore, efforts should be focused on developing and providing counselling and other support services to mitigate the effects of COVID-19 and enhance psychological wellbeing for health professions.

Use of Research Evidence in Policy and Decision-Making: Views, Attitudes and Practices of Health Policy Makers in Lusaka Province of Zambia

Background: The integration of relevant high-quality research evidence into the health decision and policy formulation process is a key strategy for improving health systems especially in developing countries such as Zambia. However, the lack of capacity to understand and value research evidence by policy and decision makers makes it difficult for them to find and use research evidence in a timely manner even when motivated to do so. This study aimed to establish the views, attitudes and practices of policy makers on the use of research evidence in policy and decision-making process in Zambia. Methodology: This descriptive cross-sectional study was conducted in Lusaka, Zambia among selected public health decision and policy making institutions. A purposive sample of 21 consenting policy makers who were working in different positions in the Ministry of Health Headquarters, Provincial and District Health Offices, Health Professions Regulatory Bodies, United Nations Agencies, International Non-Governmental Organizations and University Deans from the University of Zambia participated in the study. A self-administered questionnaire was used to collect data. The IBM? SPSS? Statistics for Windows Version 20.0 was used for data analysis. Results: The concept of Evidence Informed Health Policy was not well understood such that only less than half (47.5%) of the participants reported having heard specifically about Evidence Informed Health Policy meanwhile almost two thirds (61.9%) reported that they used research evidence in decision making and policy formulation. Similar discrepancy was expressed in the understanding of and use of rapid response mechanisms such that although (47.6%) of the participants reported having heard about it, (57%) had never used rapid response mechanisms for deci-sion-making. With regard to the sources of information, about half (52.3) of the participants reported scholarly articles as their main source of evidence. Con-clusion and Recommendations: There is need for more sensitization and ca-pacity building among the decision and policy makers on the importance of using research evidence in decision and policy making process as incorporation of relevant high-quality research evidence into the health policy making pro-cess is a key strategy for improving health systems.

Perception of the Community towards Child Sexual Abuse: A Case of Chawama Lusaka, Zambia

A number of scholars have reported high incidence of sexual abuse cases among children in the communities. However, little is known about the perceptions the community people have towards child sexual abuse cases. Therefore, this study aimed to explore the perception of the community towards child sexual abuse which hinders the disclosure and reporting of abuse cases. Data were collected through focused group discussions and indepth interviews, with sixty nine participants from nine (9) focused group discussions and nine (9) indepth interviews. Participants were the general community members and relatives to abused children. The interviews were recorded verbatim and transcribed;analysis of data was done using qualitative thematic analysis. Three themes emerged summarizing the factors associated with non-reporting of child sexual abuse cases which included, fear of family and community breakdown, relationship between the victim and the perpetrator and inadequate service provision by the police which also reflected the community’s role in supporting the child. In conclusion the study therefore showed that child sexual abuse is common in Zambia and cases are still on the increase. However, there is great need to enforce laws regarding sexual abuse and in addition great change in attitude is needed to prevent occurrence of cases.

Mental Health Problems Experienced by HIV Positive Adolescents;A Case of Choma District, Zambia

Several scholars have reported high mental health problems among adolescents with Human Immunodeficiency Virus (HIV) globally. However, little is known about the mental health of this peculiar group of young people in Choma district. This study aimed to determine the mental health problems experienced by HIV positive adolescents in Choma District. Using the Strengths and Difficulties Questionnaire (SDQ), data were obtained from 103 HIV positive adolescents receiving treatment at Choma General Hospital plus a corresponding number of parents/care givers. Information about mental health services was obtained qualitatively from 10 nurses working in the mental health unit and the Antiretroviral (ART) clinic. The results showed that more than three quarters of the adolescents had mental health problems. Of this number, 57.3 percent had multiple mental health problems: predominantly emotional and peer problems. The study also found a statistically significant relationship between level of stigma and presence of mental health problems (X2 = 1.123, P = 0.003). In conclusion, the study demonstrated that multiple mental health problems particularly emotional and peer problems are prevalent among adolescents with HIV/AIDS yet are most often undiagnosed. In addition, adolescents with high levels of internalized stigma are more likely to have multiple mental health problems. The findings suggest the need to integrate psychiatric services into routine care of HIV infected adolescents, routine screening for mental health problems and provision of continued professional development among nurses managing these patients.

Predicting Postnatal Psychological Distress in a Zambian Cohort: Relationship between the EPDS and the GHQ-12

Postnatal mental distress is a public health problem and women screening positive of psychological distress who do not meet the diagnostic criteria for psychiatric disorder may be experiencing significant distress for which they might require assistance from mental health personnel. The risk of a woman experiencing psychological distress during the postnatal period can be predicted before it occurs. The study included 300 pregnant women who were selected systematically and on whom two assessments were conducted at two different points. The first assessment was conducted at 32-week gestation while the second one at six weeks following childbirth. The participants were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the General Health Questionnaire (GHQ-12). Analysis of Variance (ANOVA) was used to test the association between the EPDS and the GHQ-12 while logistic regression analysis was carried out in order to predict postnatal psychological distress. The results showed no significant difference between the socio-demographic characteristics and the EPDS score. A significant association was found between the GHQ-12 and EPDS scores (r = 0.545;p = 0.001). Logistic regression revealed that a single predictor, antenatal EPDS individual score, alone provided a highly adequate model and was statistically reliable in distinguishing between presence and absence of psychological distress in the postnatal period (&minus;2 log likelihood = 225.634;CI (1.035 - 1.173);X2 (1) 9.633, p = 0.002). The study revealed a correlation between EPDS score and GHQ-12 and that the EPDS can predict postnatal psychological distress using the data from the antenatal period. Therefore, patients who are found with antenatal psychological distress should be consistently evaluated throughout pregnancy and during the postnatal period to allow for early detection and intervention of postnatal psychological distress.

Confinement Following Child Birth and Associated Postpartum Mental Distress

Objective: This study sought to explore confinement following childbirth and its association with mental distress. Methods: A descriptive-analytical cross sectional study design was used. The study was conducted in two districts of Zambia representing an urban and rural setting, targeting parenting mothers during the first two months after delivery. Systematic random sampling technique was used to select the participants. Every second case seen at the study sites between March to August 2017 was selected to participate in the study. The data were collected using the Edinburgh Postnatal Depression Scale and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Pearson correlation coefficient was used to determine the relationship between the dependent and independent variables while binary logistic regression was used to check the combined impact of independent variables on mental distress. Ethical approval was obtained from the local Research Ethics Committees. Participation in the study was voluntary. Results: A total of 200 women participated in the study. The results revealed a high prevalence of mental distress, with 42 percent of women reporting severe levels, and 36.0 percent showing moderate levels. A statistically significant relationship was found between mental distress and confinement (X&#178 = 29.289;P = 0.001), residential type (X&#178 = 16.863;P = 0.001), and age (X&#178 = 17.996;P = 0.006). Suicidal thoughts during confinement were also found to be prevalent in 16 percent of the participants. Binary logistic regression revealed that changes in confinement period from below 2 weeks to between 2 weeks and 1 month raised the odds of suffering mental distress 5.127 times while changes from a confinement period of between 2 weeks and 1 month to over 1 month raised the odds of suffering mental distress 7.737 times. Conclusion: The study results confirmed an association between confinement and mental distress, revealing that the longer the confinement, the more at risk the women were of mental distress.

Community Attitudes towards Child Sexual Abuse: A Case of Chawama Lusaka, Zambia

Background: Child sexual abuse continues to be an issue of great concern and recognized as a public health problem in Zambia. Hence the study examined community attitudes and beliefs that shape communities perceptions towards child sexual abuse, the interaction between adults and children which consequently hinder reporting of child sexual abuse cases. Methods: A qualitative study design was employed. Nine focus group discussions (FGD) with 49 participants comprising 5 to 6 participants in each FGD and nine indepth interviews guided by an interview guide were used to collect data. Participants were selected using purposive sampling. The collected data were transcribed verbatim and analyzed using thematic analysis. Results: Two major themes namely: 1) Defilement, an unacceptable yet concealed phenomenon, and 2) Parental negligence as a major contributor to child sexual abuse, emerged from the data. Participants highlighted that communities regarded child abuse to be necessary for reported only if the abused child was less than 5 years old, a female, and if the trauma the child was subjected to was severe. This was because older girls were seen to be able to have consensual sex, and boys were traditionally viewed as being strong and thus, not report most cases. Parents were also seen to be losing control over their children as most of them were involved in excessive alcohol intake, leading to failure in managing their children. Poverty was another aspect reported to have led parents to send their children into prostitution. As a result parents could not report, as they felt they partly contributed to their children being sexually abused. Conclusion/Recommendations: The study showed that communities do not accept child sexual abuse, but yet they were reluctant to report the cases. It is imperative therefore, that communities learn the importance of reporting sexual abuse cases;as failure to report is risky behavior that can put the abused child and others at risk of other negative vices too.