SEATTLE – Coverage for a number of child health interventions increased across districts in Zambia, a success story that corresponds with the country’s improving rates of childhood survival. Yet results were less promising for more routine services that require multiple contacts with the health system, particularly those pertaining to maternal health.
On April 2, BMC Medicine published a new study, “Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010,” conducted by a team of researchers from the University of Zambia (UNZA) and the Institute for Health Metrics and Evaluation (IHME).
Overall, Zambia has made marked progress in scaling up a subset of key health interventions since 1990, namely for malaria control (insecticide-treated nets [ITNs] and indoor residual spraying [IRS]), exclusive breastfeeding, and coverage of the measles and pentavalent vaccines. For these interventions, coverage gains often occurred in a more consistent manner across districts, reflecting Zambia’s national campaigns and initiatives to improve health.
Nevertheless, coverage trends at the national level often masked persistent disparities across geographies and health focus areas, further emphasizing the critical need for tracking and assessing local health trends in a timely manner. This was particularly evident for more routine services like antenatal care and skilled birth attendance, for which the gap between districts with the highest and lowest levels of coverage has widened over time.
“We can see how Zambia’s investments to improve child health are paying off,” said Dr. Felix Masiye, Dean of the School of Humanities and Social Sciences at UNZA and a lead researcher on the study. “For example, as a country, we focused on expanding vaccine services – and two decades later, nearly all districts have measles immunization coverage exceeding 90%. Now we need to turn our attention and efforts to improving routine services and overall health system strengthening at the district level.”
The timing of this study’s publication corresponds with an important juncture for health services in Zambia and the broader global health community. Zambia is rolling out its national health insurance scheme, and calls for achieving universal health coverage and promoting integrated health service delivery have grown louder in recent years.
Additional findings include the following:
- Zambia’s rapid scale-up of malaria control interventions nationally has been recognized worldwide. Researchers found that coverage of malaria control quickly increased from 2000 to 2010, by which point at least 55% of households in all districts owned ITNs or had received IRS. At the same time, district-level coverage rates of ITNs or IRS varied considerably, ranging from 56% to 90% in 2010. As Zambia aims to eliminate malaria in five districts by 2016, identifying localized intervention needs will be increasingly important.
- Nationally, measles immunization coverage increased from 86% in 1990 to 98% in 2010, a major success story. By 2010, 69 out of 72 districts recorded measles vaccination rates equaling or exceeding 90%, a recommended level of coverage for achieving community-level protection against the disease.
- The pentavalent vaccine was launched nationally in 2005, and by 2010, Zambia’s pentavalent vaccine coverage reached 67%. However, pentavalent coverage varied substantially at the district level, ranging from 22% to 91% in 2010. This finding may reflect differences in how the pentavalent vaccine has been rolled out – and its subsequent uptake – throughout Zambia.
- National levels of polio immunization coverage did not change much between 1990 and 2010, remaining around 81%; however, more than half of the districts in Zambia had lower polio immunization rates in 2010 than in 1990. Further, a number of districts with declines in coverage have been considered at risk for polio importation from neighboring countries (the Democratic Republic of the Congo and Angola).
- Nationally, coverage of antenatal care decreased over time. In 59 out of 72 districts, the proportion of pregnant women who had at least four antenatal care visits (ANC4) was lower in 2010 than 20 years earlier. Antenatal care has been linked to better maternal and child health outcomes, further emphasizing the concerning nature of these trends in ANC4.
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