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

Science scholars's perceptions on rearrangement of some physics topics as a way of enhancing performance: a case of Lusaka district

THESIS M.ED(SCIENCE)This study was aimed at exploring the perceptions of science scholars on the rearrangement of some physics topics as a way of enhancing performance at grade 12 physics and science national examinations. A case of selected institutions in Lusaka district was considered. The study was guided by the following objectives: To determine the perceptions of scholars (Science Specialists, Educators and Learners) on the rearrangement of some physics topics, to establish the general performance of grade 12 pupils in physics and science from 2003 to 2014 and to identify topics that can enhance the performance. An exploratory research design was used in which purposive and simple random sampling procedures were employed. The sample comprised 312 respondents - 86 were college and university students who were studying physics, 59 were teachers who were either teaching or had taught physics or science, 116 were pupils from secondary schools, and 53 were science specialists from Examinations Council of Zambia, Curriculum Development Centre, National Technology and Science Council and the Zambia Bureau of Standards. The study was situated in the frameworks of Gagne’s model of instruction design and the attribution theory. Gagne’s model of instructional design focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcomes and consequently points out the need for prerequisite knowledge for the process of meaningful learning. The attribution theory suggests that success or failure may be attributed to internal or external factors which can be controllable or uncontrollable. Data on scholars’ perceptions was collected via structured questionnaire while the one on pupils’ performance was accessed from the Examinations Council of Zambia. Data was quantitatively and qualitatively analyzed. Quantitative analysis was done descriptively using Statistical Package for Social Sciences (SPSS) software. The findings indicated that science scholars perceive the rearrangement of some physics topics as one of the ways which might enhance the performance. Relative to other selected compulsory subjects pupils performance in physics and science was lower and differed significantly (p = 0.000 for 2003, p = 0.00145 for 2009 and p = 0.000 for 2014). Finally, the results show that some topics where candidates performed poorly did not have adequate prerequisite coverage meanwhile some were repeated at both junior and senior secondary levels. In view of the above, the study recommended that those topics where candidates performed poorly (radioactivity, electromagnetism or basic electronics) are the ones which might enhance the performance if they were rearranged and their prerequisites reconsidered