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Climate Change Adaptation and Vulnerability: A Case of Rain Dependent Small-Holder Farmers in Selected Districts in Zambia  [PDF]
Cuthbert Casey Makondo, Kenneth Chola, Blesswell Moonga
American Journal of Climate Change (AJCC) , 2014, DOI: 10.4236/ajcc.2014.34034
Abstract: Food crop production by small-holder farmers in Africa is particularly vulnerable to climate change, given high dependence on rainfall coupled with limited adaptive capacity. In Zambia, smallholder farmers contribute about 79% of national stable food requirements particularly maize. This paper attempted to establish levels of food security in each of the three agro-ecological zones of Zambia, and evaluated the current adaptive measures of rain dependent small-holder farmers against climate change risks. The challenges farmers are facing in adapting to the change risks were identified and livelihood vulnerability assessed. The findings indicate that rain dependent small-holder farmers in Zambia are highly vulnerable to weather related shocks which impact greatly on their food production; and that the levels of vulnerability vary across gender and per agro-ecological zone. After the evaluation of scenarios including staple food crop yields (maize), the authors conclude that most rain-fed small-holder farmers in Zambia (about 70%) are facing considerable hardships in adapting to the changing climate, which in turn, undermines their contribution to food security. While efforts by government have been made to assist farmers towards climate change adaptation, there still remains many challenges to achieve the desired outcomes. Most farmers (66%) are unable to afford certain alternatives, such as those of agro-forestry or conservation. Difficulties in accessing markets, poor road infrastructure, fluctuating market prices, high costs and late deliveries of farming in-puts were found to be among the major challenges that farmers are facing in Zambia. There are also no systematic early warning systems in place against natural hazards and disasters. This makes farming a difficult undertaking in Zambia.
Algorithm for Compiling Unrestricted Ladder Diagram to IEC 61131-3 Compliant Instruction List
Kando Hamiyanze Moonga,You Linru,Liu Shaojun
Lecture Notes in Engineering and Computer Science , 2011,
Assessment of the therapeutic efficacy of a paediatric formulation of artemether-lumefantrine (Coartesiane?) for the treatment of uncomplicated Plasmodium falciparum in children in Zambia
Pascalina Chanda, Moonga Hawela, Mabvuto Kango, Naawa Sipilanyambe
Malaria Journal , 2006, DOI: 10.1186/1475-2875-5-75
Abstract: The design is a simple, one-arm, prospective evaluation of the clinical and parasitological response to directly observed treatment for uncomplicated malaria. The study was conducted in sentinel sites using the WHO standardized protocol for the assessment of therapeutic efficacy of antimalarial drugs (WHO 2000) in children under five years of age, weighing less than 10 Kg. The study was conducted at two clinics, one in Chongwe (Lusaka Province) and Chipata (Eastern Province). The 28-day follow-up period was used coupled with PCR genotyping for MSP1 and MSP2 in order to differentiate recrudescence from re-infections for parasites that appeared after Day 14.91/111 children enrolled in the study, were successfully followed up. Artemether-lumefantrine (Coartesiane?) was found to produce significant gametocyte reduction. The Adequate Clinical and Parasitological Response (ACPR) was found to be 100% (95% CI 96.0;100).Coartesiane? was effective in treating uncomplicated malaria in Zambian children weighing less than 10 kg, an age group normally excluded from taking the tablet formulation of artemether-lumefantrine (Coartem?).The malaria situation analysis in Zambia shows that malaria is the leading cause of mortality and morbidity, and the disease burden is worse in the biologically vulnerable children, under five years of age, and in pregnant women [1]. The development of drug resistance in Zambia has had a major impact on the success of malaria control. The country has experienced major treatment failures to chloroquine and sulphadoxine/pyrimethamine (SP), with recorded treatment failures for SP as high as 32.6% in certain parts of the country by early 2003 [2]. After the documentation of chloroquine resistance in 1983, the outpatient department (OPD) cases increased from 167 cases per thousand population to 428 cases per thousand population in 2003 [3]. The public health impact of drug resistance led to an increase in the disease prevalence rates, under five mortality r
Finding parasites and finding challenges: improved diagnostic access and trends in reported malaria and anti-malarial drug use in Livingstone district, Zambia
Masaninga Freddie,Sekeseke-Chinyama Masela,Malambo Thindo,Moonga Hawela
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-341
Abstract: Background Understanding the impact of malaria rapid diagnostic test (RDT) use on management of acute febrile disease at a community level, and on the consumption of anti-malarial medicines, is critical to the planning and success of scale-up to universal parasite-based diagnosis by health systems in malaria-endemic countries. Methods A retrospective study of district-wide community-level RDT introduction was conducted in Livingstone District, Zambia, to assess the impact of this programmed on malaria reporting, incidence of mortality and on district anti-malarial consumption. Results Reported malaria declined from 12,186 cases in the quarter prior to RDT introduction in 2007 to an average of 12.25 confirmed and 294 unconfirmed malaria cases per quarter over the year to September 2009. Reported malaria-like fever also declined, with only 4,381 RDTs being consumed per quarter over the same year. Reported malaria mortality declined to zero in the year to September 2009, and all-cause mortality declined. Consumption of artemisinin-based combination therapy (ACT) dropped dramatically, but remained above reported malaria, declining from 12,550 courses dispensed by the district office in the quarter prior to RDT implementation to an average of 822 per quarter over the last year. Quinine consumption in health centres also declined, with the district office ceasing to supply due to low usage, but requests for sulphadoxine-pyrimethamine (SP) rose to well above previous levels, suggesting substitution of ACT with this drug in RDT-negative cases. Conclusions RDT introduction led to a large decline in reported malaria cases and in ACT consumption in Livingstone district. Reported malaria mortality declined to zero, indicating safety of the new diagnostic regime, although adherence and/or use of RDTs was still incomplete. However, a deficiency is apparent in management of non-malarial fever, with inappropriate use of a low-cost single dose drug, SP, replacing ACT. While large gains have been achieved, the full potential of RDTs will only be realized when strategies can be put in place to better manage RDT-negative cases.
Association between early childhood exposure to malaria and children’s pre-school development: evidence from the Zambia early childhood development project
Fink Günther,Olgiati Analia,Hawela Moonga,Miller John M
Malaria Journal , 2013, DOI: 10.1186/1475-2875-12-12
Abstract: Background Despite major progress made over the past 10 years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development. Methods The objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures. Results No statistically significant associations were found between parasite exposure and children’s height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference 1.11, 95% CI 2.43–0.20), as well as decreased overall socio-emotional development as assessed by parents (z-score difference 1.55, 95% CI 3.13–0.02). No associations were found between malaria exposure and receptive vocabulary or fine-motor skills. Conclusions The results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.
Community case management of malaria using ACT and RDT in two districts in Zambia: achieving high adherence to test results using community health workers
Pascalina Chanda, Busiku Hamainza, Hawela B Moonga, Victor Chalwe, Franco Pagnoni
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-158
Abstract: A prospective evaluation of the effectiveness of using community health workers (CHWs) as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia.CHWs were able to manage malaria fevers by correctly interpreting RDT results and appropriately prescribing antimalarials. All severe malaria cases and febrile non-malaria fevers were referred to a health facility for further management. There were variations in malaria prevalence between the two districts and among the villages in each district. 100% and 99.4% of the patients with a negative RDT result were not prescribed an antimalarial in the two districts respectively. No cases progressed to severe malaria and no deaths were recorded during the study period. Community perceptions were positive.CHWs are effective delivery points for prompt and effective malaria case management at community level. Adherence to test results is the best ever reported in Zambia. Further areas of implementation research are discussed.Access to prompt and effective treatment is a cornerstone of the current malaria control strategy [1]. Delays in starting appropriate treatment is a major contributor to malaria mortality. Many children with suspected malaria in sub-Saharan Africa, where medical services are not easily accessible, start treatment too late or do not receive it at all and die at home without contact with formal medical services [2,3]. It is for this reason that the World Health Organization has recommended home management of malaria (HMM) as one of the strategies for improving access to prompt and effective malaria case management [4]. Further, community referral compliance rates observed in some studies indicate the possibility detecting malaria episodes early, initiating pre-health facility management of cases and improving outcomes of severe malaria cases at health facility [5].Home management of malaria with chloroquine has been effective in reducing both mortality and severe malaria morbi
Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management
Pascalina Chanda, Busiku Hamainza, Hawela B Moonga, Victor Chalwe, Patrick Banda, Franco Pagnoni
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-159
Abstract: Cost-effectiveness of home management versus health facility-based management of uncomplicated malaria in two rural districts in Zambia was analysed from a providers' perspective. The sample included 16 community health workers (CHWs) and 15 health facilities. The outcome measure was the cost per case appropriately diagnosed and treated. Costs of scaling-up HMM nationwide were estimated based on the CHW utilisation rates observed in the study.HMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility.HMM using ACT and RDTs was more efficient at appropriately diagnosing and treating malaria than the health facility level. Scaling up this intervention requires significant investments.Malaria case management is one of the key strategies to control malaria [1]. The adoption of new effective artemisinin-based combination therapy (ACT) in Africa has began to show positive health impacts in terms of malaria morbidity and mortality reduction [1,2] with some countries contemplating malaria elimination [1]. Additionally, the introduction of rapid diagnostic tests (RDTs) for malaria has changed the approach to malaria diagnosis. Presumptive treatment of fevers as malaria is no longer encouraged because it leads to misdiagnosis of the disease and irrational drug use [3]. With the adoption of RDTs in routine health services, malaria confirmation is no longer a preserve of areas with laboratory services. RDTs are increasingly gaining attention for their practical use given the limitations of scaling up microscopy services [4]. RDT diagnosis of malaria has been said to be rapid and requiring less inputs than microscopy and no specialized personnel is required to perform the tests [5,6]. This has potentially improved patient access to diagnosis se
A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia
Pascalina Chanda, Felix Masiye, Bona M Chitah, Naawa Sipilanyambe, Moonga Hawela, Patrick Banda, Tuoyo Okorosobo
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-21
Abstract: Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis).The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success) from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line treatment are considered the ICER of AL becomes negative, indicating that there are greater resource savings associated with AL in terms of reduction of costs of complicated malaria treatment.This study suggests the decision to adopt AL is justifiable on both economic and public health grounds.Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. The disease burden caused by malaria in Zambia has grown steadily over the recent decades. Malaria is endemic in most parts of Zambia although rural areas and poor urban cities tend to bear a disproportionate share of malaria transmission and burden. Estimates based on the Health Information System (HIS) suggest that malaria incidence has increased from 121.5 per 1,000 in 1976 to 429.3 per 1000 in 2003 [1,2]. Recent statisti
Human exposure to anopheline mosquitoes occurs primarily indoors, even for users of insecticide-treated nets in Luangwa Valley, South-east Zambia
Aklilu Seyoum, Chadwick H Sikaala, Javan Chanda, Dingani Chinula, Alex J Ntamatungiro, Moonga Hawela, John M Miller, Tanya L Russell, Olivier JT Bri?t, Gerry F Killeen
Parasites & Vectors , 2012, DOI: 10.1186/1756-3305-5-101
Abstract: Mosquitoes were collected by human landing catch in blocks of houses with either combined use of deltamethrin-based IRS and LLINs or LLINs alone. Human behaviour data were collected to estimate how much exposure to mosquito bites indoors and outdoors occurred at various times of the night for LLIN users and non-users.Anopheles funestus and An. quadriannulatus did not show preference to bite either indoors or outdoors: the proportions [95% confidence interval] caught indoors were 0.586 [0.303, 0.821] and 0.624 [0.324, 0.852], respectively. However, the overwhelming majority of both species were caught at times when most people are indoors. The proportion of mosquitoes caught at a time when most people are indoors were 0.981 [0.881, 0.997] and 0.897 [0.731, 0.965], respectively, so the proportion of human exposure to both species occuring indoors was high for individuals lacking LLINs (An. funestus: 0.983 and An. quadriannulatus: 0.970, respectively). While LLIN users were better protected, more than half of their exposure was nevertheless estimated to occur indoors (An. funestus: 0.570 and An. quadriannulatus: 0.584).The proportion of human exposure to both An. funestus and An. quadriannulatus occuring indoors was high in the area and hence both species might be responsive to further peri-domestic measures if these mosquitoes are susceptible to insecticidal products.
Vitamin C Prevents Hypogonadal Bone Loss
Ling-Ling Zhu, Jay Cao, Merry Sun, Tony Yuen, Raymond Zhou, Jianhua Li, Yuanzhen Peng, Surinder S. Moonga, Lida Guo, Jeffrey I. Mechanick, Jameel Iqbal, Liu Peng, Harry C. Blair, Zhuan Bian, Mone Zaidi
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0047058
Abstract: Epidemiologic studies correlate low vitamin C intake with bone loss. The genetic deletion of enzymes involved in de novo vitamin C synthesis in mice, likewise, causes severe osteoporosis. However, very few studies have evaluated a protective role of this dietary supplement on the skeleton. Here, we show that the ingestion of vitamin C prevents the low-turnover bone loss following ovariectomy in mice. We show that this prevention in areal bone mineral density and micro-CT parameters results from the stimulation of bone formation, demonstrable in vivo by histomorphometry, bone marker measurements, and quantitative PCR. Notably, the reductions in the bone formation rate, plasma osteocalcin levels, and ex vivo osteoblast gene expression 8 weeks post-ovariectomy are all returned to levels of sham-operated controls. The study establishes vitamin C as a skeletal anabolic agent.
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