Epidemiological Survey in Zambia

In 2013-2014, the first fully digital national TB prevalence survey worldwide was conducted in Zambia. A population-based prevalence survey estimates the true burden of TB disease.

KNCV’s epidemiologist and data management consultants guided the national TB program at various stages of the survey.

Besides being innovative in using digital tools for collecting and processing data, the Zambia prevalence survey was also the first in surveying the estimated burden of both TB and HIV. Pascalina Chanda-Kapata, survey coordinator from the Ministry of Health, tells about how this came to be.

A prevalence survey provides a baseline to monitor progress and impact of interventions. That is why it is seen as an important tool in TB control policy making and financing. “It was an ambitious, innovative and in many ways a new process”, says survey coordinator Pascalina Chanda-Kapata. “It took a lot of people to make this happen and strong teamwork was a major ingredient to making it a success.” “It was a Zambian project, but designed to be globally applicable”, Chanda continues. “Our survey team learned by doing. The World Health Organization (WHO) Taskforce for Impact Measurement was involved from the beginning, giving technical advice on the preparatory process, field data collection and data analysis. The Taskforce also provided a platform for inter-country ex – changes. We initially visited Rwanda and then Ghana, which were all at different stages of their prevalence surveys, and we also interacted with colleagues from Ethiopia, Nigeria, Malawi, Sudan, etc. KNCV’s epidemiologist and data management consultants … were really part of the team, not afraid to get their hands dirty, and that is just what we needed.”

Also within the government system different expertise was brought in. “With such a large project, you can really optimize by working with what is already in the system” says Chanda. “We had a strong inter-ministerial cooperation, for instance the Ministry of Communication and Transport for courier of specimens; the Ministry of Home Affairs provided the security personnel and the Central Statistical Office for the Mappers/Listers.

Full-scale field data collection started in September 2013, and the last cluster was surveyed by end of July 2014. Personal Digital Assistants (PDAs) with a Global Positioning (GPS) attached were used for registration and data collection. Information and samples from different steps in the survey were correctly linked through barcoding. The field- and central-level x-Ray system was digital and the central reference laboratories also processed their results digitally. Pascalina Chanda-Kapata is proud of the role of the local fieldworkers, many of whom had to overcome their phobia of a mix of technologies. “We took care to invest in the buy-in of the teams, making them part of the whole process. This really paid back in the commitment of people. We found that the fieldworkers started helping each other – when somebody was unable to do the work, another team member stepped in. Everybody felt part of the big picture.”

The prevalence survey in Zambia was the first ever to be fully digital. Benefits of a digitized survey include efficient and quality data collection; timely reporting and improved ICT infrastructure at various levels.

KNCV has been fighting TB since its establishment in 1903. Over the past 120 years, the organization has acquired indispensable knowledge and experience in the field of effective TB prevention and care, resulting in pre-elimination in the Netherlands and significant contributions to global evidence generation, policy development and TB program implementation worldwide.

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