Factors associated with Coronavirus disease 2019 (COVID-19) and an assessment of adherence to infection prevention and control (IPC) guidelines among health workers —Nakonde District, Zambia, 2020

Introduction: Health workers play a critical role in the clinical management of COVID-19 patients. However, research on their infection risk and clinical characteristics, particularly in Africa, is emerging. We investigated risk factors for COVID-19 infection and assessed adherence to infection prevention and control (IPC) guidelines among health workers in Nakonde District. Methods: A case-control study among health workers at Nakonde Urban Health Centre and Nakonde District Hospital was conducted from 15 to 25 May 2020. A standardized questionnaire covering demographic information; possible exposure to persons with COVID-19; adherence to infection prevention and control measures was administered to all health workers present at these facilities. Descriptive statistics were performed and logistic regression was used to calculate the odds ratio (OR) and 95% CIs. Results: A total of 197 HCWs are deployed in the two facilities out of which we obtained 138 responses. Seventy-five (54%) had complete responses that were analyzed in this study. Among the 75, 54 (72%) were female. The median age for all the HCWs that responded was 30 years (IQR 26-33). Thirty-seven (49%) were laboratory-confirmed COVID-19 cases. Symptoms that were exhibited among HCWs with COVID-19 included cough (49%), headache (43%), runny nose (32%) and fatigue (18%); fever was rarely reported (8%). Cough was associated with being a case of COVID-19 (OR 4.2 95% CI 1.5-11.9). Coexisting conditions were similar among the cases and controls. There were no statistically significant differences in exposures between HCWs with confirmed COVID-19 and those without (OR 0.96; 95% CI 0.4-2.5). The WHO five moments of hand hygiene recommended for health workers were practiced by (64%). Non availability of Personal Protective Equipment was reported by 70% of HCWs and this was similar among the cases of COVID-19 and the non-cases. Conclusion: Given the critical role HCWs play in looking after the sick, continued protection of this population at work, at home, and in the community through surveillance should be a national priority

Incidental Tuberculosis in sudden, unexpected, or violent deaths in the community Lusaka, Zambia - A descriptive forensic post-mortem examination study

Objectives: Tuberculosis remains a global emergency. In Zambia only 55% of tuberculosis cases are diagnosed. We performed a study to determine incidental cases of tuberculosis seen at forensic autopsy of individuals who died suddenly and unexpectedly in the community in Lusaka, Zambia. Methods: Whole-body autopsies were performed according to Standard Operating Procedures. Representative samples obtained from relevant organs were subjected to pathological examination. Information on circumstances surrounding the death was obtained. Data on patient demographics, gross and microscopic pathological findings, and cause(s) of death were analysed. Results: Incidental tuberculosis was found in 52 cases (45 male, 7 female, age range 14-66) out of 4286 whole-body autopsies. 41/52 (80%) were aged 21-50 years. One was a 14-year old boy who died during a football match. 39/52 (75%) deaths were attributable specifically to tuberculosis only. Other deaths were due to acute alcohol intoxication(4), violence(7), ruptured ectopic pregnancy(1), bacterial meningitis (1). All the cases were from poor socio-economic backgrounds and lived in high-density areas of Lusaka. Conclusions: Incidental cases of active tuberculosis undiagnosed antemortem seen at forensic autopsy reflects major gaps in the national TB control programs. More investments into proactive screening, testing, treatment activities, and accurate data collection are required

Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series

Background: Since information on the pathology of COVID-19 from sub-Saharan Africa (SSA) remains scarce, the objective of our study was to define the gross pathology and histological features of COVID-19. We report data from 29 whole-body autopsies of COVID-19 deaths occurring in hospitals in Lusaka, Zambia - the first large autopsy case series from Africa. Methods: We performed a descriptive post-mortem examination study of inpatient COVID-19 related deaths at two hospitals in Lusaka, Zambia. Whole-body autopsies were conducted according to Standard Operating Procedures. Gross and histopathological examinations of all organs were performed. Patient demographics, history, co-morbidities, autopsy gross and microscopic findings, and cause(s) of death were recorded and analyzed using STATA version 14. Variables were grouped and presented as frequencies and percentages. Findings: Autopsies were performed on 29 decedents (mean age = 44 ± 15.8years; age range = 19-82; 17/29 [58.8%] males). 22/29 [75.9%] cases were <55 years of age. A spectrum of pathological manifestations of COVID-19 were seen in all organs. The commonest causes of death were pulmonary thromboembolism (13/29, 45%), Diffuse Alveolar Damage (9/29, 31%), and COVID-19 pneumonia (7/29, 25%). 22/29 (76%) had co-morbidities. Common co-morbidities included HIV (8/29, 28%), Hypertension (6/29, 20%) Tuberculosis (3/29, 10%), Diabetes (3/29, 10%). Conclusions: A spectrum of gross anatomical and histopathological findings are seen in COVID-19 deaths in hospitalized decedents. These appear broadly similar to those reported from China, Europe and USA. Differences include a younger age group, and co-morbidities of HIV and TB co-infection which require further investigation