The social determinants of tuberculosis and their association with TB/HIV co-infection in Lusaka, Zambia

Introduction: Tuberculosis (TB) is a major public health problem globally.Progress made in TB control through the implementation of the DOTS strategy, has been retarded by factors such as poverty, the HIV pandemic and the advent of multidrug resistant tuberculosis. There is currently an increasing shift in TB control strategies to emphasize the importance of social determinants of TB if notable impact has to be attained. However, limited data exist that describe these determinants in high burden settings such as Zambia. This study was conducted to explore the social determinants of TB and their association with TB/HIV co-infection, in order to inform TB control strategies that would lead to appropriate action for impact.Method: A cross-section study of TB patients presenting to four peri-urban health facilities in Lusaka through administration of a standard structured questionnaire. STATA 12 Version 1 was used for analysis.Results: There were 1,259 TB patients enrolled. The median age was 35 (IQR; 29 – 41). The main determinants that were associated with TB/HIV co-infection were: being in the age-group 24-49 (p = 0.0001); being female (p = 0.0001); re-treatment (p = 0.0001); having extrapulmonary TB (p = 0.02); being married or widowed (p = 0.05 and p = 0.01, respectively)Conclusions: Describing the social determinants of TB and their association with TB/HIV co-infection highlighted a number of opportunities to strengthen control beyond the Stop TB Strategy

Tuberculosis in prisons in sub-Saharan Africa--a potential time bomb.

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Application of highly portable MinION nanopore sequencing technology for the monitoring of nosocomial tuberculosis infection

Referral hospitals in sub-Saharan Africa concentrate large numbers of tuberculosis (TB) and multidrug-resistant TB (MDR-TB) patients, failed by community TB services. We have previously shown, from enhanced screening and through autopsy studies, a significant burden of missed TB infections at the University Teaching Hospital, Lusaka, Zambia, with many patients dying or being discharged without treatment. With minimal TB isolation facilities and minimal political will to invest in broader screening and isolation, the risk of nosocomial transmission is likely to be extremely high. Studies from other hospitals in low burden settings and in South Africa have shown that next generation sequencing (NGS) is a very powerful tool for rapidly sequencing whole TB genomes and comparing them to confirm or rule out nosocomial transmission. The established platforms for NGS analysis, such as Illumina, are very expensive, immobile, and require regular maintenance, making them a costly inclusion on a research proposal or programmatic intervention grant in Africa. MinION nanopore sequencing has changed the NGS landscape with cheap portable sequencers, rapid simple library preparation (15min), and automated real-time analysis tools. The application of highly portable MinION nanopore sequencing technology for the monitoring of nosocomial TB infection will be discussed. Preliminary data from our pediatric pneumonia study will demonstrate the detection of TB in induced sputum from children admitted to the University Teaching Hospital

Tuberculosis among older adults in Zambia: Burden and characteristics among a neglected group

BACKGROUND: The 2010 Global Burden of Disease estimates show that 57% of all TB deaths globally occurred among adults older than 50 years of age. Few studies document the TB burden among older adults in Southern Africa. We focused on adults older than 55 years to assess the relative TB burden and associated demographic factors. METHODS: A cross sectional nationally representative TB prevalence survey conducted of Zambian residents aged 15 years and above from 66 clusters across all the 10 provinces of Zambia. Evaluation included testing for TB as well as an in-depth questionnaire. We compared survey data for those aged 55 and older to those aged 15-54 years. Survey results were also compared with 2013 routinely collected programmatic notification data to generate future hypotheses regarding active and passive case finding. RESULTS: Among older adults with TB, 30/ 54 (55.6%) were male, 3/27 (11.1%) were HIV infected and 35/54 (64.8%) lived in rural areas. TB prevalence was higher in those aged ≥55 (0.7%) than in the 15-54 age group (0.5%). Males had higher rates of TB across both age groups with 0.7% (15-54) and 1.0% (≥55) compared with females 0.4% (15-54) and 0.6% (≥55). In rural areas, the prevalence of TB was significantly higher among older than younger adults (0.7% vs 0.3%), while the HIV infection rate was among TB patients was lower (11.1% vs 30.8%). The prevalence survey detected TB in 54/7484 (0.7%) of older adults compared to 3619/723,000 (0.5% ) reported in 2013 programmatic data. CONCLUSION: High TB rates among older adults in TB endemic areas justify consideration of active TB case finding and prevention strategies

Characterization and Local Perceptions of Poverty Among Rural Households in Northern Zambia

Background: Poverty has been linked with poor  health outcomes in world health reports and cited by many scholars and leading health economists and public health specialist as a cause for poor health seeking behaviours especially for the rural poor. Poverty and ill-health are so closely intertwined that it is possible to use the words interchangeably, and still mean the same thing. Poverty has been defined as “a state of relative equilibrium of body form and function which results from its successful dynamic adjustments to forces tending to disturb it. It is not a passive interplay between body and forces impinging upon it but an active response of body forces working towards readjustment”. Poverty on the other hand has been defined as a “lack of access to income, employment, and normal internal entitlements for the citizens to such things as freely determined consumption of goods and services, shelter and other basic needs of life”. The poverty and ill-health situation has grown grimmer for Africa and some Asian countries. The last decade has seen an emergence of new and a resurgence of old infections with a virulence and velocity hard to compare. East Asia and Sub-Saharan Africa have been at the receiving end of most the consequences of poverty and the ill health that result exacerbated by the HIV and AIDS pandemic. It has been suggested that attacking poverty is the answer to better health. Many agree with this notion of improving health. The million dollar question has however remained how to proceed with the war against poverty. Experts and scholars have done commendable work studying, defining and designing solutions for poverty. That much has been achieved in these lines, again there is no denying. Success in reducing poverty has however remained elusive, especially in sub-Saharan Africa. World Health Organisation (WHO) in its World Health Report for 2005, admits failure in improvement of most health indicators in sub-Saharan Africa and more so for Zambia.Methods: The participatory action research (PAR) was conducted in Chikoti village in Luwingu area among 212 households, Kungu village in Kasama with 236 households, Mpepo village in Mpika with 220 households and Ilondola village with 360 households. The study investigated the relationship between poverty and ill-health and how the rural poor respond to this discourse.Results: The communities demonstrated a clear understanding of their own environment and were able to define factors which make them vulnerable to poverty and inversely to poor health. The study communities were able to distinctly define their own poverty levels and identify the categories of community members into the poverty status that is: managing poor, moderately poor and the extremely poor according to their local conditions and in their own local language.Conclusion: It is clear from the study findings that the rural communities do perceive poverty to affect all of the community members equally regardless of age or education levels. The study participants also demonstrated that they understood the vulnerability of women and children to poverty and its effects. It was also observed that poverty stricken communities often give preference to food than health, introducing ill-health due to negligence

A 10-year Review of TB Notifications and Mortality Trends Using a Joint Point Analysis in Zambia - a High TB burden country

BACKGROUND: Zambia is one of the TB high-burden countries. It is important to track the progress being made towards enhancing case finding and reducing mortality. We reviewed routine TB notifications and mortality trends, over a decade from all facilities in Zambia. METHODS: A 10-year retrospective study of TB notifications and mortality trends was performed using a Joint Point Analysis version 4.9.0.0, NCI. We extracted the annual national TB program data for the period under review. RESULTS: There was a decline in annual point average for notification between 2010 and 2020 in both males and females, but the females notification rates had a higher rate of decline (AAPC = -6.7, 95%CI:-8.3 to -5.0), p<0.001) compared to the decline in males notification rate (AAPC = -4.1, 95%CI:-4.1 to -5.1, P<0.001). We found a significant growth rate in the proportion of TB patients that were bacteriologically confirmed (AAPC = 6.1, 95% CI: 3.6 to 8.7, p< 0.001), while the proportion of clinically diagnosed patients declined (AAPC= -0.1, 95%CI: -2.3 to 2.1, p<0.001). Notification of drug-resistant TB increased exponentially (AAPC=27.3, 95% CI: 13 to 41), p< 0.001) while mortality rate declined from 21.3 in 2011 to 12.7 in 2019 per 100,000 population (AAP=-5.6, 95%CI: -9.6 to -1.5, p=0.008). CONCLUSIONS: This study has illustrated the importance of reviewing and analyzing routinely collected TB data by national programs. The study revealed areas of improvement in terms of TB control and underscores the need for increased and sustained investment in case detection and diagnostics