Multicriteria Risk Ranking of Zoonotic Diseases in a Developing Country: A Case Study of Zambia

The integration of a multicriteria decision analysis approach, including techniques such as the Analytic Hierarchy Process (AHP) and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), has yielded valuable insights in the realm of zoonotic disease risk assessment. This analytical framework draws from the OIE-supported manual, utilizing impact assessments, transmission pathways, and categorizations as provided by the OIE itself. Moreover, the consideration of specific zoonotic disease scenarios tailored to individual countries enhances the contextual relevance of the analysis. Through this approach, the ranking of zoonotic diseases is systematically established, offering a comprehensive evaluation of their potential impacts and risks. This methodology encompasses pivotal criteria, including prevalence, economic impact, health impact, transmission pathways, and healthcare capacity, collectively offering a holistic perspective that mirrors the intricate nature of zoonotic diseases. The resultant rankings, derived from both ECDC and OIE data, illuminate diseases that harbor significant threats to both human and animal populations. This ranking fosters the identification of diseases with potential for rapid spread and substantial impact, guiding resource allocation towards prevention, control, and mitigation strategies. The alignment between ECDC and OIE rankings underscores the robustness of the applied methodology, with Plague and Zoonotic TB consistently emerging as high-ranking diseases, reinforcing their acknowledged significance. A consolidated ranking, amalgamating data from both sources, provides an insightful overview of potential risks linked to various zoonotic diseases. Plague, Zoonotic TB, Brucellosis, Trypanosomiasis, and Rabies consistently occupy top positions, presenting a valuable instrument for policymakers, public health officials, and stakeholders in prioritizing resource allocation and intervention strategies. The implementation of a multicriteria decision analysis approach, integrating AHP and TOPSIS methodologies, underpins the generation of informed rankings for Zambian zoonotic diseases. The intricate interplay of criteria like prevalence, economic impact, health impact, transmission pathways, and healthcare capacity forms a comprehensive framework for evaluating the potential risks of diverse diseases. The ensuing ranking, led by Plague and succeeded by Anthrax, Rabies, and others, mirrors their collective risk scores calculated via the adopted methodology. This approach empowers strategic decision-making by pinpointing diseases with heightened potential for adverse impacts on both human and animal populations. The rankings serve as invaluable aids in directing resources, devising strategic interventions, and formulating targeted measures for prevention and control. However, acknowledgment of the dynamic disease landscape and the imperative of adaptive strategies underscores the ongoing importance of monitoring and managing zoonotic diseases effectively in Zambia. By amalgamating data from authoritative sources and embracing a systematic, evidence-based approach, this study accentuates the necessity of addressing zoonotic diseases with a holistic lens, fostering proactive perspectives that augment public health and avert future outbreaks

Community health impacts of the trident copper mine project in Northwestern Zambia: results from repeated cross-sectional surveys

The application of a health impact assessment (HIA) for a large-scale copper mining project in rural Zambia triggered the long-term monitoring and evaluation of determinants of health and health outcomes in communities living in proximity to the mine. Three consecutive cross-sectional surveys were conducted at intervals of four years; thus, at baseline (2011), four (2015) and eight (2019) years into the project's development. Using the same field and laboratory procedures, the surveys allowed for determining changes in health indicators at the household level, in young children (<5 years), school attendees (9-14 years) and women (15-49 years). Results were compared between communities considered impacted by the project and communities outside the project area (comparison communities). The prevalence of; Plasmodium falciparum; infection increased in both the impacted and comparison communities between 2011 and 2019 but remained consistently lower in the impacted communities. Stunting in children < 5 years and the prevalence of intestinal parasite infections in children aged 9-14 years mostly decreased. In women of reproductive age, selected health indicators (i.e., anaemia, syphilis, underweight and place of delivery) either remained stable or improved. Impacted communities generally showed better health outcomes than comparison communities, suggesting that the health interventions implemented by the project as a consequence of the HIA have mitigated potential negative effects and enhanced positive effects. Caution is indicated to avoid promotion of health inequalities within and beyond the project area

Epidemiological Tools in Focus: A Comprehensive Assessment of Their Role in Addressing Infectious Disease Challenges in Zambia

In the relentless pursuit of mitigating infectious diseases, this investigative study critically examines the nuanced application and effectiveness of epidemiological tools within the context of Zambia. The study meticulously navigates the landscape of infectious diseases in Zambia, considering its unique ecological and socio-economic features. Employing a rigorous methodology that integrates primary data from epidemiological reports, field observations, and laboratory analyses with insights from diverse scientific literature, the study investigates the types and applications of epidemiological tools such as spatial analysis, case-control studies, molecular epidemiology, and serological assays. Unfolding the challenges posed by resource constraints, data reliability issues, and the dynamic nature of infectious diseases in Zambia, the study offers a comprehensive assessment that extends to the implications of these tools for informed public health decision-making. This scholarly inquiry concludes by affirming the significance of ongoing refinement and adaptation of epidemiological tools, emphasizing their pivotal role in addressing infectious disease challenges within Zambia and advocating for their continued enhancement on the global public health stage

Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection

Sorgho and imphee, the Chinese and African sugar canes : a treatise upon their origin, varieties, and culture, their value as a forage crop, and the manufacture of sugar, syrup, alcohol, wines, beer, cider, vinegar, starch, and dye-stuffs : with a paper by Leonard Wray, Esq., of Caffraria, and a description of his patented process for crystallizing the juice of the imphee : to which are added, copious translations of valuable French pamphlets /

Pages 1-10 at end consist of advertising.Part 2 (p. [191]-228) has special t.p.: The Zulu-Kaffir imphee, or, "sweet reed" (the Holcus Saccharatus of Linnaeus) : comprising a description of its numerous varieties, its mode of cultivation, and the manufacture of sugar and other products from its rich saccharine juice / by Leonard Wray.Spine title: Sorgho and imphee, the new sugar canes.Part II. The Zulu-Kaffir imphee, or, "sweet reed," (the Holcus Saccharatus of Linnaeus) ... / by Leonard Wray: p. [191]-228.Bitting, K.G. Gastronomic bib.,Mode of access: Internet

The history of rabies in the Western Hemisphere

Before the introduction of control programs in the 20th century, rabies in domestic dogs occurred throughout the Western Hemisphere. However, historical records and phylogenetic analysis of multiple virus isolates indicate that, before the arrival of the first European colonizers, rabies virus was likely present only in bats and skunks. Canine rabies was either rare or absent among domestic dogs of Native Americans, and first arrived when many new dog breeds were imported during the period of European colonization. The introduction of the cosmopolitan dog rabies lyssavirus variant and the marked expansion of the dog population provided ideal conditions for the flourishing of enzootic canine rabies. The shift of dog-maintained viruses into gray foxes, coyotes, skunks and other wild mesocarnivores throughout the Americas and to mongooses in the Caribbean has augmented the risk of human rabies exposures and has complicated control efforts. At the same time, the continued presence of bat rabies poses novel challenges in the absolute elimination of canine and human rabies. This article compiles existing historical and phylogenetic evidence of the origins and subsequent dynamics of rabies in the Western Hemisphere, from the era preceding the arrival of the first European colonizers through the present day. A companion article reviews the current status of canine rabies control throughout the Western Hemisphere and steps that will be required to achieve and maintain its complete elimination

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated