Laboratory-confirmed Congenital Rubella Syndrome at the University Teaching Hospital in Lusaka, Zambia-Case Reports

Background: Congenital rubella syndrome (CRS) caused by rubella infection in uterine, is a major public health problem among women of child bearing age as it causes serious complications including foetal death or  abnormalities including cardiovascular, ophthalmologic, respiratory and hearing impairment. Though there is  evidence of rubella infection amongst the population under the expanded programme on immunization (epi)  surveillance programme, there is no documented evidence of laboratory confirmed congenital rubella syndrome  cases in Zambia. A report is given on four cases of CRS that were identified and confirmed during routine activities of the national measles surveillance program in Zambia. Clinical data on the symptomatic cases were collected and  serum samples tested for rubella IgM to confirm the cases.Case presentation: The first confirmed case was a baby girl presented to the Neonatal Intensive Care unit of the University Teaching Hospital for low birth weight and hypothermia. At seven weeks, the girl was found to have  cataracts, spleno-hepatomegaly, microcephaly, and patent ductus arteriosus (PDA). The baby tested positive to  rubella IgM antibodies. The second case was a baby boy who was first seen at the University Teaching Hospital at  three weeks and on examination was found to have bilateral cataracts, congenital heart disease and microcephaly.  Rubella Immunoglobulin M (IgM) results were positive. The third case, a girl, was seen at twelve weeks and brought in for slow growth rate. On examination, the girl was found to have bilateral cataracts,  microcephaly and  developmental delay. The fourth case is a girl who was brought to the hospital for failure to thrive, tachypnea and  fever. On further investigations there was evidence of cataracts, patent ductus arteriosus. At eight weeks, she tested  positive for rubella IgM antibodies.Conclusion: The clinical symptoms and laboratory evidence of rubella infection confirmed congenital rubella syndrome in the four patients. There is an urgent need for surveillance of congenital rubella syndrome and a  baseline rubella sero-prevalence survey in Zambia in order to determine the burden of the disease and use this  data to direct policy in terms of interventions for supportive treatment, control and possible elimination of rubella  infection through immunization with measlesrubella vaccine.Keywords: Congenital Rubella Syndrome; Confirmed; Measles-Rubella vaccine; Lusaka, Zambi

Assessment of animal African trypanosomiasis (AAT) vulnerability in cattle-owning communities of sub-Saharan Africa

Background: Animal African trypanosomiasis (AAT) is one of the biggest constraints to livestock production and a threat to food security in sub-Saharan Africa. In order to optimise the allocation of resources for AAT control, decision makers need to target geographic areas where control programmes are most likely to be successful and sustainable and select control methods that will maximise the benefits obtained from resources invested. Methods: The overall approach to classifying cattle-owning communities in terms of AAT vulnerability was based on the selection of key variables collected through field surveys in five sub-Saharan Africa countries followed by a formal Multiple Correspondence Analysis (MCA) to identify factors explaining the variations between areas. To categorise the communities in terms of AAT vulnerability profiles, Hierarchical Cluster Analysis (HCA) was performed. Results: Three clusters of community vulnerability profiles were identified based on farmers’ beliefs with respect to trypanosomiasis control within the five countries studied. Cluster 1 communities, mainly identified in Cameroon, reported constant AAT burden, had large trypanosensitive (average herd size = 57) communal grazing cattle herds. Livestock (cattle and small ruminants) were reportedly the primary source of income in the majority of these cattle-owning households (87.0 %). Cluster 2 communities identified mainly in Burkina Faso and Zambia, with some Ethiopian communities had moderate herd sizes (average = 16) and some trypanotolerant breeds (31.7 %) practicing communal grazing. In these communities there were some concerns regarding the development of trypanocide resistance. Crops were the primary income source while communities in this cluster incurred some financial losses due to diminished draft power. The third cluster contained mainly Ugandan and Ethiopian communities which were mixed farmers with smaller herd sizes (average = 8). The costs spent diagnosing and treating AAT were moderate here. Conclusions: Understanding how cattle-owners are affected by AAT and their efforts to manage the disease is critical to the design of suitable locally-adapted control programmes. It is expected that the results could inform priority setting and the development of tailored recommendations for AAT control strategies

Rational use of antibiotics by community health workers and caregivers for children with suspected pneumonia in Zambia: A cross-sectional mixed methods study

Background: Antibiotic resistance is an issue of growing global concern. One key strategy to minimise further development of resistance is the rational use of antibiotics, by providers and patients alike. Through integrated community case management (iCCM), children diagnosed with suspected pneumonia are treated with antibiotics; one component of an essential package to reduce child mortality and increase access to health care for remote populations. Through the use of clinical algorithms, supportive supervision and training, iCCM also offers the opportunity to improve the rational use of antibiotics and limit the spread of resistance in resource-poor contexts. This study provides evidence on antibiotic use by community health workers (CHWs) and caregivers to inform iCCM programmes, safeguarding current treatments whilst maximising access to care. Methods: 1497 CHW consultations were directly observed by non-clinical researchers, with measurement of respiratory rate by CHWs recorded by video. Videos were used to conduct a retrospective reference standard assessment of respiratory rate by experts. Fifty-five caregivers whose children were prescribed a 5-day course of antibiotics for suspected pneumonia were followed up on day six to assess adherence through structured interviews and pill counts. Six focus group discussions and nine in depth interviews were conducted with CHWs and caregivers to supplement quantitative findings. Results: The findings indicate that CHWs adhered to treatment guidelines for 92 % of children seen, prescribing treatment corresponding to their assessment. However, only 65 % of antibiotics prescribed were given for children with experts' confirmed fast breathing pneumonia. Qualitative data indicates that CHWs have a good understanding of pneumonia diagnosis, and although caregivers sometimes applied pressure to receive drugs, CHWs stated that treatment decisions were not influenced. 46 % of caregivers were fully adherent and gave their child the full 5-day course of dispersible amoxicillin. If caregivers who gave treatment for 3 to 5 days were considered, adherence increased to 76 %. Conclusions: CHWs are capable of prescribing treatment corresponding to their assessment of respiratory rate. However, rational use of antibiotics could be strengthened through improved respiratory rate assessment, and better diagnostic tools. Furthermore, a shorter course of dispersible amoxicillin could potentially improve caregiver adherence, reducing risk of resistance and cost

Movement Behaviour of Traditionally Managed Cattle in the Eastern Province of Zambia Captured Using Two-Dimensional Motion Sensors

Two-dimensional motion sensors use electronic accelerometers to record the lying, standing and walking activity of cattle. Movement behaviour data collected automatically using these sensors over prolonged periods of time could be of use to stakeholders making management and disease control decisions in rural sub-Saharan Africa leading to potential improvements in animal health and production. Motion sensors were used in this study with the aim of monitoring and quantifying the movement behaviour of traditionally managed Angoni cattle in Petauke District in the Eastern Province of Zambia. This study was designed to assess whether motion sensors were suitable for use on traditionally managed cattle in two veterinary camps in Petauke District in the Eastern Province of Zambia. In each veterinary camp, twenty cattle were selected for study. Each animal had a motion sensor placed on its hind leg to continuously measure and record its movement behaviour over a two week period. Analysing the sensor data using principal components analysis (PCA) revealed that the majority of variability in behaviour among studied cattle could be attributed to their behaviour at night and in the morning. The behaviour at night was markedly different between veterinary camps; while differences in the morning appeared to reflect varying behaviour across all animals. The study results validate the use of such motion sensors in the chosen setting and highlight the importance of appropriate data summarisation techniques to adequately describe and compare animal movement behaviours if association to other factors, such as location, breed or health status are to be assessed

Antibiotic and disinfectant resistance of Salmonella serovars isolated from the poultry production environment in Zambia

RESISTANCE A L\'ANTIBIOTIQUE ET AU DESINFECTANT DES SEROVARS DE SALMONELLA ISOLES D\'UN MILIEU DE PRODUCTION AVICOLE EN ZAMBIE Résumé L\'objet de la présente étude était de déterminer la résistance de l\'antibiotique et du désinfectant aux isolats de Salmonella recueillis dans le milieu de l\'usine de traitement de volailles dans des fermes commerciales en Zambie. Quatre fermes commerciales avicoles et deux usines de traitement de volailles étaient choisies en Zambie. Dans le milieu de la ferme et dans l\'usine de traitement de volailles 18/496 (3,6%) et 6/220 (2,7%) échantillons respectivement étaient positifs pour Salmonella. Une sélection de ces souches étaient testées pour déterminer la résistance à ces antibiotiques et à ces désinfectants largement utilisés en Zambie. Les isolats de Salmonella testés avaient une résistance antibiotique multiple à des antibiotiques utilisés pour traiter l\'homme et le bétail. Il n\'y avait pas de résistance aux désinfectants utilisés au taux de dilution recommandé par le fabricant. Les bactéries étaient résistantes même à des dilutions plus faibles, ce qui montre qu\'il faudrait utiliser ces désinfectants à la concentration adéquate. Mots-clés: Antibiotique, désinfectant, Salmonella, volaille, résistance. Summary The objective of this study was to determine the antibiotic and disinfectant resistance of Salmonella isolates collected from the environment of the poultry processing plant and commercial farms in Zambia. Four commercial poultry and two processing plants were sampled in Zambia. In the farm environment and poultry plant 18/496 (3.6 %) and 6/220 (2.7 %) samples respectively were positive for Salmonella. A selection of these strains were tested for resistance to those antibiotics and disinfectants commonly used in Zambia. The Salmonella isolates tested displayed multiple antibiotic resistance to a number of antibiotics used to treat both humans and animals. No resistance was seen to disinfectants used at the manufacturer\'s recommended rate of dilution. The bacteria were resistant, though, at lower dilutions, highlighting the necessity of using such disinfectants at the proper concentration. Key words: Antibiotic, Disinfectant, Salmonella, Poultry, Resistance. Bull Anim. Hlth. Prod. Afr. Vol.52(3) 2004: 168-17

Antibiotic and disinfectant resistance of <i>Salmonella</i> serovars isolated from the poultry production environment in Zambia

RESISTANCE A L\'ANTIBIOTIQUE ET AU DESINFECTANT DES SEROVARS DE SALMONELLA ISOLES D\'UN MILIEU DE PRODUCTION AVICOLE EN ZAMBIE Résumé L\'objet de la présente étude était de déterminer la résistance de l\'antibiotique et du désinfectant aux isolats de Salmonella recueillis dans le milieu de l\'usine de traitement de volailles dans des fermes commerciales en Zambie. Quatre fermes commerciales avicoles et deux usines de traitement de volailles étaient choisies en Zambie. Dans le milieu de la ferme et dans l\'usine de traitement de volailles 18/496 (3,6%) et 6/220 (2,7%) échantillons respectivement étaient positifs pour Salmonella. Une sélection de ces souches étaient testées pour déterminer la résistance à ces antibiotiques et à ces désinfectants largement utilisés en Zambie. Les isolats de Salmonella testés avaient une résistance antibiotique multiple à des antibiotiques utilisés pour traiter l\'homme et le bétail. Il n\'y avait pas de résistance aux désinfectants utilisés au taux de dilution recommandé par le fabricant. Les bactéries étaient résistantes même à des dilutions plus faibles, ce qui montre qu\'il faudrait utiliser ces désinfectants à la concentration adéquate. Mots-clés: Antibiotique, désinfectant, Salmonella, volaille, résistance. Summary The objective of this study was to determine the antibiotic and disinfectant resistance of Salmonella isolates collected from the environment of the poultry processing plant and commercial farms in Zambia. Four commercial poultry and two processing plants were sampled in Zambia. In the farm environment and poultry plant 18/496 (3.6 %) and 6/220 (2.7 %) samples respectively were positive for Salmonella. A selection of these strains were tested for resistance to those antibiotics and disinfectants commonly used in Zambia. The Salmonella isolates tested displayed multiple antibiotic resistance to a number of antibiotics used to treat both humans and animals. No resistance was seen to disinfectants used at the manufacturer\'s recommended rate of dilution. The bacteria were resistant, though, at lower dilutions, highlighting the necessity of using such disinfectants at the proper concentration. Key words: Antibiotic, Disinfectant, Salmonella, Poultry, Resistance. Bull Anim. Hlth. Prod. Afr. Vol.52(3) 2004: 168-17

Detection of re-emerging bovine trypanosomiasis in southern Zambia by loop-mediated isothermal amplification (LAMP

In the present study, trypanosome species-specific Loop-mediated isothermal amplification (LAMP) technique, specifically targeting the 18S rRNA gene of Trypanosoma congolense, the repetitive insertion mobile element (RIME) gene of the Trypanozoon subgenus group and the human serum resistant associated (SRA) gene of Trypanosoma brucei rhodesiense, was used to determine the prevalence of bovine trypanosomiasis in the Choma - Kalomo block, an important agricultural area within the Southern province of Zambia. Our data show that out of the 460 cattle sampled, 12.8% (59) were detected to have trypanosomes in their blood by LAMP, suggesting the resurgence of bovine trypanosomiasis in the previously aerial-sprayed Choma-Kalomo block. The majority of those infections were caused by T. congolense. Considering that LAMP is a highly sensitive and specific technique and yet user friendly, thistest may in future prove to be instrumental in the routine accurate detection of trypanosomiasis in field samples in resource-limited countries such as Zambia