Factors associated with tuberculosis mortality in selected health facilities in Lusaka, Zambia, 2016

Introduction: Zambia is among the 30 countries with the highest burden of tuberculosis (TB), with an estimated incidence rate of 346 per 100,000 population in 2018. Lusaka is among the districts with the highest TB incidence in Zambia. In 2015, TB mortality (6%) exceeded the national target of less than 5%. We sought to assess factors associated with TB mortality in selected public health facilities in Lusaka, in order to gain knowledge required to design appropriate strategies for reduction.Methods: We conducted a cross-sectional study in three purposively selected public health facilities in Lusaka including a 1st level-hospital, an urban-clinic, and a periurban clinic. We used the 2013 World Health Organisation's (WHO), definitions and reporting framework for TB and defined TB mortality as any TB patient who died for any reason during the course of TB treatment. We abstracted data from treatment registers for TB cases on treatment in 2016. Using multivariable logistic regression, we analysed the associations between TB mortality and age, health facility type or HIV status and reported adjusted odds ratios(AOR), and 95% confidence intervals(CI).Results: We included 1,537 registered TB patients from the three sites in 2016 (urbanclinic(n=676), 1st-level-hospital(n=630) and peri-urban-clinic(n=231)). The overall mortality rate was 9%, and by facility: 8%(urban-clinic), 11%(1st-level-hospital) and 8%(peri-urban-clinic). The odds of TB mortality were higher among patients >64 years (AOR=7.6, 95%CI:1.97–29.55), TB/HIV co-infected (AOR=3.1, 95%CI:1.91–4.93) and those treated at the 1st-level-hospital (AOR=1.6, 95%CI:1.08–2.40).Conclusion: TB mortality in the selected facilities was high compared to the national target. We recommend scaling up of TB treatment and preventive therapy among people living HIV especially those >64 years old in the selected health facilities

Factors associated with Coronavirus disease 2019 (COVID-19) and an assessment of adherence to infection prevention and control (IPC) guidelines among health workers —Nakonde District, Zambia, 2020

Introduction: Health workers play a critical role in the clinical management of COVID-19 patients. However, research on their infection risk and clinical characteristics, particularly in Africa, is emerging. We investigated risk factors for COVID-19 infection and assessed adherence to infection prevention and control (IPC) guidelines among health workers in Nakonde District. Methods: A case-control study among health workers at Nakonde Urban Health Centre and Nakonde District Hospital was conducted from 15 to 25 May 2020. A standardized questionnaire covering demographic information; possible exposure to persons with COVID-19; adherence to infection prevention and control measures was administered to all health workers present at these facilities. Descriptive statistics were performed and logistic regression was used to calculate the odds ratio (OR) and 95% CIs. Results: A total of 197 HCWs are deployed in the two facilities out of which we obtained 138 responses. Seventy-five (54%) had complete responses that were analyzed in this study. Among the 75, 54 (72%) were female. The median age for all the HCWs that responded was 30 years (IQR 26-33). Thirty-seven (49%) were laboratory-confirmed COVID-19 cases. Symptoms that were exhibited among HCWs with COVID-19 included cough (49%), headache (43%), runny nose (32%) and fatigue (18%); fever was rarely reported (8%). Cough was associated with being a case of COVID-19 (OR 4.2 95% CI 1.5-11.9). Coexisting conditions were similar among the cases and controls. There were no statistically significant differences in exposures between HCWs with confirmed COVID-19 and those without (OR 0.96; 95% CI 0.4-2.5). The WHO five moments of hand hygiene recommended for health workers were practiced by (64%). Non availability of Personal Protective Equipment was reported by 70% of HCWs and this was similar among the cases of COVID-19 and the non-cases. Conclusion: Given the critical role HCWs play in looking after the sick, continued protection of this population at work, at home, and in the community through surveillance should be a national priority

Investigation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infections among health care workers - Lusaka District, Zambia, April-June 2020

Introduction: Zambia is experiencing an epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19). Infections initially sporadic, but community transmission began to occur widely in late June 2020. Over 100 health care workers (HCWs) reported infected with SARS-CoV-2 in Lusaka District. We investigated factors associated with SARS-CoV-2 infections among HCWs in four hospitals in Lusaka District during April to June 2020. Methods: Case control study among HCWs with confirmed SARS-CoV-2 infections at Levy Mwanawasa Hospital, Cancer Disease Hospital, Chilenje First level Hospital, and Women and Newborn Hospital in April to June 2020. Controls drawn from HCWs working in a department within 14 days before a positive test of cases. Standardized questionnaire assessing demographics, medical history, exposures, and infection prevention practices administered. Logistic regression conducted to assess associations with SARS-CoV-2 infection, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Forty-three cases occurred in four facilities from April through June 2020. We interviewed 39 cases and 101 controls. Median age was 33 years (interquartile range: 28, 38). Twenty-nine (74%) cases self-reported being asymptomatic. Most (25(65.8%)) cases tested positive during HCW screening with no known HCW index case. Unknown exposure status in facilities had increased odds of acquiring SARS-CoV-2 compared to known exposure (OR = 4.5 (95% CI: 1.73, 11.9)). Low adherence to handwashing (OR=4.53 (95% CI: 1.74, 11.8)) and inadequate use of personal protective equipment (OR=2.87 (1.20, 6.87)) increased odds of having SARS-CoV-2. Conclusion: Low adherence to personal protective measures like hand washing, PPE use and absence of knowledge about potential SARS-CoV-2 exposures in health facilities suggest that transmission could have occurred in health facilities. Routine HCW screening for early identification and isolation of cases to minimise nosocomial transmission is recommended

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

Since its first discovery in December 2019 in Wuhan, China, COVID-19, caused by the novel coronavirus SARS-CoV-2, has spread rapidly worldwide. While African countries were relatively spared initially, the initial low incidence of COVID-19 cases was not sustained for long due to continuing travel links between China, Europe and Africa. In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 h of the individual entering the country by air travel from a trip to France. Contact tracing showed that SARS-CoV-2 infection was contained within the patient’s household, with no further spread to attending health care workers or community members. Phylogenomic analysis of the patient’s SARS-CoV-2 strain showed that it belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. At the African continental level, our analysis showed that B.1 and B.1.1 lineages appear to be predominant in Africa. Whole genome sequence analysis should be part of all surveillance and case detection activities in order to monitor the origin and evolution of SARS-CoV-2 lineages across Africa

Zambia field epidemiology training program: strengthening health security through workforce development

The Zambia Field Epidemiology Training Program (ZFETP) was established by the Ministry of Health (MoH) during 2014, in order to increase the number of trained field epidemiologists who can investigate outbreaks, strengthen disease surveillance, and support data-driven decision making. We describe the ZFETP´s approach to public health workforce development and health security strengthening, key milestones five years after program launch, and recommendations to ensure program sustainability. Program description: ZFETP was established as a tripartite arrangement between the Zambia MoH, the University of Zambia School of Public Health, and the U.S. Centers for Disease Control and Prevention. The program runs two tiers: Advanced and Frontline. To date, ZFETP has enrolled three FETP-Advanced cohorts (training 24 residents) and four Frontline cohorts (training 71 trainees). In 2016, ZFETP moved organizationally to the newly established Zambia National Public Health Institute (ZNPHI). This re-positioning raised the program´s profile by providing residents with increased opportunities to lead high-profile outbreak investigations and analyze national surveillance data-achievements that were recognized on a national stage. These successes attracted investment from the Government of Republic of Zambia (GRZ) and donors, thus accelerating field epidemiology workforce capacity development in Zambia. In its first five years, ZFETP achieved early success due in part to commitment from GRZ, and organizational positioning within the newly formed ZNPHI, which have catalyzed ZFETP´s institutionalization. During the next five years, ZFETP seeks to sustain this momentum by expanding training of both tiers, in order to accelerate the professional development of field epidemiologists at all levels of the public health system

Euvichol-plus vaccine campaign coverage during the 2017/2018 cholera outbreak in Lusaka district, Zambia: a cross-sectional descriptive study

Objective To determine the coverage for the oral cholera vaccine (OCV) campaign conducted during the 2017/2018 cholera outbreak in Lusaka, Zambia.Study design A descriptive cross-sectional study employing survey method conducted among 1691 respondents from 369 households following the second round of the 2018 OCV campaign.Study setting Four primary healthcare facilities and their catchment areas in Lusaka city (Kanyama, Chawama, Chipata and Matero subdistricts).Participants A total of 1691 respondents 12 months and older sampled from 369 households where the campaign was conducted. A satellite map-based sampling technique was used to randomly select households.Data management and analysis A pretested electronic questionnaire uploaded on an electronic tablet (ODK V.1.12.2) was used for data collection. Descriptive statistics were computed to summarise respondents’ characteristics and OCV coverage per dose. Bivariate analysis (χ2 test) was conducted to stratify OCV coverage according to age and sex for each round (p<0.05).Results The overall coverage for the first, second and two doses were 81.3% (95% CI 79.24% to 83.36%), 72.1% (95% CI 69.58% to 74.62%) and 66% (95% CI 63.22% to 68.78%), respectively. The drop-out rate was 18.8% (95% CI 14.51% to 23.09%). Of the 81.3% who received the first dose, 58.8% were female. Among those who received the second dose, the majority (61.0%) were females aged between 5 and 14 years (42.6%) and 15 and 35 years (27.7%). Only 15.5% of the participants aged between 36 and 65 and 2.5% among those aged above 65 years received the second dose.Conclusion These findings confirm the 2018 OCV campaign coverage and highlight the need for follow-up surveys to validate administrative coverage estimates using population-based methods. Reliance on health facility data alone may mask low coverage and prevent measures to improve programming. Future public health interventions should consider sociodemographic factors in order to achieve optimal vaccine coverage

Changes in mobility patterns during the COVID-19 pandemic in Zambia: Implications for the effectiveness of NPIs in Sub-Saharan Africa.

The COVID-19 pandemic has impacted many facets of human behavior, including human mobility partially driven by the implementation of non-pharmaceutical interventions (NPIs) such as stay at home orders, travel restrictions, and workplace and school closures. Given the importance of human mobility in the transmission of SARS-CoV-2, there have been an increase in analyses of mobility data to understand the COVID-19 pandemic to date. However, despite an abundance of these analyses, few have focused on Sub-Saharan Africa (SSA). Here, we use mobile phone calling data to provide a spatially refined analysis of sub-national human mobility patterns during the COVID-19 pandemic from March 2020-July 2021 in Zambia using transmission and mobility models. Overall, among highly trafficked intra-province routes, mobility decreased up to 52% during the time of the strictest NPIs (March-May 2020) compared to baseline. However, despite dips in mobility during the first wave of COVID-19 cases, mobility returned to baseline levels and did not drop again suggesting COVID-19 cases did not influence mobility in subsequent waves

A foodborne disease outbreak investigation experience in a College in Lusaka, Zambia, 2017

Introduction: On 19 March 2017, an outbreak of unknown etiology was reported among students at a college in Lusaka, Zambia. We investigated to confirm the outbreak, identify exposures, determine the aetiological agent, and implement preventive measures. Methods: We conducted an unmatched case-control study. Cases and controls were selected conveniently. A suspected case was diarrhea or abdominal pains in any student at College A and Controls were asymptomatic students at College A during 18-23 March. We interviewed cases and controls about exposures to suspected food and water and collected saved food samples and swabs from food-handlers' hands and kitchen surfaces for culture. We analyzed data using Epi-info v 7.2 (Atlanta, Georgia). Results: We identified 59 suspected case-patients. Predominant symptoms were diarrhea (n = 51.83%) and abdominal pains (n = 44.75%). The outbreak started on 18 March, peaked on 19, and concluded on 20 March. We interviewed 30 case-patients and 71 controls. Exposures associated with increased odds of illness included eating food served at dinner on Saturday (18 March) in school cafeteria (OR = 5.8, 95% CI = 2.0-16.7); specifically, eating beans at Saturday dinner (OR = 21.6, 95% CI = 4.5- 104) and drinking water supplied at school (OR = 8.8, 95% CI = 1.45-53.6). Samples from all food-handlers (n = 13) yielded Staphylococcus aureus and all food samples (n = 3) yielded Escherichia coli, Staphylococcus aureus and fecal coliforms. Conclusion: The results suggest a foodborne outbreak caused by consumption of contaminated food served at dinner on 18 March at College A. We educated the food handlers and school management about the importance of disinfection of preparation surfaces, supervision of food handling and handwashing practices