Breaking the taboo surrounding menstrual hygiene management in schools, a case of David Kaunda Technical School in Lusaka

Mapalo. M. Chungu getting instructions from the Matron at David Kaunda National Technical School, Mrs Ikowa Ida

Mapalo Chungu, a 14-year-old grade 9 pupil from David Kaunda Secondary School, was gripped with fears of menstruation when she first attended boarding school. There was basic knowledge of maintaining good menstrual hygiene practices at the school, and this always sent chills in her.

However, having the confidence to attend school all the time can make the difference between succeeding and dropping out for many adolescent girls. Thus, CIDRZ came up with a Menstrual Hygiene Management course and toolkit for teachers which is being used to educate pupils, both boys and girls.

While some people treated this opportunity with derision and opted out, curiosity got the better of Mapalo and she decided to attend. Today, she is an inspiration to many at her school.

MHM Crisis due to Lack of Knowledge

Mapalo confessed that at first, she was not comfortable going to school during her menstrual period days. Though she attended class despite the distress, many girls who lack knowledge of how to manage their menstruation are reported with recurrent absenteeism in school every month which subsequently affects their studies.

For, they would not even take part in extra-curricular activities, stay away from the playgrounds and never take part in outdoor activities during their menstrual days due to the possible embarrassment and the pain it brings.

The school matron in charge of the sick bay, Ms. Ikowa Ida, says,

“Previously, when the girls would stain themselves the boys would laugh at them. I used to find sanitary pads in the shower, on the soap racks, sometimes they would try to flush them down the toilets. It used to block somewhere then open on the other side of the fence. As a result, there would be infections that came because someone could not change the pad or dispose it in the right way.”

This poor sanitary condition contributed to dysentery, at some point in time, at David Kaunda National Technical School in Lusaka.

Introduction of MHM Toolkit brings revival

During the training, the facilitator taught on what menstruation is, the different cycles, what you use when you are undergoing this process and most important part of all was breaking the silent taboo of discussing the topic between boys and girls.

Mapalo M. Chungu demonstrating what she had learnt through the training

Mapalo recalls,

“They taught us how to be more open and free about the topic without having any feeling of regret, doubt or fear. I shared the information with my roommates and they were like, ‘Ah! The boys didn’t laugh and start making jokes when you were done?’ When I reassured them that was not the case, the next day I came with one, the next day another one, then the last day everyone came. They also appreciated the programme.”

Matron Ikowa also recalls,

“What we found very interesting and what was not there before is the involvement of boys. We found the teaching useful for everyone! The boys said they were going to help their sisters at home. The MHM toolkit has helped keep our environment clean. It has helped the first-time girls be aware of what is happening to them. The course has helped the big girls manage their menstrual cycle whether they have light or heavy flows. Apart from that, it has helped us know that when girls are on their menstrual they should not just rely on the sanitary pads that they buy in the shops. That they can also improvise using the washable pads that they were taught to make and use.”

The girls were also advised on precautionary measures to take the pain away such as taking warm water and painkillers that came along with the MHM toolkit supplies.

“I realised that there are people in boarding in similar situations who also go through menstruation and still manage to have a normal life. It shouldn’t be something that drags you down or affects other school programs. It prepares me for adult life and some other intense circumstances,” says Mapalo.

At the hostels, there has been a lot of change. There has been an improvement in the disposal of sanitary pads and general hygiene. Now the girls change their pads regularly and infections have reduced.

Preparing for a Hygienic Generation

Matron Ikowa says,

“I now freely talk about menstrual hygiene management regardless of who is there. I would recommend that it should be implemented in the school curriculum so that the children can grow up with it and the next generation can be better than ours.”

Today, Mapalo serves as an example to rest of the students. They started taking interest in maintaining the sanitary blocks and making the students aware of the best hygiene practices.

Dr Craig Wilson visits CIDRZ

(l-r) Dr Chileshe Mabula and Mbaita Shawa both UAB Sparkman Center – CIDRZ HealthCorps Fellows; Dr Craig Wilson; Dr Roma Chilengi, CIDRZ Chief Scientific Officer; and Dr Izukanji Sikazwe, CIDRZ CEO

CIDRZ is pleased to have hosted Dr. Craig Wilson, Director of University of Alabama at Birmingham (UAB) Sparkman Centre for Global Health. Dr. Wilson a Professor of Epidemiology Pediatrics and Microbiology  made a presentation on “Community mobilization for HIV prevention and impact on the Continuum of Care in 15 cities in the US” at the CIDRZ research meeting.

Notable from Dr Wilson’ presentation were lessons and experiences leading to the formation of an Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) in the United States of America, a network funded primarily by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) with Office of AIDS Research funds and supplemented by National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA) and the National Institute on Minority Health and Health Disparities (NIMHD) focusing on youth aged 12-24 years.

The ATN community initiatives were implemented from 2002 to 2016 through a model, Connect to Protect (C2P): Mobilizing Communities for Structural Change to Impact HIV/AIDS conceptualized In 2001, when half of all new HIV infections were among people 25 years and younger, HIV determinants were viewed through a narrow lens, individual-level interventions were primary focus and limited collaboration with stakeholders outside of traditional HIV prevention and care..

Dr Craig Wilson

The C2P model is based on the “Community Empowerment Framework” that emphasizes seven factors for successful coalition development and function namely, defining a clear vision and mission, strategic planning, coalition leadership, providing resources to mobilizers, documentation of coalition efforts and feedback on progress, technical assistance and making outcomes matter.

The  central focus of C2P was the identification of local social and structural factors that impede HIV prevention and treatment in youth and utilized the power of community stakeholders to bring about structural level changes that would be difficult for any single organization to achieve independently.

Dr. Wilson has nearly 15 years of experience in Zambia working predominantly on capacity building programs supported by PEPFAR and working  with CIDRZ, Ministry of Health and UNZA SOM.

His first  Zambian visit was in 1998 before CIDRZ was operational to establish HIVNET 025 study and returned in 2004 to support CIDRZ scale up efforts and trainings. He facilitated technical aspects of Kalingalinga laboratory remodeling and establishment  from 2004 to 2006 and did clinical trainings (pediatric and adult) in Lusaka, Southern and Eastern Provinces.

CIDRZ holds research symposium

CIDRZ CEO Dr Izukanji Sikazwe

Since inception, CIDRZ has been committed to answering research questions relevant to improving health in Zambia. The work, ranging from pharmacokinetic, behavioural studies, individual and cluster-randomized trials to large multi-country programme evaluations, aims at identifying locally-relevant, culturally-acceptable, resource-appropriate, evidence-based interventions that will influence policy and thus raise healthcare service delivery in the public health sector.

CIDRZ research teams are supported by a research and regulatory infrastructure with dedicated staff skilled in regulatory affairs, human subjects protections, Good Clinical Practices, quality control and assurance, data management, analysis, and research pharmacy and laboratory. The findings are disseminated at local, regional and international meetings after sharing with the Ministry of Health.

CIDRZ Chief Scientific Officer, Dr Roma Chilengi

In all its work CIDRZ strives to contribute to the Zambian healthcare system through innovation in programming and as part of achieving the above, a one-day scientific symposium centred around diversifying research funding was held on the 6th of November 2017.

The symposium brought together CIDRZ researchers, Principal Investigators (PIs) and Board members to showcase current CIDRZ research activities and see how best to build a vibrant research practice at CIDRZ.

CIDRZ Grants and Contracts Consultant, Jill Morse said

“a more targeted strategy for financial diversification among our grants will be developed, department-level business plans will be created to identify key types and potential areas for funding, and business development at the departmental level will be tied to key strategic plan targets for revenue concentration”.

CIDRZ Head of Community, Musonda Musonda, talking about the adolescent programme during the symposium

CIDRZ Chief Scientific Officer Dr Roma Chilengi said CIDRZ had a lot of opportunities in its training programs.

“Our HealthCorps Fellowship program has produced critical -thinking scholars in the areas of clinical trials, implementation science, health systems strengthening, laboratory science, HIV/AIDS, Tuberculosis, Hepatitis and Enteric Disease, Non-Communicable Diseases, Women’s cancer control, Reproductive & Maternal Health, Newborn & Child Health, Water, Sanitation & Hygiene and data analysis.

The quality of fellows we produce at CIDRZ could contribute immensely to research work in the organisation. And being the largest healthcare related non-governmental organisation in Zambia, our laboratory would compete favorably in sub-Sahara Africa”.

CIDRZ Board Member, Dr Mike Saag of UAB during the Symposium

Some of the research presentations included:

  • Hepatitis B by Dr Michael Vinikoor, which looked at the growing global recognition of Hepatitis B by stakeholders and what CIDRZ has accomplished around HBV since 2003. CIDRZ work in this area has the potential to make the organisation the leading African implementer of HBV research and programmes.
  • Factors associated with Rotavirus vaccine failure in Zambiainfantsts by CIDRZ PhD candidates, Michelo Simuyandi, Natasha Labana and Katayi Kazimbaya.
  • The aetiology of diarrheoa among Zambia infants presenting with moderate and severe diarrhoea in Zambian health facilities byCarol Chisenga, John Mwaba and Neha Buddhdev.

Deputy Director Health Systems Strengthening and Primary Care, Cheryl Rudd-Mallaghan presenting on Finding Efficiencies in Zambia’s Immunisation Supply Chain

Other presentations were on studies and programs: Better Information for Health in Zambia; Community ART for Retention in Zambia; ART Readiness in HIV-infected Pregnant Women; Finding Efficiencies in Zambia’s Immunisation Supply Chain;  and Reaching At-Risk Adolescents through Facility-Based Youth-Friendly Services.

And CIDRZ Board Member, Mr. Charles Mpundu, said “listening to the different presentations gives an idea of not only the skill-set CIDRZ has, but also the amount of work and dedication that goes into the various programs.

The insights the Board Members have received here today would not have any impact had we just read about it. Given the amount of work done, there is need to package the information in a simplified way for more people to understand and eventually attract more financial support.”

CIDRZ Awards Bauleni Compound Landlords for Improving Sanitary Conditions in their Housing Units

CIDRZ has awarded 12 landlords for improving their toilets in Bauleni Compound under the organisation’s behavioural change meetings dubbed ‘Indaba Yama Landlords’ (meeting of landlords).

This is under the CIDRZ, in collaboration with the London School of Hygiene and Tropical Medicine project which is aimed at ‘Sanitation Demand: Creating Demand for Sanitation in Peri-urban Areas or SanDem.’

A total of 508 Landlords participated in Bauleni Compound and each of them was asked to make four improvements to their toilets:

  • Initiate the ‘pamodzi’ cleaning rota for the toilets which would involve the participation of all households within a housing unit;
  • Provide an inside lock to ensure privacy in the toilet;
  • Provide an external lock to the toilet to ensure that toilets are kept clean all the times and used responsibly; and
  • Provide a cover pan to reduce the smell.

One of the Landlord recipients being rewarded for taking sanitation seriously on her plot during the prize-giving ceremony in Bauleni Compound.

Meetings were held with landlords to sensitise them on the key issues including the building of improved toilets. Within a period of four weeks, we saw great improvement as some landlords worked on all the four requirements and some went further and bought modern fittings including cisterns, while others even started the process of constructing new toilets. This elated the CIDRZ SanDem project who decided to award the outstanding landlords with various prizes.

The SanDem project is funded by the U.K. Department for International Development (DFID) under the Sanitation and Hygiene Supply for Equity (SHARE) project.

The project is designed to create demand for sanitation in peri-urban areas of Lusaka such as Bauleni Compound through formative research, innovation, and intervention. The aim is to determine how far a state-of-the-art communication approach to behaviour change can enhance demand for and acquisition of improved toilets in urban Zambia.

Simple improvements made to pit latrine toilets

Evidence shows that poor sanitation and exposure to human excreta have been implicated in the transmission of many infectious diseases including diarrhoea, cholera, typhoid, intestinal worms, infectious hepatitis, trachoma among many others.

Globally, diseases related to water and sanitation are one of the major causes of death in children under five years old. About 4 billion cases of diarrhoea occur per year, causing 1.8 million deaths among children under five. Therefore improving sanitation is an effective and sustainable means to reduce the risk of infection,  the severity of infection, and ultimately, morbidity and mortality.

The United Nations Children’s Fund and the World Health Organization report that about 2.5 billion people have inadequate toilets globally, and almost one billion defecate in the open.

In Zambia, out of a population of ≈15 million, 5.6 million have no safe toilets and 2.3 million defecate in the open.

 

CIDRZ Holds First Lusaka District Medical Doctors Clinical Meeting

Dr Monde Muyoyeta, CIDRZ Director of TB Programmes

CIDRZ organised the first ever Medical Doctors Clinical Meeting for Lusaka District to, among other things, give an update on the cholera situation in Lusaka and discuss ways in which the organisation can better work and coordinate with the Lusaka District Medical Office to bring health services as closer to the people as possible.

 
CIDRZ works with the government of Zambia, in ensuring equitable access to quality healthy services to all, as closer to the community as possible.
 
CIDRZ took this opportunity to share with the medical staff on its overall work which centres around its mission: “To improve access to quality healthcare in Zambia through innovative capacity development, exceptional implementation science and research, and impactful and sustainable public health programs” as per mission.
 

Lusaka District Health Director, Dr Namani Monze

Some of the presentations during the Meeting included the “Intensified TB Case-Finding” by CIDRZ Clinical Care Specialist, Dr Mary Kagujje, Isoniazid Preventive Therapy and TB in Children by Dr Monde Muyoyeta, Director of TB Programmes. These presentations aimed at strengthening ways of identifying cases of TB infections with the aim of ensuring that we achieve not only HIV epidemic control but TV as well.

 
It was an interactive forum that brought together 33 medical doctors working under different hospitals and health centres within Lusaka District.
 
In closing the meeting, CIDRZ Lusaka Province Coordinator, Dr Daniel Mwamba said the meetings would be held quarterly and will be an opportunity for different medical personnel to present on their areas of work in the facilities.

Continuous Professional Development Training: Good Clinical Practice Guidelines and Introduction to Epidemiology and Biostatistics

Call for Training Applications for Continuous Professional Development Short Courses

Accredited by the Health Professions Council of Zambia (HPCZ)
for Early and Mid-Career Research and Healthcare Professionals
Taught by CIDRZ and UNZA School of Public Health Faculty

NEW! Deadline for Applications     17:00hrs Friday 5th January 2018

 

17 – 19  January 2018
Good Clinical Practice (GCP) Guidelines for Clinical Trials

GCP is an international ethical and scientific quality standard for designing, conducting, recording, and reporting clinical trials that involve the voluntary participation of human subjects. Compliance with GCP provides assurance that the rights, safety, and well-being of trial participants are protected, are consistent with the principles that have their origin in the Declaration of Helsinki, and that the trial data are credible.

Holding Certification in GCP is required prior to undertaking clinical research in Zambia and internationally.

  • Understand and explain current International Conference on Harmonization/GCP requirements and their application to clinical trials in Zambia
  • Describe Investigator and Sponsor responsibilities and the role of Institutional Review Boards
  • List key essential documents required for a clinical study
  • Understand basics of clinical data management, and study document management and storage
  • Define quality control and quality assurance in clinical research
  • Learn to write Standard Operating Procedures

 

22 – 26 January 2018
Introduction to Epidemiology and Biostatistics
Epidemiological research is an important tool in the study of the natural history of infectious and non-infectious diseases and assessing health effects in populations. This course will provide key epidemiological concepts and an understanding of study designs used to answer research questions. It will focus on the basic principles and methods of epidemiology and biostatistics with an emphasis on the design and interpretation of epidemiological studies. Statistical methods will be integrated into the epidemiological content, and practical sessions will make use of relevant computer software.

  • Debate principles of research, differentiate between basic and applied research, and qualitative and quantitative approaches
  • Identify a research problem, formulate a research question, and hypothesis
  • Practice and evaluate research methodological considerations and choose appropriate designs, techniques and tools
  • Receive introduction to epidemiological thinking, basic concepts, and define common epidemiological terms

Course Information:

  • Facilitators are Centre for Infectious Disease Research in Zambia (CIDRZ) and University of Zambia School of Public Health faculty with broad teaching and research experience.
  • Illustrations will use epidemiological data from developing countries, investigations of communicable and non-communicable diseases, and aetiological and public health studies.
  • Training is student-centred and includes lectures, small group discussions, seminars, and case studies.
  • Students are expected do additional reading and exercises outside of class, and bring their own laptop.

Who Can Apply:
Applicants must hold a basic degree in a science or relevant field, be involved in clinical research or healthcare provision, and commit to attending the full course of 8 hrs per day.

Fee Per Course Per Student (includes tea breaks and lunch):
GCP     K3,000
Epidemiology and Biostatistics       K4,500
Short-listed applicants will receive details where to submit fees prior to course start.

Training Venue:
VenYou Conference and Events Centre, Plot 378a Main Street, Ibex Hill, Lusaka

  • Free parking available.
  • Short-listed applicants will receive a map to the location.

Deadline for Applications       17:00hrs Friday 5th January 2018

How to Apply:

Go to http://www.cidrz.org/continuous-professional-development-short-courses-for-research-and-healthcare-professionals/ to complete the  Continuous Professional Development Application Form