Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria.

BACKGROUND: In Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester of pregnancy. In a context of limited information on ACT, the safety and efficacy of three combinations, namely artemether-lumefantrine (AL), mefloquine-artesunate (MQAS) and dihydroartemisinin-piperaquine (DHAPQ) were assessed in pregnant women with malaria. METHODS: The trial was carried out between July 2010 and August 2013 in Nchelenge district, Luapula Province, an area of high transmission, as part of a multi-centre trial. Women in the second or third trimester of pregnancy and with malaria were recruited and randomized to one of the three study arms. Women were actively followed up for 63 days, and then at delivery and 1 year post-delivery. RESULTS: Nine hundred pregnant women were included, 300 per arm. PCR-adjusted treatment failure was 4.7% (12/258) (95% CI 2.7-8.0) for AL, 1.3% (3/235) (95% CI 0.4-3.7) for MQAS and 0.8% (2/236) (95% CI 0.2-3.0) for DHAPQ, with significant risk difference between AL and DHAPQ (p = 0.01) and between AL and MQAS (p = 0.03) treatments. Re-infections during follow up were more frequent in the AL (HR: 4.71; 95% CI 3.10-7.2; p < 0.01) and MQAS (HR: 1.59; 95% CI 1.02-2.46; p = 0.04) arms compared to the DHAPQ arm. PCR-adjusted treatment failure was significantly associated with women under 20 years [Hazard Ratio (HR) 5.35 (95% CI 1.07-26.73; p = 0.04)] and higher malaria parasite density [3.23 (95% CI 1.03-10.10; p = 0.04)], and still women under 20 years [1.78, (95% CI 1.26-2.52; p < 0.01)] had a significantly higher risk of re-infection. The three treatments were generally well tolerated. Dizziness, nausea, vomiting, headache and asthenia as adverse events (AEs) were more common in MQAS than in AL or DHAPQ (p < 0.001). Birth outcomes were not significantly different between treatment arms. CONCLUSION: As new infections can be prevented by a long acting partner drug to the artemisinins, DHAPQ should be preferred in places as Nchelenge district where transmission is intense while in areas of low transmission intensity AL or MQAS may be used

Safety of daily co-trimoxazole in pregnancy in an area of changing malaria epidemiology: a phase 3b randomized controlled clinical trial.

INTRODUCTION: Antibiotic therapy during pregnancy may be beneficial and impacts positively on the reduction of adverse pregnancy outcomes. No studies have been done so far on the effects of daily Co-trimoxazole (CTX) prophylaxis on birth outcomes. A phase 3b randomized trial was conducted to establish that daily CTX in pregnancy is not inferior to SP intermittent preventive treatment (IPT) in reducing placental malaria; preventing peripheral parasitaemia; preventing perinatal mortality and also improving birth weight. To establish its safety on the offspring by measuring the gestational age and birth weight at delivery, and compare the safety and efficacy profile of CTX to that of SP. METHODS: Pregnant women (HIV infected and uninfected) attending antenatal clinic were randomized to receive either daily CTX or sulfadoxine-pyrimethamine as per routine IPT. Safety was assessed using standard and pregnancy specific measurements. Women were followed up monthly until delivery and then with their offspring up to six weeks after delivery. RESULTS: Data from 346 pregnant women (CTX = 190; SP = 156) and 311 newborns (CTX = 166 and SP = 145) showed that preterm deliveries (CTX 3.6%; SP 3.0%); still births (CTX 3.0%; SP 2.1%), neonatal deaths (CTX 0%; SP 1.4%), and spontaneous abortions (CTX 0.6%; SP 0%) were similar between study arms. The low birth weight rates were 9% for CTX and 13% for SP. There were no birth defects reported. Both drug exposure groups had full term deliveries with similar birth weights (mean of 3.1 Kg). The incidence and severity of AEs in the two groups were comparable. CONCLUSION: Exposure to daily CTX in pregnancy may not be associated with particular safety risks in terms of birth outcomes such as preterm deliveries, still births, neonatal deaths and spontaneous abortions compared to SP. However, more data are required on CTX use in pregnant women both among HIV infected and un-infected individuals. TRIAL REGISTRATION: Clinicaltrials.gov NCT00711906

Management of pulmonary tuberculosis patients in an urban setting in Zambia: a patient's perspective

<p>Abstract</p> <p>Background</p> <p>Zambia continues to grapple with a high tuberculosis (TB) burden despite a long running Directly Observed Treatment Short course programme. Understanding issues that affect patient adherence to treatment programme is an important component in implementation of a successful TB control programme. We set out to investigate pulmonary TB patient's attitudes to seek health care, assess the care received from government health care centres based on TB patients' reports, and to seek associations with patient adherence to TB treatment programme.</p> <p>Methods</p> <p>This was a cross-sectional study of 105 respondents who had been registered as pulmonary TB patients (new and retreatment cases) in Ndola District between January 2006 and July 2007. We administered a structured questionnaire, bearing questions to obtain individual data on socio-demographics, health seeking behaviour, knowledge on TB, reported adherence to TB treatment, and health centre care received during treatment to consenting respondents.</p> <p>Results</p> <p>We identified that respondents delayed to seek treatment (68%) even when knowledge of TB symptoms was high (78%) or when they suspected that they had TB (73%). Respondent adherence to taking medication was high (77%) but low adherence to submitting follow-up sputum (47%) was observed in this group. Similarly, caregivers educate their patients more often on the treatment of the disease (98%) and drug taking (100%), than on submitting sputum during treatment (53%) and its importance (54%). Respondent adherence to treatment was significantly associated with respondent's knowledge about the disease and its treatment (p < 0.0001), and with caregiver's adherence to treatment guidelines (p = 0.0027).</p> <p>Conclusions</p> <p>There is a need to emphasise the importance of submitting follow-up sputum during patient education and counselling in order to enhance patient adherence and ultimately treatment outcome.</p

Diversity of Mycobacterium tuberculosis genotypes circulating in Ndola, Zambia

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB) is one of the major public health problems in Zambia. However, information about lineages of <it>M. tuberculosis </it>complex (MTBC) isolates useful for epidemiology investigations is unknown. In this study, we investigated the diversity of MTBC isolates from Ndola, a typical Zambian urbanized city with a documented high HIV prevalence.</p> <p>Methods</p> <p>This was part of a prospective cohort study in subjects with sputum smear-positive pulmonary TB. Spoligotyping was used to genotype the MTBC isolates and establish the circulating lineages. The 15-locus Mycobacterial Interspersed Repetitive Units - Variable Number Tandem Repeats (MIRU-VNTR) typing was used to study recent transmission.</p> <p>Results</p> <p>A total of 98 different spoligotypes were identified among 273 MTBC isolates. The majority (64.8%) of the isolates belonged to 9 known families, while 96 (35.2%) of the isolates were orphans. While LAM (41.8%) was the largest spoligotype family observed, most of the isolates (87.7%) belonging to the SAF1 family, with a significant portion coming from the T (13.6%), and X (5.9%) families. A few isolates (3.6%) belonged to the CAS, EAI, H, S, X1-LAM9 or U families. MIRU-VNTR typing was highly discriminatory (h = 0.988) among the 156 isolates tested in our sample, and increased the discrimination among 82 SAF1 isolates from 6 to 46 distinct patterns. In addition, 3.2% (5/156) of cases with available MIRU-VNTR results harbored more than one MTBC strain.</p> <p>Conclusions</p> <p>Our findings show a limited diversity of MTBC in Ndola with a high clustering rate (37.7%), which indicates that recent transmission plays an appreciable role in the dynamics of TB disease in this setting. This conclusion emphasizes the importance of early diagnosis and timely treatment. The results also confirm that MIRU-VNTR typing is suitable for studying the molecular epidemiology of TB in Ndola.</p

Prevalence of cigarette and marijuana smoking and its associated factors amongst secondary school going adolescents in ndola urdan, Zambia

Introduction: The aim in this study was to determine prevalence and associated factors of tobacco and marijuana smoking among secondary school going adolescents in Ndola Zambia. Methods: Data was used from a selfadministered questionnaire based cross-sectional survey of grades 8’s and 10’s in five regions of Ndola Zambia. Outcomes were ‘been an ever and current cigarette smoker’ and ‘been an ever and current marijuana smoker’. Factors were socio-economic and demographic variables, personal and family behaviour, peer behaviour and media exposure. Multivariate logistic regression models were used to determine the factors associated with the outcomes. Results: The total number of pupils who participated in the study was 400. The overall prevalence of cigarette smoking and marijuana smoking was 13% (53/400) and 3% (13/400) respectively. Smokers at home and alcohol consumption were found associated with smoking cigarettes; AOR=1.65 (95%CI = [1.16, 2.35]) and AOR=2.47 (95% CI = [1.67, 3.64]) respectively. Non-smoking friends, education on dangers of smoking and seeing cigarette brands on TV were found to be protective factors of smoking cigarettes; AOR=0.42 (95%CI = [0.28, 0.63]), AOR=0.45 (95% CI=[0.31, 0.67]) and AOR=0.67 (95% CI=[0.46, 0.98]) respectively. Smokers at home and alcohol consumption were found associated with marijuana smoking; AOR= 2.93 (95%CI = [1.50, 5.72]) and AOR= 2.98 (95% CI = [1.65, 5.37]) respectively. Conclusion: Both cigarette smoking and marijuana smoking are prevalent among secondary school going adolescents in Ndola Zambia. Family and friends’ behaviour, education and media messages, as well as alcohol consumption are related to adolescent smoking of cigarettes and marijuana. This aspect needs to be integrated into design of programmes aimed at reducing use of the two substances

Factors associated with neonatal deaths at Arthur Davidson Children’s Hospital Ndola Zambia

Background: Neonatal mortality has been a public health concern for a long time and remains relatively unchanged especially in developing countries. In Zambia, 34% of all under-five deaths occur in the neonatal period. Methods: The study was designed as a comparison of cases and controls – new-born children who died before the age of 28 days and those who survived (treated) beyond 28 days respectively. Data was extracted from the 2014 and 2015 summary reports from the HMIS at Arthur Davison’s Children Hospital in Ndola Zambia. A multivariate logistic regression model was built through a back-wards step process to determine the factors associated with neonatal deaths.Results: A total of 1,534 records were extracted from the 2015 HMIS and 924 from the 2014 HMIS. Out of the total, 1,272 were treated whilst 262 died in 2015 and 726 were treated and 198 died in 2014. In 2015, infections caused less neonatal deaths than prematurity (AOR=0.29, CI 95% (0.21, 0.38)). In 2014, the sex of a child was significantly associated with surviving the first week of life; females were less likely to die than males (AOR= 0.62, CI 95 %( 0.44, 0.89)). Also in 2014, infections caused less neonatal deaths than prematurity (AOR=0.25, CI 95% (0.18, 0.36)).Conclusion and recommendations: This study revealed that factors associated with neonatal mortality include cause of death and sex. The sex of a neonate was significantly associated with surviving the first week of life. Further classification of cause of death would be beneficial in policy formulation

Uptake of HIV testing and its associated factors among long-distance truck drivers in Zambia, 2015

Introduction: Globally, long distance truckers have been reported to have an important role in the spread of sexually transmitted infections (STIs) including Human Immunodeficiency Virus (HIV). Evidence on the uptake of HIV testing among this key population is not well established. We analysed the 2015 Behavioral Surveillance Survey (BSS) data to determine the uptake of HIV testing and assess factors associated with HIV testing among Long Distance Truck Drivers (LDTDs) in Zambia. Methods: We analysed secondary data from the 2015 BSS. The BSS was carried out in five of the 10 Corridors of Hope (COH) III project sites (Kazungula, Solwezi, KapiriMposhi, Chipata and Chirundu) among male LDTDs. The Zambian Corridors of Hope HIV and AIDS Prevention Initiative project was formed to address rising rates of HIV and other sexually transmitted infections. The BSS study included LDTDs from truck depots, border sites, Zambia Revenue Authority offices and those parked along the road side. Association between independent variables and history of HIV testing was determined by bivariate logistic analysis. Multivariable logistic regression was done to control for confounders. Results: Overall, 1,386 male LDTDs were included in the study, with mean age of 38 years. Over 75% reported being currently married and living with a spouse while 82% reported having only one wife. Uptake for ever having tested for HIV among LDTDs was 83%. Having a relative or friend who was infected or who had succumbed to HIV/AIDS (adjusted OR: 0.61, 95%CI: 0.40 – 0.92) and having two or more wives (adjusted OR: 0.4, 95%CI: 0.2 – 0.6) were independent inhibitory factors for uptake of HIV testing. Conclusion: Knowledge of someone infected or died of HIV and having at least two wives were drivers for HIV testing. These findings suggest the need to implement focused Behavioral Change interventions and messages to increase uptake of HIV testing among LDTDs