Diarrhoea: Tackling a Complex Problem

by Dr Roma Chilengi

In a recent article, as part of the Best Buys in Global Health series, Seth Berkley, the CEO of GAVI Alliance, pointed out that vaccine preventable diseases, diarrhoea included, has a huge negative impact on individuals in the developing world.  Zambia is a perfect example.  Currently, diarrhoea is the third leading cause of death and hospitalizations for Zambian children under the age of 5 years.

This means that Zambia’s 2.4 million children under the age of 5 years will experience millions of diarrhoeal episodes leaving them susceptible to premature death and preventing them from experiencing a healthy childhood. The impact on their families and communities is extensive: caregivers are unable to adequately provide for their families because the time they would spend engaging in paid work or in business is spent caring for sick children; community literacy levels are kept on the low end because children with frequent diarrhoeal episodes are unable to access educational opportunities; families have more children than they can support due to the fear of experiencing multiple child deaths; and affected children struggle with chronic malnutrition, stunted growth and general ill health resulting in poor intellectual development. The resulting effects of diarrhoeal disease entrench poverty in the developing world.

Understanding that the causes and factors that propagate diarrhoea and its complications in Zambia are diverse, we came up with a broad range of solutions to address this complex problem.

Leveraging on our long-standing work and success in strengthening the Zambian public health system, CIDRZ, with support from a UK-based charity – Absolute Return for Kids, and in collaboration with the Zambian government created the Programme for Awareness and Elimination of Diarrhoea or PAED. As the Program Director of PAED, I lead a team of researchers and programme managers to identify and implement high impact initiatives that will address diarrhoeal disease in Zambia. Beginning in 2010, we set out to demonstrate a 15% decrease in diarrhoeal-related deaths among children under the age of 5 in Lusaka Province by introducing a comprehensive diarrhoeal control programme, which includes rotavirus vaccination through the national immunization programme, improved clinical care, and community education. Lusaka Province will serve as our proof-of-concept and our successes and lessons learnt will be applied throughout the rest of the country.

Our second goal, which we have partly accomplished, is to accelerate the country-wide introduction of rotavirus and other high-priority childhood vaccines in Zambia through strategic investments in cold chain, commodities management, in addition to policy and protocol development, planning and advocacy. 

On the 27thof November 2013, the rotavirus vaccine was rolled out nationally at a launch in Mazabuka District by the Minister of Community Development, Mother and Child Health, Dr Joseph Katema.  The result of the roll-out is that any baby can now receive rotavirus and pneumococcal vaccination within any health facility in Zambia.

At the community level, our efforts have resulted in full vaccination of 123,000 babies and training of over 500 frontline health workers in Integrated Management of Childhood Illness. We are also working on a behaviour change campaign that will address attitudes that promote diarrhoeal disease within communities. At the same time, we are conducting both facility and community surveys to determine the impact of our programme.

By working closely with the Zambian government and its partners – and within the public health system in all aspects of implementation – we ensure that our programmes will remain sustainable and will form part of the National Health Strategic Plan for paediatric diarrhoea control.

We will not relent because we know that elimination of diarrhoeal disease is possible. We look forward to the day when no Zambian child, and indeed, no African child dies from severe diarrhoea.

Dr Roma Chilengi is CIDRZ Director of Health Systems and Primary Care

CIDRZ collaborates with MIT Sloan School of Management Groundwork Initiative for Global Health

CIDRZ recently hosted four graduate business/consultant students from the US-based MIT Sloan School of Management Groundwork Initiative for Global Health. http://groundwork.mit.edu

Their project was to explore management innovations and practices to improve healthcare delivery and specifically to identify ways to decrease patient wait times in the ART Pharmacy Department at the extremely busy Kanyama Health Centre, in the capital Lusaka. This clinic has over 10,000 registered patients on anti-retroviral therapy and sees from 200-300 ART patients per day.

The goal was to look at problems from the patient’s perspective, and to build solutions that could also be used in other clinics in Zambia. The main targets of the project were to find ways to shorten the length of time that patients have to wait at the clinic – currently averaging 4.5 hours, streamline logistic processes and improve staff morale.

The students collaborated with the CIDRZ and Lusaka District Pharmacy Department staff and by all accounts the project was a great success with a detailed report of easy to implement recommendations presented. All of the students have had prior experience consulting for large businesses and international organisations.

While in-country they were supervised by Helen B. Mulenga Head of the CIDRZ Pharmacy Dept., Nick Sze, Global Health Lab Teaching Assistant, Dr Anjali Sastry, senior lecturer in Management Science at MIT Sloan School of Management and Lecturer at Harvard Medical School’s Department of Global Health and Social Medicine; Kate Long, MScPH, Research and Projects Lead at MIT Sloan’s Global Health Lab; and Dr Lindi van Niekerk, Health Innovation Lead for the Bertha Centre for Social Innovation at the University of Cape Town.

MIT in community

From L to R: Paul Meggs, Shriya Palekar, Sylvia Benavides, and Saurabh Sanghvi.

8th INTEREST Workshop on HIV Treatment, Pathogenesis and Prevention Research in Resource-Poor Settings, 5-9 May, Lusaka

The 8th INTEREST Workshop will take place at the Intercontinental Hotel in Lusaka from 5-9 May, 2014. Known as the “African CROI”, the INTEREST Workshop brings together scientists involved in HIV treatment, pathogenesis and prevention research in Africa to share pivotal findings, promote collaboration and transfer experiences across fields and continents.
Launched in 2007, this annual international workshop has become one of the leading sub-Saharan conferences in the field of HIV/AIDS.

The Workshop focuses on issues of particular relevance for Africa and gives young researchers from the South an opportunity to present their data. The Workshop size and atmosphere facilitates discussion and discourse between participants. The format of this 8th INTEREST Workshop will consist of a 2.5 day programme of plenary sessions by renowned invited speakers, abstract-driven presentations, round-table discussions and poster sessions. CIDRZ experts are represented on the Local Organising Committee.

For more information about the 8th INTEREST WORKSHOP please go to: http://www.virology-education.com/event/upcoming/8th-interest-meeting-2014/

CIDRZ CEO Charles Holmes to address the 5th Annual Consortium of Universities for Global Health (CUGH) Conference, May 10-12, in Washington D.C.

pp_HolmesAs a Centre of Excellence Leader , CIDRZ CEO Dr Charles Holmes has been invited to speak as part of the Accordia Global Health Foundation panel “Collaborating to Achieve Sustainable Impact: Africa’s Centers of Excellence in Global Health” at the 5th Annual Consortium of Universities for Global Health conference under the theme: “Universities 2.0: Advancing the Global Health Agenda in the Post-MDG Era.”
The panel will detail the important and unique role that Centers of Excellence in Health play in strengthening sub-Saharan African health systems, and how vital it is that the global community supports them through upfront investment, sustained support, and increased collaboration among a wide range of partners. http://2014cughconference.org/

Corporate Social Responsibility: Our Employees Make Us What We Are

by Dr Izukanji Sikazwe
Since I joined CIDRZ in 2013, I am continually amazed by the generosity displayed by CIDRZ employees in their work. I see this in the dedication and selfless service they display in the field and in the office. Our employees are motivated and they see our CIDRZ mission to improve the health outcomes of Zambians by ensuring access to quality healthcare as a personal one. They see a problem and they want to solve it; not just for themselves but for all Zambians.

Marjorie Chileka, our CIDRZ Grants and Contracts Manager, is one such employee. After she experienced difficulty obtaining urgent blood transfusions family members needed due to shortages of blood supply at the Blood Bank, Marjorie thought about how to contribute to correcting the problem.

She did not think only of herself and her family, but of the hundreds, and thousands of Zambians who are at risk of premature death because of scarcity of blood at the blood bank during school breaks. So what did Marjorie do? She took action: she spoke to me and several employees and we joined forces and partnered with the Zambian National Blood Transfusion Service (ZNBTS) to host a blood drive within our premises. On the 31st of January 2014, the blood drive took place at CIDRZ with the ZNBTS Medical Director, Dr Joseph Mulenga, gracing the event. ZNBTS staff was on hand to collect blood as CIDRZ employees, their friends and relatives came in to donate.

One of the donors, Anthony Willombe, a CIDRZ employee, said: “I donate blood because I know that one day I may need it. If not me, then a friend or a family member would need it.” Our employees inspire me.

Corporate social responsibility does not exist in a vacuum. It stems from the worthwhile activities of the people that make up the organisation. Our people at CIDRZ are very responsible and responsive, and they make CIDRZ the same. They care deeply about their work. So together, we at CIDRZ will stand with the Zambian government and our local and international partners to achieve our vision of “a Zambia, and a region, in which all people have access to quality healthcare and enjoy the best possible health, including a life free of AIDS”.

<small></em>Dr Izukanji Sikazwe is CIDRZ Deputy Chief Executive Officer</em></small>

Kalo Musukuma Awarded HIV Research Trust Grant

Kalo Musukuma, a CIDRZ Hepatitis study Laboratory Research Associate has been awarded an HIV Research Trust grant to support her training in HIV/Hepatitis B Virus virology under the mentorship of colleagues at the Infectious Diseases Institute of the University of Bern, Switzerland. Kalo will spend a few months learning special laboratory techniques specifically related to investigating the Hepatitis B virus and will bring this technical expertise back to Zambia.

Here is a photo of Kalo with one of the Hepatitis B study investigators, Dr Michael Vinikoor an Infectious Disease Specialist at CIDRZ.


Kaoma and mike


Visit   http://www.hivresearchtrust.org.uk/ to learn more

Dr Groesbeck Parham receives the Foundation of Gynecologic Oncology’s 2014 Humanitarianism and Volunteerism Award

The Foundation for Gynecologic Oncology presents this award to an individual for their exemplary local, national or international volunteer and outreach efforts in women’s cancer care, research or training.

As per the award letter: Dr Parham, “Your leadership in the CIDRZ Cervical Cancer Prevention Programme to expand cervical cancer screening throughout Zambia, as well as your extensive collaborative efforts to raise awareness of women’s health issues in sub-Saharan Africa, make you the ideal recipient. Congratulations on this honour and thank you for your selfless dedication to improving the lives in women throughout Zambia and beyond.”

“The Power of Permanence” Mary Fisher

Remarks for CIDRZ Staff & Guests
Lusaka, Zambia – 31 January 2014

It’s so good to see all of you again, and to be with you at a place which is so important to me. I realize that for most of you, coming to CIDRZ means coming to work or engaging in a brief visit. But for me, there is a sense of “coming home” when I’m allowed to be with you. Lusaka was not the first African city where I worked, but I quickly adopted it as my city away from home where I was most at home, most felt as though I belonged, most wanted always to come and never to leave. And it’s worth my saying that as an HIV-positive woman, when I first visited nearly a decade-and-a-half ago, I was a different woman than I am today.

The first time I visited we were just becoming convinced that the anti-retroviral drug therapies were not only going to work – as AZT and other prescriptions had worked – but that it was going to work on a sustained, continual basis. Longitudinal studies and real-life experience were coming together by the late 1990s to say, “Hey, this works! We’re going to be keeping people alive.”

We were still a long way from the sophisticated drugs and combinations which we have today. And we were far, far from moving toward universal access which remains a critical goal today. But for the first time since I and so many others had been diagnosed with the virus that leads certainly to AIDS, there was hope in the air. And hope was new.

And being a woman with AIDS in the United States in 1991, when I was diagnosed, made me a novelty of sorts. Of course there were other women with the virus, but their numbers were low and public awareness was even lower. Being a novelty is not all bad but neither is it all good. And as the years wore on, the novelty wore off. I longed to find others like myself: mothers who wondered how to manage both illness and children, women who had experience with being told we would die, but still needed to live. I did not want to be the exception any longer.

And then I came to Lusaka. What I found here was a community of women very much like myself. We recognized that we are different in race and nationality, language and habits. But those differences paled by comparison to the similarities. We were, and we have remained, literally “blood-relatives.” What binds us is a virus that wants to kill us and a joyful unity that keeps us alive. For the first time in my life with AIDS, here in this city I found myself in the context of others who knew my experience and shared it. And this companionship, this sisterhood, this acceptance which enables us to laugh and sing and dance together – it was new.

And at the core of my life in Lusaka has always been CIDRZ. This is the place of healing that enables me to go home and return, and find my sisters healthy and happy and well. Because CIDRZ welcomed the Abataka Women as they engaged in learning and employment, it has become even more a place in which I feel at home.

And for all this, I thank you. I thank you for taking on the challenges of work within CIDRZ. It is not easy, and sometimes it is not very rewarding. We who are sick can be difficult to serve; we are not always kind, or thankful, or courteous. The hours get long and the pay seems low. The challenges seem never to go away, whether they are scientific barriers, financial limitations or bureaucratic obstacles. It isn’t easy. And yet you come each day, you pour out your energy and your creativity on behalf of all who are sick and dying. And I rise today to offer a sincere “thank you.”

Last Spring I was honored to be with some of you when we dedicated the Max M and Marjorie S Community and Training Centre. We were joined by Charles Holmes, Jessica Grillo and Idah Mukuka and so many others who have made CIDRZ what it is today. And when I was allowed to make a few remarks on that occasion, I recalled that the Rev. Dr. Martin Luther King struggled for his whole life to build what he always called “the beloved community…in which poverty would have no place, racism would have no quarter and violence would have no purpose.”

I said on that occasion that “if I understand King’s dream correctly, what he was calling us to, is nothing more nor less than risking ourselves for one another. The beloved community…will be ushered in when we clearly see our differences and pursue the risk of devotion to one another nonetheless — when I see the pain of your burdens, and risk my comfort to take up your agonies. Dark days have shadowed our history; dark days will come again. And when they come, if we are truly dedicated to the work of community-building, we will be ready.” And here we are again. Once more you have opened your doors and hearts to me; once more you have welcomed me home.

In a world where institutions rise and fall in a span of months, CIDRZ has been committed to the work of learning and healing for years, and now approaching decades. It has taken on work that others see as a project and turned that work into a community commitment that endures. CIDRZ has become, during the years I have known you, a permanent organization committed to sustainable service to the people of Zambia.

We can recall hard times and dark days but, when we do, we need also to see that we have found our way from the darkness to the light. If leadership faltered or funding seemed uncertain, we have emerged from our own fears to see the dawn of a new and better day.

Every day that you work and every night that you labor long, you demonstrate to the people of Zambia that your commitment is not brief or limited; it is not temporary. You are here, and you are here to stay. Permanence is your hallmark.

And as the world of higher education and medical research looks for models, they turn with regularity to you, to see what it is that CIDRZ has done and how you’ve done it. What makes this possible is not only what you have achieved in the past but, more importantly, what you continue to do now. Permanence has brought you this far, but permanence will carry you much further.

And what you mean, as an institution and as individuals, to me is beyond my own description.
I am an American who sometimes despairs of American self-interest; when I am here, and I see what you are accomplishing as an international community drawn from many nations, I take hope for all nations and all humanity.

And I am a woman with AIDS. I am working this week with other women who share with me not only that virus but all that comes with it. And for each of us, CIDRZ stands as proof that aid and comfort is not temporary; it is enduring. When we grow weak, you will be here. If our families need comfort, you will be here. Where others may take their leave, you will take the opportunity to stay, to labor, to heal and to love.

Permanence is more than the accumulation of years and experience. It is the promise that CIDRZ is not only excellent; it is also trustworthy. It will be here long after I leave, and it – you – will be here should I return again. To all of you, and for all of you, I give thanks. Thank you…thank you…thank you!!!

GAVI Supported Rotavirus Vaccines Introduced in Zambia

Following a successful pilot program delivering rotavirus vaccines as part of an integrated approach to diarrhoea prevention and control, in November 2013, Zambia rolled out GAVI-supported rotavirus vaccines nationwide. Read more

Improving Equitable Access and Coverage of Hygiene and Sanitation Practices in Rural Communities

In the following write-up, Dr Roma Chilengi, CIDRZ’s Director of Health Systems and Primary Care highlights CIDRZ’s objectives in its sanitation programmes and the advantages of implementing the Community-Led Total Sanitation (CLTS) model.

CIDRZ has partnered with UNICEF to work with the Government of Zambia, to improve equitable access and coverage of hygiene and sanitation practices in the rural communities of Chongwe and Kafue districts. Through the implementation of Community-Led Total Sanitation (CLTS) and School-Led Total Sanitation (SLTS) programmes, CIDRZ will collaborate to ensure that:

  •  150,633 people have improved access to sanitation and hygiene facilities and have their own household latrines
  • 20,859 school children in 24 schools have improved access to sanitation and hygiene facilities through construction of 190 Ventilated Improved Pit Latrines with hand washing facilities

The ambitious goal of this programme is to objectively demonstrate that targeted villages attain Open Defecation Free (ODF) status”, that is, each household must have a toilet (with a lid and super structure), as well as a hand washing facility.

 Lessons Learnt

Such apparently simple interventions can help avert diarrhoeal disease if appropriately implemented. The CLTS model comes with several key lessons:

  • To be sustainable, communities themselves must build and own their own toilets
  • The involvement of traditional leaders, especially village headmen and chiefs as opposed to civic leaders is key
  • Use proven triggering process and ensure trained professionals verify and certify ODF status
  •  With appropriate strategies, ODF can be achieved in most rural places through cost efficient strategies
  • CLTS champions need to be recognised and made proud as agents of change.

Appropriate toilets and hand washing with soap are key transmission breakers for most causes of diarrhoeal diseases and CIDRZ not only recognizes that; it is in the forefront to support primary prevention; PREVENTION IS BETTER THAN CURE!