Diagnosis of \u3cem\u3eSchistosoma mansoni\u3c/em\u3e without the Stool: Comparison of Three Diagnostic Tests to Detect \u3cem\u3eSchiostosoma mansoni\u3c/em\u3e Infection from Filtered Urine in Zambia

Diagnosis for intestinal Schistosoma mansoni lacks sensitivity and is arduous to conduct. The standard diagnostic tests, Kato-Katz (KK) and circulating cathodic antigen (CCA) both lack sensitivity and with KK, require obtaining, transporting, and examining fresh stool. We compared diagnostic efficacy of KK, CCA, and polymerase chain reaction (PCR) to detect S. mansoni infection (species-specific DNA) from 89 filtered urine samples collected in Zambia. The PCR was the strongest indicator of positive cases with sensitivity and specificity of 100% in comparison to CCA (67% and 60%) and KK (50% and 100%). High positive and negative predictive values (100%) were also indicative of robustness of PCR. The same pattern was observed when stratified for sex and age group-specific analysis. Diagnosis of S. mansoni from filtered urine samples by PCR is an effective means to detect low intensity infection and would enhance the effectiveness of surveillance and control programs of schistosomiasis

The clinical associations of dyslipidaemia among hypertensive adults presenting to the university teaching hospital (UTH), Lusaka adult hospital, Zambia.

Thesis of Master of Medicine in Internal Medicine.Co-existence of hypertension and dyslipidaemia, also referred to as dyslipidaemic hypertension (DH), is known to have synergistic effect on the development of cardiovascular disease (CVD). In Zambia, there is scanty information on distinguishing features of dyslipidaemic hypertension. The study aimed at identifying factors associated with dyslipidaemic hypertension in adults at a tertiary hospital in Zambia. This was a cross-sectional study conducted from January 2017 to July, 2017. One hundred and sixty-one (161) participants were enrolled comprising 88 hypertensives and 73 controls. Relevant demographics, physical examinations, bio-electric impedance analysis and laboratory investigations were performed. Fasting lipid and lipoprotein parameters which included fasting serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDC-C) and triglycerides (TG) were analysed for lipid abnormalities. Data was analyzed using Stata version 15. The median age was 47 years (IQR; 39, 58) and 38 years (IQR; 38, 48) for the hypertensive and control groups, respectively. 53.3% of hypertensive and 46.7% of controls had at least one lipid abnormality. The factors associated with dyslipidaemic hypertension were; TC [aOR 2.41; 95%CI 1.57, 3.69; p<0.001], TG [aOR 3.28; 95%CI 1.12, 9.63; p=0.031] and HDL-C [aOR 0.10; 95%CI 0.03, 0.39; p=0.001]. On the other hand, the factors noted to be associated with dyslipidaemia only were; TC [aOR 3.61; 95%CI 2.08, 6.28; p<0.001], male gender [aOR 0.22; 95%CI 0.09, 0.53, p=0.001] and HDL-C [aOR 0.03; 95%CI 0.01, 0.11; p<0.001]. Traditional risk factors such as age, body mass index, waist circumference, waist-to-hip ratio did not show strong associations on multi-variate analysis. The study showed that increase in total cholesterol and triglycerides, and a reduction in high density lipoprotein cholesterol was significantly associated with dyslipidaemic hypertension. It is therefore imperative that management of hypertension should also focus on identifying and correcting associated lipid disorders

Gut microbiota dependant trimethylamine N-oxide and hypertension

The human gut microbiota environment is constantly changing and some specific changes influence the host’s metabolic, immune, and neuroendocrine functions. Emerging evidence of the gut microbiota’s role in the development of cardiovascular disease (CVD) including hypertension is remarkable. There is evidence showing that alterations in the gut microbiota and especially the gut-dependant metabolite trimethylamine N-oxide is associated with hypertension. However, there is a scarcity of literature addressing the role of trimethylamine N-oxide in hypertension pathogenesis. In this review, we discuss the impact of the gut microbiota and gut microbiota dependant trimethylamine N-oxide in the pathogenesis of hypertension. We present evidence from both human and animal studies and further discuss new insights relating to potential therapies for managing hypertension by altering the gut microbiota

Hepatosplenic schistosomiasis in Zambian adults is characterized by increased liver stiffness: A nested case-control study.

Cirrhosis commonly complicates portal hypertension worldwide but in Zambia hepatosplenic schistosomiasis (HSS) dominates as the cause of portal hypertension. We need easier and non-invasive ways to assess HSS. Transient elastography (TE), a measure of liver stiffness can diagnose liver cirrhosis. TE remains unexplored in HSS patients, who generally have normal liver parenchyma. We aimed to explore liver stiffness in HSS. This nested case control study was conducted at the University Teaching Hospital, Lusaka, Zambia between January 2015 and January 2016. We enrolled 48 adults with HSS and 22 healthy controls. We assessed liver stiffness using TE while plasma hyaluronan was used to assess liver fibrosis. Plasma tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) were used to assess inflammation. The median (interquartile range) liver stiffness was higher in patients, 9.5 kPa (7.8, 12.8) than in controls, 4.7 kPa (4.0, 5.4), P < 0.0001. We noted linear correlations of hyaluronan and TNFR1 with the liver stiffness, P = 0.0307 and P = 0.0003 respectively. HSS patients seem to have higher liver stiffness than healthy controls. TE may be useful in identifying fibrosis in HSS. The positive correlations of inflammatory markers with TE suggest that HSS has both periportal and parenchymal pathophysiology

Cervicovaginal immune activation in Zambian women with female genital schistosomiasis

HIV-1 infection disproportionately affects women in sub-Saharan Africa, where areas of high HIV-1 prevalence and Schistosoma haematobium endemicity largely overlap. Female genital schistosomiasis (FGS), an inflammatory disease caused by S. haematobium egg deposition in the genital tract, has been associated with prevalent HIV-1 infection. Elevated levels of the chemokines MIP-1 alpha (CCL-3), MIP-1 beta (CCL-4), IP-10 (CXCL-10), and IL-8 (CXCL-8) in cervicovaginal lavage (CVL) have been associated with HIV-1 acquisition. We hypothesize that levels of cervicovaginal cytokines may be raised in FGS and could provide a causal mechanism for the association between FGS and HIV-1. In the cross-sectional BILHIV study, specimens were collected from 603 female participants who were aged 18-31 years, sexually active, not pregnant and participated in the HPTN 071 (PopART) HIV-1 prevention trial in Zambia. Participants self-collected urine, and vaginal and cervical swabs, while CVLs were clinically obtained. Microscopy and Schistosoma circulating anodic antigen (CAA) were performed on urine. Genital samples were examined for parasite-specific DNA by PCR. Women with FGS (n=28), defined as a positive Schistosoma PCR from any genital sample were frequency age-matched with 159 FGS negative (defined as negative Schistosoma PCR, urine CAA, urine microscopy, and colposcopy imaging) women. Participants with probable FGS (n=25) (defined as the presence of either urine CAA or microscopy in combination with one of four clinical findings suggestive of FGS on colposcope-obtained photographs) were also included, for a total sample size of 212. The concentrations of 17 soluble cytokines and chemokines were quantified by a multiplex bead-based immunoassay. There was no difference in the concentrations of cytokines or chemokines between participants with and without FGS. An exploratory analysis of those women with a higher FGS burden, defined by >= 2 genital specimens with detectable Schistosoma DNA (n=15) showed, after adjusting for potential confounders, a higher Th2 (IL-4, IL-5, and IL-13) and pro-inflammatory (IL-15) expression pattern in comparison to FGS negative women, with differences unlikely to be due to chance (p=0.037 for IL-4 and p<0.001 for IL-5 after adjusting for multiple testing). FGS may alter the female genital tract immune environment, but larger studies in areas of varying endemicity are needed to evaluate the association with HIV-1 vulnerability.Cancer Signaling networks and Molecular Therapeutic

Cervicovaginal Immune Activation in Zambian Women With Female Genital Schistosomiasis.

HIV-1 infection disproportionately affects women in sub-Saharan Africa, where areas of high HIV-1 prevalence and Schistosoma haematobium endemicity largely overlap. Female genital schistosomiasis (FGS), an inflammatory disease caused by S. haematobium egg deposition in the genital tract, has been associated with prevalent HIV-1 infection. Elevated levels of the chemokines MIP-1α (CCL-3), MIP-1β (CCL-4), IP-10 (CXCL-10), and IL-8 (CXCL-8) in cervicovaginal lavage (CVL) have been associated with HIV-1 acquisition. We hypothesize that levels of cervicovaginal cytokines may be raised in FGS and could provide a causal mechanism for the association between FGS and HIV-1. In the cross-sectional BILHIV study, specimens were collected from 603 female participants who were aged 18-31 years, sexually active, not pregnant and participated in the HPTN 071 (PopART) HIV-1 prevention trial in Zambia. Participants self-collected urine, and vaginal and cervical swabs, while CVLs were clinically obtained. Microscopy and Schistosoma circulating anodic antigen (CAA) were performed on urine. Genital samples were examined for parasite-specific DNA by PCR. Women with FGS (n=28), defined as a positive Schistosoma PCR from any genital sample were frequency age-matched with 159 FGS negative (defined as negative Schistosoma PCR, urine CAA, urine microscopy, and colposcopy imaging) women. Participants with probable FGS (n=25) (defined as the presence of either urine CAA or microscopy in combination with one of four clinical findings suggestive of FGS on colposcope-obtained photographs) were also included, for a total sample size of 212. The concentrations of 17 soluble cytokines and chemokines were quantified by a multiplex bead-based immunoassay. There was no difference in the concentrations of cytokines or chemokines between participants with and without FGS. An exploratory analysis of those women with a higher FGS burden, defined by ≥2 genital specimens with detectable Schistosoma DNA (n=15) showed, after adjusting for potential confounders, a higher Th2 (IL-4, IL-5, and IL-13) and pro-inflammatory (IL-15) expression pattern in comparison to FGS negative women, with differences unlikely to be due to chance (p=0.037 for IL-4 and p<0.001 for IL-5 after adjusting for multiple testing). FGS may alter the female genital tract immune environment, but larger studies in areas of varying endemicity are needed to evaluate the association with HIV-1 vulnerability

Rifaximin Reduces Markers of Inflammation and Bacterial 16S rRNA in Zambian Adults with Hepatosplenic Schistosomiasis: A Randomized Control Trial

We thank the Wellcome Trust through the Southern Africa Consortium for Research Excellence for funding this study (WT087537MA)

An investigation into the anticipated impact on quality assurance of implementing a tourism management information system at the Zimbabwe Tourism Authority

The Zimbabwe Tourism Authority has a mandate to market the country as a preferred destination of choice and is therefore responsible for the quality of the country’s tourism and hospitality products and services. This is in spite of the Authority not having a Management Information System that is integrated and computerised to regulate and manage the industry’s products and services. Earlier drafted Management Information Systems have not included the quality assurance aspect yet there continue to be inconsistencies, inefficiencies and ineffectiveness in this area. The main objective of this study therefore was to investigate the anticipated impact on quality assurance of implementing a Tourism Management Information System at ZTA, as well as coming up with the ideal components of such a system which are relevant and applicable to this case. Literature has shown that a tourism management system is not an off the shelf system but is designed as per need to fill gaps, which have been identified and the architecture of the TMIS made to suit these. Research has shown that such a tailor made system has the greatest positive impact on quality assurance and brings out the necessary components. This research was carried out in Harare. The research used purposive/judgemental sampling to come up with the sample as it required specifically only knowledgeable people in decision making positions’ opinions. Semi structured interviews were carried out and information on the current gaps in quality assurance, requirements of an ideal quality assurance aligned TMIS together with the challenges was obtained. Furthermore was an assessment of the impact which specific components had on quality assurance which resulted in the discovery of other more relevant components. Overally the operational efficiencies, Decision Support, Knowledge Management, Business Intelligence, Executive Information component, Compliance management and Quality Management aspects were found to have the greatest impact on quality assurance, therefore these are imperative to any TMIS on quality assurance. â€

''An analysis of agricultural policy process in Zambia

Over the last decades, Zambia has been constantly carrying out and implementing agricultural policy initiatives that have been aimed at addressing agricultural constraints. However, its impact and the performance of agricultural sector have been unsatisfactory. Therefore, this study focused on identifying the players in the Agricultural Policy formulation, information flow from inception to the implementation level, and to identifying the bottlenecks hindering the formulation and implementation of agricultural policy and then offers policy recommendations. Qualitative method was used to collect data, which involved informal interviews with experts, and key informants in both informal and formal organisations using appropriately designed checklists directed at the employees or key informants in these organisations. Published and unpublished documents were also reviewed as sources of information. The data and information from the checklist was collated, compiled and synthesized into useful information From the results the major stakeholders identified in Agricultural Policy formulation process were MACO, ZNFU, Cabinet, Parliament, MCTI, MLA, MFNP, ZRA, ZCC, IC, donors and ZACCI. In addition, the phases in the agricultural policy formulation process are policy inception and implementation. Stakeholder Consultation, inter-Ministries Consultations, Cabinet Memorandum Review and Implementation. The study also identified the major bottlenecks, which affect the formulation of agricultural policy, and these are lack of co-ordination between ministries, conflicts of views, overlapping responsibilities of ministries, lack of resources and different stakeholders' groups. Therefore, for the government to improve the problems encountered in the policy process it must raise the quality of publicly funded research and extension services, as well as increasing the process of consultation to maximise farmers' participation in the policy formulation process, implementation, monitoring and evaluation