Abstract
Background: Stroke, a major public health issue in developing countries, is the fifth leading cause of death and disability in Zambia. Despite the implemented Non-Communicable Disease Strategic Plan’s aim to reduce stroke-related risks, disability, and mortality, a knowledge gap persists regarding effective community-level prevention strategies.
Aim: This study aimed to identify existing community-level stroke prevention strategies, determine key implementers, and explore factors influencing strategy implementation.
Setting: The study was conducted in Lusaka district, Zambia’s urban capital, focusing on government-run health facilities across six sub-districts.
Methods: A descriptive case study employing a convergent design was conducted. Quantitative data were collected using a structured checklist, while qualitative data were obtained through face-to-face interviews with two NGO leaders and four health promotion staff selected via purposive sampling. Thematic content analysis was applied to qualitative data, and quantitative findings were summarised using descriptive statistics.
Results: Three key implementers were identified; Lusaka District Health Office, Zambia Heart and Stroke Foundation, and Public Health and Environmental Promotion Organization of Zambia. Seven prevention strategies emerged, including awareness campaigns, screenings, lifestyle interventions, and stakeholder partnerships. Facilitators included community engagement and partner support, while barriers involved limited health education, financial constraints, and logistical challenges.
Conclusion: Community-level stroke prevention in Zambia shows potential but requires stronger partnerships, increased community involvement, and solutions to funding and literacy barriers.
Contribution: Findings support policy development and resource allocation, emphasizing the need for literacy-sensitive interventions and sustainable funding to strengthen stroke prevention efforts.
Keywords: stroke prevention; community health; implementation barriers; health policy; public health interventions; resource-limited settings.
Background
Stroke, a devastating cardiovascular disease, has emerged as a critical public health priority in developing countries (Kalkonde et al. 2018). Over the last few decades, the global burden of stroke has shifted significantly, with developing nations currently carrying the majority of this burden (Feigin, Norrving & Mensah 2017). In Zambia, the impact is substantial, with stroke being recognised as the eighth leading cause of death. Current statistics indicate that stroke accounts for 7948 deaths, representing 7.12% of total deaths in the country (World Health Organization [WHO] 2020). Notably, the profile of Zambian stroke patients is characterised by younger age at onset, high prevalence of hypertension (HTN) and significant co-occurrence of human immunodeficiency virus (HIV) infection (Nutakki et al. 2021).
The challenge of addressing stroke in Zambia is compounded by broader healthcare system constraints. Although compiling accurate and consistent country-level data on non-communicable diseases (NCDs) is still difficult, there is emerging evidence that these conditions represent a national public health emergency (Ministry of Health [MOH] 2013). Reducing NCDs, especially stroke is crucial for achieving developmental goals such as poverty eradication, inequality reduction and improved population health and well-being (NCD Alliance 2016). Prevention strategies typically focus on modifiable risk factors through various interventions such as promoting healthy dietary habits, encouraging physical activity, reducing alcohol consumption, decreasing tobacco use and limiting salt intake (Jeet et al. 2017; Singh, Reddy & Prabhakaran 2011). In response to this challenge, Zambia launched its NCDs strategic plan in 2013, implementing strategies aimed at reducing risk factors and, consequently, NCDs-related morbidity and mortality (MOH 2016). The NCD strategic plan operates within the framework of the Zambia National Health Strategic Plan, overseen by the MOH. However, a significant knowledge gap exists regarding the translation of these national policies into community-level stroke prevention strategies. This gap is particularly of concern given that community-based interventions often serve as the frontline in disease prevention efforts.
This study aimed to bridge this knowledge gap by identifying and analysing existing community stroke prevention strategies in Lusaka district, evaluating key implementers and assessing factors influencing their implementation. This study’s findings highlighted the various areas of intervention in which physiotherapy practitioners can play an important role in public health, expanding their role from reactive to preventive care, and laying the groundwork for evidence-based, multi-disciplinary and policy-informing practice. Gaining insights into these elements is essential for enhancing the effectiveness of stroke prevention efforts and improving health outcomes in Zambian communities. Majority of stroke can be prevented through screening for risk factors and implementing measures to address them (George et al. 2017).
Research methods and design
Study design and setting
A case study employing mixed methods was implemented, using the results point of integration to have a naturalistic understanding of the implementation of preventive strategies allowing an interpretive perspective (Nickerson 2024; Satter 2024). A convergent design with more weighting on the qualitative arm was employed. The study was conducted in Lusaka district, the capital (urban setting) of Zambia, a landlocked country in Southern Africa. The city has an approximate population of 3 million (Zambia Statistic Agency 2025). A study done at the University Teaching Hospital Lusaka revealed that stroke constituted 43% of all neurological admissions. The district has health facilities at all levels of care which are under the jurisdiction of the district health office (DHO). The DHO operates through six sub-districts namely Chelstone, Chipata, Matero, Kanyama, Chawama and Chilenje (MOH Master Facility List 2023). Each sub-district maintains a mother facility, supplemented by health centres and health posts. Services offered at this level of care can be preventative, curative and rehabilitative. Most of the preventative services in Lusaka district are conducted through the sub-districts. These facilities attend to both acute and chronic stroke cases as well as coordinate disease prevention activities in various communities.
Participants and sampling
The study involved key stakeholders in community-level stroke prevention efforts in Lusaka district, including health promotion coordinators and programme managers from non-governmental organisations (NGOs) involved in stroke prevention and NCD initiatives. Participants were selected based on their direct involvement in NCD prevention programmes for more than 2 years, to ensure they provided relevant insights into existing stroke prevention strategies, key implementers and influencing factors. A purposive sampling approach was employed to recruit health promotion coordinators to the study. The criterion of inclusion was based on their position, expertise and experience (Flick 2014). Other participants were identified using snowball sampling. The health promotion coordinator at the Lusaka district medical office played a role in the inclusion of the health promotion coordinators, while NGOs’ programme managers were selected via an internet search based on their active involvement in stroke prevention efforts. This methodological approach facilitated a comprehensive exploration of stroke prevention techniques, key implementers and challenges influencing implementation. Four health promotion coordinators from the sub-districts and two programme managers from NGOs actively engaged in stroke prevention initiatives were included in the study bringing the number of participants to six. To minimise bias during the selection process, the researchers kept monitoring if there were certain patterns on those not selected.
Data collection
Data were collected between August 2021 and September 2021. The study involved six participants, including four health promotion coordinators from sub-districts and two programme managers from NGOs, actively involved in stroke prevention activities. Individual face to face in-depth key informant interviews guided by an interview schedule with predetermined themes were used to collect qualitative data from the participants. Each participant was interviewed separately. Interviews were conducted in English at the sub-districts mother facilities for key informants in the public sector, and at their work offices for those in the NGOs. All interviews were conducted by the principal investigator. Consistency was upheld by adhering to the questions specified on the interview guide. Appointments with the participants were physically done and follow ups were made using phone calls. Information sheets which explained the study’s aims were given to the participants before the interviews. All participants signed consent forms before being interviewed and questions were solicited with answers given. Participants participated in the study freely with the right to withdraw at any time without repercussions. Interviews lasted between 40 min and 60 min. The interviews were conducted until redundancy was reached. A digital recorder was used to record interviews and recorded data were protected on the computer with a password for 3 years. Quantitative data were collected using checklists to determine the number of potential implementers and the community-level preventative activities being implemented in Lusaka district.
Data analysis and management
Recorded interviews were transcribed verbatim. The transcriptions were done by the principal investigator and verified by the other researchers. Thematic content analysis and coding was done and recurring patterns were identified (Delve & Limpaecher 2023). Qualitative data analysis was done concurrently with the data collection, and when no information emerged, data collection was halted as redundancy was reached. Quantitative data were analysed manually. Descriptive statistics such as frequency distribution tables were used to summarise the data. The number of informants implementing specific strategies were summarised using counts and proportions. After analysis, qualitative and quantitative data were mixed for presentation.
Ethical considerations
Ethical approval to conduct this study was obtained from the University of Lusaka, School of Medicine and Health Sciences Research Ethics Committee (IORG0010092/MPH19114856) and the National Health Research Authority (NHRA 000013/13/07/2021). Additional permission was secured from the Ministry of Health (MOH) through the Lusaka district medical office. The participants gave written consent before data collection. All participants were assigned anonymising codes to ensure confidentiality, following standard research ethics protocols. All research procedures adhered to international ethical guidelines for health research, with particular emphasis on maintaining participant confidentiality and anonymity throughout the study process.
Results
Profile of the study participants
Six key informants, ranging in age from 25 years to 56 years, took part in the study. Males made up the majority of participants. Four participants held master’s degrees in public health, one who is a medical doctor, held a doctorate in physiology and vascular health, and one held a national diploma in environmental health. These were the ideal people to collect data from because they were actively involved in running NCD preventive activities in their respective institutions. Table 1 shows the profile of the participants.
| TABLE 1: Profile of the study participants. |
Implementers of community stroke preventive strategies in Lusaka district
The study revealed three implementers – one from the public sector (DHO) and two from the private sector (NGOs). The DHO carries out the strategies and actions via the public health structures in the six sub-districts. Each of these implementers has organisations assisting them in implementing community stroke prevention initiatives. Table 2 lists the implementers as well as the organisations that support them.
| TABLE 2: Implementers and their supporting organisation. |
Community stroke preventive strategies and activities in Lusaka district
Table 3 clearly depicts a dominance of community-wide and group-based prevention strategies over individual or media-driven approaches, emphasising the need for broader integration of personalised and language-specific interventions to enhance stroke prevention efforts in Lusaka district. All key informants (100%) reported implementing community-wide HTN screening and treatment programmes, information, education and communication (IEC) activities, market-based health education initiatives and social marketing campaigns as core strategies. Health education programmes were widely conducted in markets (100%), schools (83%) and churches (67%), while workplace-based programmes were not reported. In addition, clinic and hospital-based patient education was practised by 83% of respondents, reinforcing the role of health facilities in stroke awareness. However, media-based interventions had lower adoption, with only 33% of informants utilising radio or television programmes in local languages. Similarly, individual lifestyle modification programmes were reported by only 33% of respondents, while group-based programmes were more widely adopted at 67%.
| TABLE 3: Community-based stroke prevention strategies and implementation in Lusaka District. |
Facilitators and barriers to the implementation of community stroke prevention strategies
The study identified five key factors influencing the implementation of community stroke prevention strategies in Lusaka district. These were categorised as facilitators and barriers, as outlined in Table 4.
| TABLE 4: Predetermined and emergent themes. |
Theme 1: Facilitators
As shown in Table 4, key informants highlighted several facilitators that support the successful implementation of community stroke prevention initiatives.
Sub-theme 1.1: Community acceptance and participation
The effectiveness of prevention strategies relies heavily on community engagement. Respondents emphasised that community involvement is essential for the success of stroke prevention efforts. One informant noted that Zambians are welcoming and eager to participate, which fosters awareness and recognition of NCDs:
‘And also the community participation. Zambian people are very nice people. Everywhere we go, they welcome us heartily and they participate in the programs. And they are very, very willing to talk to you about their condition. That is one of the biggest enablers.’ (Key informant 005, Male, 56 years old)
Sub-theme 1.2: Involvement of community volunteers
Community health workers (CHWs) and volunteers play a crucial role in raising awareness and conducting HTN screenings. Many NGOs rely on volunteer health professionals, while neighbourhood health committees actively promote prevention strategies. ‘We act as enablers because without our presence or without getting committed we can’t do this’ (Key informant 006). Another informant highlighted the commitment of community volunteers, stating:
‘What has been enabling us to implement is the availability of our community volunteers who are almost ready at any time to be sent to do something in the community, whether an activity has got money or not.’ (Key informant 002, Male, 36 years old)
Sub-theme 1.3: Support from partners
Collaboration with both local and international partners has significantly facilitated the implementation of stroke prevention initiatives. These partners provide financial support, educational materials (i.e, IEC materials) and equipment. One informant highlighted the role of partnerships in smoking prevention campaigns among youths:
‘Based on how successfully we collaborate with stakeholders, such as the Drug Enforcement Commission, we might even invite them to speak about tobacco and display the different types of tobacco products.’ (Key informant 003, Male, 32 years old)
Theme 2: Barriers
As shown in Table 4, respondents also identified several challenges hindering the successful implementation of community stroke prevention strategies.
Sub-theme 2.1: Lack of health education
Low levels of awareness about NCDs, particularly stroke, were cited as a major barrier. Many individuals do not perceive stroke as a serious health risk, which affects their participation in preventive measures. One health promotion officer described the lack of community interest in physical activities, stating:
‘I’ll be truthful to say one thing I’ve noticed is that people don’t take these preventive measures serious. Sometimes when they see you doing aerobics, they think you are just playing. They don’t want to join you. They would be shouting, instead of you attending to us, you are playing!!!!’ (Key informant 003, Male, 32 years old)
Sub-theme 2.2: Financial and logistical challenges
Funding constraints were consistently highlighted as a major barrier to implementation. Many informants noted that the lack of financial resources affects logistics, transportation and staff mobilisation for awareness campaigns:
‘The biggest problem off course is funding. You find that even if you have volunteers, you need resources to move them around. If you keep in the field for very long, you need some resources to get them things like refreshments. So there’s demand for finances. That has been our biggest constraint.’ (Key informant 005, Male, 56 years old)
In addition, the coronavirus disease 2019 (COVID-19) pandemic redirected available resources towards infection prevention measures, further limiting funding for NCD programmes. Informants also expressed concerns about insufficient IEC materials, noting that colour-printed materials are more engaging but often unavailable because of budget constraints. ‘When partners come, we request them to help us with the IEC materials, they look good and attractive. They easily attract someone to read when they are in colour’ (Key informant 002).
Discussion
This study highlights the critical role of community-based stroke prevention strategies in Lusaka district and identifies key implementers, facilitators and barriers. The findings emphasise that government-led initiatives, complemented by NGOs, drive stroke prevention efforts. The dominant strategies include market-based health information, education and communication (IEC) activities, social marketing campaigns and community-wide HTN screening and treatment programmes. However, barriers such as the lack of health education as well as financial and logistical challenges continue to hinder effective implementation, while community acceptance and participation, involvement of community volunteers and support from partners serve as key facilitators.
The study revealed that the MOH, through the Lusaka DHO, is the primary implementer of community-based stroke prevention strategies, supported by NGOs such as the Zambia Heart and Stroke Foundation (ZAHESFO) and the Public Health and Environmental Promotion Organization of Zambia (PHEPOZ). This aligns with global public health best practices, where government-led primary healthcare systems take responsibility for NCD prevention, with NGOs acting as partners to amplify outreach and advocacy efforts (Frieden 2014). Government initiatives are more likely to be sustainable when integrated with NGO efforts. This will leverage partnerships for technical, financial and logistical support thereby amplifying the impact of the preventive programmes (WHO 2025).
Findings from this study show a preference for group-based interventions over individualised programmes. For example, community-wide HTN screening, group health education sessions and social marketing campaigns were widely adopted, whereas individual lifestyle modification programmes and media-driven approaches (radio/television) had lower uptake. While group-based approaches enhance community engagement, evidence suggests that individualised programmes, such as targeted lifestyle interventions and home-based HTN management, are equally crucial in achieving long-term stroke prevention (Jeet et al. 2017; Singh et al. 2011). The absence of community-based HTN control programmes using CHWs in Lusaka could lead to undiagnosed and unmanaged cases, undermining the overall effectiveness of stroke prevention efforts. This gap is significant, given that CHWs have been widely recognised as key agents in NCD prevention and self-management strategies, particularly in resource-limited settings (Singh et al. 2011). Integrating CHWs into stroke prevention programmes could strengthen community engagement, improve early detection of risk factors and promote adherence to lifestyle modifications.
The study underscores the importance of community-based health education initiatives, implemented across markets, schools and churches. These settings offer accessible and familiar platforms for public health messaging. Markets, where people congregate daily, serve as effective venues for health education, ensuring that traders receive vital information without disrupting their work. Schools provide an opportunity for early intervention, aligning with global recommendations for embedding NCD education within curricula (World Health Organization and the United Nations Educational, Scientific and Cultural Organization 2021). However, a notable gap exists in engagement with non-Christian religious groups. Despite Islam representing 2.7% of Zambia’s population (United States Department of State 2022), no stroke prevention programmes were reported among Muslim communities. Expanding outreach to diverse religious institutions could enhance inclusivity and cultural relevance in community health interventions (Tettey 2018).
One of the most significant challenges identified was low awareness and misconceptions about stroke and its risk factors. Many community members did not perceive stroke as a priority health issue, and some believed it only affected affluent individuals. This finding aligns with existing research, which highlights low health literacy as a key determinant of poor health-seeking behaviour and limited adoption of preventive measures (Kickbusch et al. 2013; Šedová et al. 2021). A clear relationship has been demonstrated between health literacy and stroke education outcomes (Sanders et al. 2014). Health education efforts should therefore be strengthened and tailored to simplify complex medical concepts and counter misinformation. Community-driven campaigns using culturally appropriate messaging may improve knowledge retention and encourage behavioural change (Tettey 2018).
Financial and logistical challenges emerged as a major barrier to scaling up community stroke prevention efforts. Financial constraints impeded transportation, staffing and procurement of IEC materials, all of which are essential for effective implementation. Because the government was dealing with the COVID-19 pandemic, the shift of resources to COVID-19 response activities significantly limited funding availability for NCD preventive programmes. Despite these challenges, studies have shown that cost-effective interventions, such as promoting physical activity through sports, structured community exercise sessions and leveraging digital health tools, can significantly reduce the stroke burden (NCD Alliance 2016). Governments and stakeholders should explore alternative financing models, including public-private partnerships, donor funding and integration of NCD programmes into broader health initiatives.
While group-based interventions remain dominant, efforts to strengthen individualised prevention measures should be prioritised. Regular community-based lifestyle modification programmes, personalised risk assessment clinics and continuous physical activity interventions could enhance stroke prevention outcomes. In addition, while community-based health education is well-established, expanding faith-based health interventions to reach non-Christian groups would improve inclusivity. Furthermore, integrating CHWs into HTN control and stroke prevention efforts could improve early detection and self-management of stroke risk factors.
Study limitations
The study was carried out in 2021 during the time when the COVID-19 pandemic had a major impact on Zambia’s healthcare system. The majority of resources were allocated to combating the pandemic. This might have affected how the informants perceived obstacles to implementation. Another drawback was that health promotion officers from the Chawama and Matero sub-districts were not interviewed because they were unavailable at the time of data collection, which would have resulted in the omission of important information from these regions. Because of the study’s strict timeframe, the researchers were unable to prolong the data gathering period in order to compensate for this limitation. In addition, the research examined implementation strategies but did not assess the uptake or effectiveness of these prevention measures in communities, while its limited geographic scope to Lusaka district restricts generalisability to other regions of Zambia.
Clinical implications
Several clinical implications emerge from the findings. While group-based interventions dominated current community-level prevention activities, there’s a critical need to strengthen individualised prevention measures including personalised risk assessment clinics and lifestyle modification programmes. Incorporating CHWs into HTN control and stroke prevention could significantly improve early detection and self-management of risk factors. Current health education efforts need expansion to reach non-Christian religious groups and other underserved populations to improve inclusivity and cultural relevance. The lack of health education remains a significant barrier, requiring tailored educational approaches that simplify complex medical concepts and counter misconceptions about stroke risk factors. Financial constraints limiting programme effectiveness suggest a need for innovative funding approaches including public-private partnerships.
Conclusion
This study reinforces the importance of community engagement, volunteerism and partnerships in driving stroke prevention initiatives. However, the lack of health education, financial and logistical challenges, as well as the absence of individualised prevention strategies remain significant challenges. Strengthening targeted health education, expanding CHW-led interventions and securing sustainable funding are crucial next steps in enhancing community-based stroke prevention efforts in Lusaka district. The study offers several actionable recommendations. Further research should evaluate the uptake of stroke prevention measures across communities and identify factors influencing their application. Similar studies should be expanded to the national level to analyse stroke prevention strategies throughout Zambia. It’s important to evaluate the effects of initiatives outlined in the NCDs strategic plan (operating since 2013) on the prevention of risk factors and stroke incidence in the Zambian population. Implementation should include both group-based and individualised prevention strategies, while developing CHW-led HTN control programmes to improve community engagement, early detection and management of stroke risk factors. Increased efforts should also be made to implement workplace-based programmes, media-based health education in local languages and lifestyle modification strategies. Prevention programmes should extend to diverse religious institutions beyond Christian churches to enhance inclusivity, and alternative financing models including donor partnerships should be explored to ensure programme sustainability beyond short-term interventions.
Acknowledgements
Competing interests
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
Authors’ contributions
J.M.C.S. was involved in every stage of the research beginning from conceptualisation all the way to article writing. M.M. and L.A.N. were involved from the conceptual stage to article writing including supervision.
Funding information
The authors received no financial support for the research, authorship, and/or publication of this article.
Data availability
Filled checklists and transcripts of key informant interviews are available and stored securely by the authors. Data supporting the findings of this study are available from the corresponding author, J.M.C.S., upon request.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or the publisher. The authors are responsible for this article’s results, findings and content.
References
Council for International Organizations of Medical Sciences (CIOMS), 2016, International ethical guidelines for health-related research involving humans, 4th edn., Council for International Organizations of Medical Sciences (CIOMS), Geneva, viewed 13 April 25, from https://doi.org/10.56759/rgxl7405.
Delve, H.L. & Limpaecher, A., 2023, What is thematic content analysis in qualitative research?, Delve, viewed 13 February 2025, from https://delvetool.com/blog/thematic-content-analysis.
Feigin, V.L., Norrving, B. & Mensah, G.A., 2017, ‘Global burden of stroke’, Circulation Research 120(3), 439–448. https://doi.org/10.1161/CIRCRESAHA.116.308413
Flick, U., 2014, The SAGE handbook of qualitative data analysis, Sage, Los Angeles, CA, viewed 03 March 2025, from https://dl1.cuni.cz/pluginfile.php/1143324/mod_resource/content/1/Uwe%20Flick%20%28ed.%29%20-%20The%20SAGE%20Handbook%20of%20Qualitative%20Data%20Analysis.pdf.
Frieden, T.R., 2014, ‘Six components necessary for effective public health program implementation’, American Journal of Public Health 104(1), 17–22. https://doi.org/10.2105/AJPH.2013.301608
George, M.G., Fischer, L., Koroshetz, W., Bushnell, C., Frankel, M., Foltz, J. et al., 2017, ‘CDC grand rounds: Public health strategies to prevent and treat strokes’, Morbidity and Mortality Weekly Report 66(18), 479–481. https://doi.org/10.15585/mmwr.mm6618a5
Jeet, G., Thakur, J.S., Prinja, S. & Singh, M., 2017, ‘Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications’, PLoS One 12(7), e0180640. https://doi.org/10.1371/journal.pone.0180640
Kalkonde, Y.V., Alladi, S., Kaul, S. & Hachinski, V., 2018, ‘Stroke prevention strategies in the developing world’, Stroke 49(12), 3092–3097. https://doi.org/10.1161/STROKEAHA.118.017384
Kang, E. & Hwang, H.-J., 2023, ‘The importance of anonymity and confidentiality for conducting survey research’, Journal of Research and Publication Ethics 4(1), 1–7.
Kickbusch, I., Pelikan, J.M., Apfel, F. & Tsouros, A.D. (eds.), 2013, Health literacy: The solid facts, World Health Organization Regional Office for Europe (The solid facts), Copenhagen, viewed 13 March 2025, from https://iris.who.int/bitstream/handle/10665/128703/e96854.pdf.
Medical Facility List, 2023, Facility list, viewed 13 April 2025, from https://mfl.moh.gov.zm/facility/index?FacilitySearch%5Bname%5D=&FacilitySearch%5Bprovince_id%5D=6&FacilitySearch%5Bdistrict_id%5D=72&FacilitySearch%5Btype%5D=5&FacilitySearch%5Bownership_type%5D=1&FacilitySearch%5Bownership%5D=1&type=5.
Ministry of Health (MOH), 2013, Zambian strategic plan 2013–2016 non-communicable diseases and their risk factors, Directorate of Disease Surveillance, Control and Research Non-communicable Diseases Unit, Ndeke House, Lusaka, viewed 05 November 2024, from https://www.iccp-portal.org/system/files/plans/ZMB_B3_NCDs%20Strategic%20plan.pdf.
Ministry of Health (MOH), 2016, Zambia National Health Strategic Plan 2017–2021, viewed from https://www.moh.gov.zm/?wpfb_dl=3.
NCD Alliance, 2016, NCD Alliance Strategic Plan 2016–2020: From global commitments to national and regional action on NCD prevention and control, NCD Alliance, Geneva, viewed 12 February 2025, from http://www.ncdalliance.org
Nickerson, C., 2024, Interpretivism paradigm & research philosophy, Simply Psychology, viewed 03 February 2025, from https://www.simplypsychology.org/interpretivism-paradigm.html#.
Nutakki, A., Chomba, M., Chishimba, L., Zimba, S., Gottesman, R.F., Bahouth, M.N. et al., 2021, ‘Risk factors and outcomes of hospitalized stroke patients in Lusaka, Zambia’, Journal of the Neurological Sciences 424, 117404. https://doi.org/10.1016/j.jns.2021.117404
Sanders, K., Schnepel, L., Smotherman, C., Livingood, W., Dodani, S. & Antonios, N., 2014, ‘Assessing the impact of health literacy on education retention of stroke patients’, Preventing Chronic Disease 11, E55. https://doi.org/10.5888/pcd11.130259
Satter, S., 2024, How to write a case study after usability testing?, Trymata, viewed 03 February 2025, from https://trymata.com/blog/how-to-write-a-case-study/.
Šedová, L., Bártlová, S., Hudáčková, A., Havierniková, L., Dolák, F. & Ostrý, S., 2021, ‘Health literacy and modifiable risk factors of a stroke’, Kontakt 23(3), 149–156. https://doi.org/10.32725/kont.2021.024
Singh, K., Reddy, K.S. & Prabhakaran, D., 2011, ‘What are the evidence based public health interventions for prevention and control of NCDs in relation to India?’, Indian Journal of Community Medicine 36(suppl1), S23. https://doi.org/10.4103/0970-0218.94705
Tettey, N.-S., 2018, ‘Overcoming initial barriers in implementing faith-based health education programs: Insights from HeartSmarts’, Cogent Medicine 5(1), 1478478. https://doi.org/10.1080/2331205X.2018.1478478
United States Department of State, O. of I.R.F., 2022, Zambia, United States Department of State, viewed 10 November 2024, from https://www.state.gov/reports/2022-report-on-international-religious-freedom/zambia/.
World Life Expectancy, 2020, Stroke in Zambia, viewed 12 February 2025, from https://www.worldlifeexpectancy.com/zambia-stroke.
World Health Organization (WHO), 2025, Multisectoral action plan to prevent and control noncommunicable diseases in the Eastern Mediterranean Region, World Health Organization – Regional Office for the Eastern Mediterranean, viewed 15 April 2025, from http://www.emro.who.int/noncommunicable-diseases/publications/questions-and-answers-on-the-multisectoral-action-plan-to-prevent-and-control-noncommunicable-diseases-in-the-region.html.
World Health Organization and the United Nations Educational, Scientific and Cultural Organization, 2021, Making every school a health-promoting school: Global standards and indicators for health-promoting schools and systems, 1st edn., World Health Organization, Geneva, viewed 10 June 2023, from https://www.who.int/publications/i/item/9789240025059.
Zambia Statistic Agency, 2025, Zambia 2022 census of population and housing: Revised population summary report, vol. 2, viewed 15 March 2025, https://www.zamstats.gov.zm/Publications/Revised%202022%20Census%20of%20Population%20and%20Housing%20Summary%20Report%20Volume%20II.pdf.
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