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

Laboratory-confirmed Congenital Rubella Syndrome at the University Teaching Hospital in Lusaka, Zambia-Case Reports

Background: Congenital rubella syndrome (CRS) caused by rubella infection in uterine, is a major public health problem among women of child bearing age as it causes serious complications including foetal death or  abnormalities including cardiovascular, ophthalmologic, respiratory and hearing impairment. Though there is  evidence of rubella infection amongst the population under the expanded programme on immunization (epi)  surveillance programme, there is no documented evidence of laboratory confirmed congenital rubella syndrome  cases in Zambia. A report is given on four cases of CRS that were identified and confirmed during routine activities of the national measles surveillance program in Zambia. Clinical data on the symptomatic cases were collected and  serum samples tested for rubella IgM to confirm the cases.Case presentation: The first confirmed case was a baby girl presented to the Neonatal Intensive Care unit of the University Teaching Hospital for low birth weight and hypothermia. At seven weeks, the girl was found to have  cataracts, spleno-hepatomegaly, microcephaly, and patent ductus arteriosus (PDA). The baby tested positive to  rubella IgM antibodies. The second case was a baby boy who was first seen at the University Teaching Hospital at  three weeks and on examination was found to have bilateral cataracts, congenital heart disease and microcephaly.  Rubella Immunoglobulin M (IgM) results were positive. The third case, a girl, was seen at twelve weeks and brought in for slow growth rate. On examination, the girl was found to have bilateral cataracts,  microcephaly and  developmental delay. The fourth case is a girl who was brought to the hospital for failure to thrive, tachypnea and  fever. On further investigations there was evidence of cataracts, patent ductus arteriosus. At eight weeks, she tested  positive for rubella IgM antibodies.Conclusion: The clinical symptoms and laboratory evidence of rubella infection confirmed congenital rubella syndrome in the four patients. There is an urgent need for surveillance of congenital rubella syndrome and a  baseline rubella sero-prevalence survey in Zambia in order to determine the burden of the disease and use this  data to direct policy in terms of interventions for supportive treatment, control and possible elimination of rubella  infection through immunization with measlesrubella vaccine.Keywords: Congenital Rubella Syndrome; Confirmed; Measles-Rubella vaccine; Lusaka, Zambi

Timely Response and Containment of 2016 Cholera Outbreak in Northern Zambia

Background: The Northern Province of Zambia has recorded outbreaks of Cholera in Nsumbu area over the years including the year 2008 and 2012. Recently, an outbreak of cholera was reported in Northern Province between March and April 2016. This study aims to document the appropriateness of the response to the cholera outbreak to guide outbreak preparedness and timely response in the future.Method: A prospective study where a team was put in place to investigate an outbreak of diarrhoeal disease of undetermined cause. The team comprising of surveillance, medical, environmental and laboratory staff was formed to investigate this outbreak within the context of cholera an on-going cholera epidemic Lusaka and other parts of Zambia. Stool samples and water samples were taken for laboratory investigations. Various interventions including contact tracing and community sensitisation were employed to contain the outbreak. A descriptive analysis of the data and review of literature was used to determine the quality of detection, investigation and response to this cholera outbreak.Results: Sixty six people were clinically affected 8 of who were laboratory confirmed for strain 01 Ogawa. The case fatality rate (CFR) was 4.5%(3/66). The outbreak was detected and contained within 24 days.Discussion: The CFR was high compared to the WHO standards of a similar scenario in the 2012 outbreak in the same area. Of the 3 deaths, one was brought in dead and a week into the outbreak while the other two died at the health facility. The two fell sick in Congo DR and brought to Kapisha health post for treatment. Although the high CFR indicates inadequate response or poor case management the general response and management of the cases seemed adequate with detection and response within 48 hours of the notification. The interventions employed played a pivotal role in containing the outbreak.Conclusion: Based on the CFR, the response to the outbreak was inadequate. However, the outbreak was generally well managed. The interventions implored as a response to the outbreak and active and rapid response contributed to the containment of the cholera in Nsama district within a short period

Echoviruses diagnosed in two Children presenting with Acute Flaccid Paralysis (AFP): An Illustration of the Evolving role of the Zambian AFP Surveillance Programme in the Absence of Polio

Background: The Enteric Cytopathic Human Orphan virus commonly referred to by  the acronym ECHO virus has been known to cause acute flaccid paralysis (AFP). Zambia has since 1993 run a national AFP surveillance program to primarily detect and confirm poliomyelitis cases. Through this program other enteroviruses have  been confirmed to be associated to the non-polio cases. We describe two patients with acute flaccid paralysis presenting like poliomyelitis and yet are non-polio cases associated with ECHO virus.Case reports: In March 1995, a 2 year old male from Misisi compound, presented at the UTH with muscle weakness and paralysis of sudden onset. Aside from the acute flaccid paralysis presenting in both legs and arms, the child had no other signs of  symptoms of significance. Laboratory investigations using the WHO polio laboratory network standard protocols revealed the  presence of ECHO 7 virus. In April 1995, a 4 year old girl from Kamwala South in Lusaka presented at the UTH with symptoms and signs of AFP of asymmetrical presentation affecting the Left upper and lower limbs, fever and sore throat. Two stool  specimens collected for laboratory analysis revealed the presence of Echovirus untyped.Discussion: AFP is a neurological condition primarily suspected as a poliomyelitis commonly seen in children below 15 years defined by sudden onset of weakness and floppiness affecting usually one or more limbs. Laboratory analysis has revealedother viruses including the Echovirus being associated with acute flaccid paralysis. This case series reveals Echovirus 7 and Echovirus untyped as being associated with AFP cases that presented to the UTH initially suspected to be poliomyelitis.Conclusion: The clinical manifestations and laboratory results provide evidence of ECHO virus causing acute flaccid paralysis similar to that caused by polio virus. The last wild polio cases circulating in Zambia were in 2001. It is important that Zambia continues to investigate other causes of AFP for clinical decision making, scientific documentation and policy guidance

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

Acute Flaccid Paralysis Surveillance in Zambia: Progress towards the Polio End Game

Background: In the global polio eradication initiative acute flaccid paralysis cases are followed up two to three months after onset of paralysis to assess recovery of the children. In Zambia AFP cases are followed up regularly but there is no documentation of the clinical and laboratory findings. The purpose of this paper is to document the support WHO country office offers to the follow up of the AFP cases in Zambia to identify gaps which the WHO Country office could address.Methods: This study used secondary data from a case control study design, conducted and supported by WHO country office, which was aimed at assessing the association of NPEVs with AFP. Particularly this study aims at assessing the presence or absence of residual paralysis and the laboratory findings of the affected children.Results: A total of 93 cases of, which over 55% were males were included in this study. Majority of the cases were aged between 24 and 35 months (28.4%). Regarding vaccination status, 77% of the cases had received 1 to 4 doses of the Oral Polio (OPV) vaccine. About 62% of the viruses isolated were identified as Cox B, and Echo 3, 6, 7, 11, 12, 14 and 29. Of all NPEVs 37.1% yielded no neutralization pattern. Only 9 (9.67%) cases were followed up; out of which 3 (33.3%) had residual paralysis with one of those with residual paralysis who later died.Conclusion: AFP surveillance and follow up of cases is carried out in Zambia. However, rehabilitation information of the affected children is not followed up, an issue which WHO country office with regards to the transformation agenda could pursue to ensure that the affected children are adequately supported as a contribution to the polio eradication end game

Using E-Learning for Skills Transfer, Motivation and Retention of Health Workers in Zambia

Background: Health system strengthening continues to be a moving target for developing countries with the human resource factor the most critical bottleneck towards universal health coverage.The human resource management cycle revolves around three interdependent factors: production, recruitment, deployment and retention. The most elusive is retention where both monetary and non-monetary reward systems are equally important. The purpose of this is to document establishment of e-learning as a tool for online skills transfer to address retention of health workers in a cost effectively.Methods: This prospective study analyses the process of establishing an e-learning facility in Central Province of Zambia. Visitations of the site in the PEPFAR (US President Emergency Plan for Aids Relief in Africa) sponsored Chainama College of Health Sciences, Kabwe Campus premises and technical inputs and specifications were documented.Results: The Ministry of Health maximized the prevailing thriving partnership in the health sector by allocating accommodation to e-learning using resources from RMNCH Trust Fund with the WHO dedicating technical support for this concept in close liaison with Ministry of Health officials in Central Province. The facility can accommodate 36 students and is earmarked to be a training facility equipped with appropriate equipment and software to cater for the entire spectrum of diseases and conditions in Zambia. This is an institution which can support the human resource cycle of production, recruitment, deployment and retention, an innovation that be scaled up to address national retention needs.Discussion: E-learning has ushered a sustainable modality of skills transfer to many areas including human resources for health. The government has successfully engaged cooperating partners in Zambia to implement this improvision in the health sector. The WHO has played its part in ensuring that the critical health resource for health pillar of health systems is addressed.Conclusion: Zambia health sector is instituting an intervention that can improve retention of health workers using non-financial motivation through sustainable elearning

Current challenges and implications for dengue, chikungunya and Zika seroprevalence studies worldwide: A scoping review.

BACKGROUND:Arboviral infections are a public health concern and an escalating problem worldwide. Estimating the burden of these diseases represents a major challenge that is complicated by the large number of unapparent infections, especially those of dengue fever. Serological surveys are thus required to identify the distribution of these diseases and measure their impact. Therefore, we undertook a scoping review of the literature to describe and summarize epidemiological practices, findings and insights related to seroprevalence studies of dengue, chikungunya and Zika virus, which have rapidly expanded across the globe in recent years. METHODOLOGY/PRINCIPAL FINDINGS:Relevant studies were retrieved through a literature search of MEDLINE, WHOLIS, Lilacs, SciELO and Scopus (2000 to 2018). In total, 1389 publications were identified. Studies addressing the seroprevalence of dengue, chikungunya and/or Zika written in English or French and meeting the inclusion and exclusion criteria were included. In total, 147 studies were included, from which 185 data points were retrieved, as some studies used several different samples. Most of the studies were exclusively conducted on dengue (66.5%), but 16% were exclusively conducted on chikungunya, and 7 were exclusively conducted on Zika; the remainder were conducted on multiple arboviruses. A wide range of designs were applied, but most studies were conducted in the general population (39%) and in households (41%). Although several assays were used, enzyme-linked immunosorbent assays (ELISAs) were the predominant test used (77%). The temporal distribution of chikungunya studies followed the virus during its rapid expansion since 2004. The results revealed heterogeneity of arboviruses seroprevalence between continents and within a given country for dengue, chikungunya and Zika viruses, ranging from 0 to 100%, 76% and 73% respectively. CONCLUSIONS/SIGNIFICANCE:Serological surveys provide the most direct measurement for defining the immunity landscape for infectious diseases, but the methodology remains difficult to implement. Overall, dengue, chikungunya and Zika serosurveys followed the expansion of these arboviruses, but there remain gaps in their geographic distribution. This review addresses the challenges for researchers regarding study design biases. Moreover, the development of reliable, rapid and affordable diagnosis tools represents a significant issue concerning the ability of seroprevalence surveys to differentiate infections when multiple viruses co-circulate