Seroprevalence of West Nile Virus specific IgG and IgM antibodies in North-Western and Western provinces of Zambia

Background: West Nile Virus (WNV) infection has been reported worldwide, including in Africa but its existence in Zambia is unknown. Symptoms for the virus include headache, myalgia, arthralgia and rash.Objectives: This study aimed to determine the seroprevalence of WNV and its correlates.Methods: A cross sectional study was conducted in North-Western and Western provinces of Zambia. Samples were subjected to IgG and IgM antibodies testing against WNV. Logistic regression analyses were conducted to determine magnitudes of association.Results: A total of 3,625 of persons participated in the survey out of which 10.3% had WNV infection. Farmers were 20% (AOR=0.80; 95% CI [0.64, 0.99]) less likely to have infection compared to students. Meanwhile participants who lived in grass roofed houses were 2.97 (AOR=2.97; 95% CI [1.81, 4.88]) times more likely to be infected than those who lived in asbestos roofed houses. IRS was associated with reduced risk of infection (AOR=0.81; 95% CI [0.69, 0.94]). Travelling to Angola was associated with the infection [AOR=1.40; 95% CI [1.09, 1.81].Conclusion: Spraying houses with insecticide residual spray would minimize mosquito-man contact. Furthermore, surveillance at the border with Angola should be enhanced in order to reduce importation of the virus into the country.Keywords: Seroprevalence, West Wile Virus, Western province, North-Western province, Zambi

Significant decline in lymphatic filariasis associated with nationwide scale-up of insecticide-treated nets in Zambia.

Lymphatic filariasis (LF) is a mosquito-borne disease, broadly endemic in Zambia, and is targeted for elimination by mass drug administration (MDA) of albendazole and diethylcarbamazine citrate (DEC) to at-risk populations. Anopheline mosquitoes are primary vectors of LF in Africa, and it is possible that the significant scale-up of malaria vector control over the past decade may have also impacted LF transmission, and contributed to a decrease in prevalence in Zambia. We therefore aimed to examine the putative association between decreasing LF prevalence and increasing coverage of insecticide-treated mosquito nets (ITNs) for malaria vector control, by comparing LF mapping data collected between 2003-2005 and 2009-2011 to LF sentinel site prevalence data collected between 2012 and 2014, before any anti-LF MDA was started. The coverage of ITNs for malaria was quantified and compared for each site in relation to the dynamics of LF. We found a significant decrease in LF prevalence from the years 2003-2005 (11.5% CI95 6.6; 16.4) to 2012-2014 (0.6% CI95 0.03; 1.1); at the same time, there was a significant scale-up of ITNs across the country from 0.2% (CI95 0.0; 0.3) to 76.1% (CI95 71.4; 80.7) respectively. The creation and comparison of two linear models demonstrated that the geographical and temporal variation in ITN coverage was a better predictor of LF prevalence than year alone. Whilst a causal relationship between LF prevalence and ITN coverage cannot be proved, we propose that the scale-up of ITNs has helped to control Anopheles mosquito populations, which have in turn impacted on LF transmission significantly before the scale-up of MDA. This putative synergy with vector control has helped to put Zambia on track to meet national and global goals of LF elimination by 2020

Complete In Vitro Life Cycle of Trypanosoma congolense: Development of Genetic Tools

Trypanosoma congolense is a parasite responsible for severe disease of African livestock. Its life cycle is complex and divided into two phases, one in the tsetse fly vector and one in the bloodstream of the mammalian host. Molecular tools for gene function analyses in parasitic organisms are essential. Previous studies described the possibility of completing the entire T. congolense life cycle in vitro. However, the model showed major flaws including the absence of stable long-term culture of the infectious bloodstream forms, a laborious time-consuming period to perform the cycle and a lack of genetic tools. We therefore aimed to develop a standardized model convenient for genetic engineering. We succeeded in producing long-term cultures of all the developmental stages on long-term, to define all the differentiation steps and to finally complete the whole cycle in vitro. This improved model offers the opportunity to conduct phenotype analyses of genetically modified strains throughout the in vitro cycle and also during experimental infections

Underpinning Sustainable Vector Control through Informed Insecticide Resistance Management

Background: There has been rapid scale-up of malaria vector control in the last ten years. Both of the primary control strategies, long-lasting pyrethroid treated nets and indoor residual spraying, rely on the use of a limited number of insecticides. Insecticide resistance, as measured by bioassay, has rapidly increased in prevalence and has come to the forefront as an issue that needs to be addressed to maintain the sustainability of malaria control and the drive to elimination. Zambia’s programme reported high levels of resistance to the insecticides it used in 2010, and, as a result, increased its investment in resistance monitoring to support informed resistance management decisions. Methodology/Principal Findings: A country-wide survey on insecticide resistance in Zambian malaria vectors was performed using WHO bioassays to detect resistant phenotypes. Molecular techniques were used to detect target-site mutations and microarray to detect metabolic resistance mechanisms. Anopheles gambiae s.s. was resistant to pyrethroids,DDT and carbamates, with potential organophosphate resistance in one population. The resistant phenotypes were conferred by both target-site and metabolic mechanisms. Anopheles funestus s.s. was largely resistant to pyrethroids and carbamates, with potential resistance to DDT in two locations. The resistant phenotypes were conferred by elevated levels of cytochrome p450s. Conclusions/Significance: Currently, the Zambia National Malaria Control Centre is using these results to inform their vector control strategy. The methods employed here can serve as a template to all malaria-endemic countries striving to create a sustainable insecticide resistance management pla

A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia

OBJECTIVES: To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. METHODS: This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. RESULTS: Out of 4 891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI 95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI 95 21.3.1-23.7) were not subjected to any malaria test. Of the 2 247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI 95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI 95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI 95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices. CONCLUSIONS: Malaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines

Improved Financial Probity in the Health Sector Following the WHO Reforms in Zambia

Background: The World Health Organization (WHO) Reform emphasizes strict adherence to two procedures for disbursements of resources allocated to all the 196 member states as per approval from the World Health Assembly. Direct financial cooperation (DFC) are transactions where funds are transferred to government and concluded in three months after completion of activity. Direct implementation is the procedure when the WHO pays on behalf of the Government of the Republic of Zambia (GRZ) for implementation of processes concluded within 5 months after the activity. The aim of this study is to document financial compliance to WHO reform of WHO Zambia with government.Methods: This was a desk review of financial activities from the WHO country office from January to December 2015. Findings and recommendations from the November 2015 External Audit conducted on the financial operations of the WHO Zambia office in the area of implementation and management of Direct Financial Corporation and Direct Implementation were also analysed.Results: The resource allocations were equally distributed between DFCs and DIs during the year of study. The WHO Zambia conducted fortnightly meetings to review DFC and DI status and, monitoring with all Program officers. Of the 34 DFCs issued only three (8%) were submitted late at the beginning of 2015 with progressive improvement thereafter. WHO Zambia received commendation from the Regional Office, a consideration which was corroborated by the External Audit recommendations.Discussion: One of the reasons for reform was financial accountability challenges in the WHO with donors raising concern. The conformity of the WHO Zambia is an attribute. The WHO Zambia implemented the DFC and DI in accordance with WHO guidelines as evidenced by positive Audit recommendation in this area.Conclusion: The regular WHO Zambia tracking of the status of DFCs and DI is a best practice that the other regional Country offices can emulate. This practice if scaled up to the entire region will increase donor trust and confidence