Stockout eliminator : the objectives and design of the eZICS technical solution in Zambia

The goal of the eZICS project is the development and pilot testing of a rational, sustainable, transparent and scalable supply chain management system that will improve access to essential drugs at the point of service delivery

Foot and mouth disease in Zambia: Spatial and temporal distributions of outbreaks, assessment of clusters and implications for control

Zambia has been experiencing low livestock productivity as well as trade restrictions owing to the occurrence of foot and mouth disease (FMD), but little is known about the epidemiology of the disease in these endemic settings. The fundamental questions relate to the spatio-temporal distribution of FMD cases and what determines their occurrence. A retrospective review of FMD cases in Zambia from 1981 to 2012 was conducted using geographical information systems and the SaTScan software package. Information was collected from peer-reviewed journal articles, conference proceedings, laboratory reports, unpublished scientific reports and grey literature. A space–time permutation probability model using a varying time window of one year was used to scan for areas with high infection rates. The spatial scan statistic detected a significant purely spatial cluster around the Mbala–Isoka area between 2009 and 2012, with secondary clusters in Sesheke–Kazungula in 2007 and 2008, the Kafue flats in 2004 and 2005 and Livingstone in 2012. This study provides evidence of the existence of statistically significant FMD clusters and an increase in occurrence in Zambia between 2004 and 2012. The identified clusters agree with areas known to be at high risk of FMD. The FMD virus transmission dynamics and the heterogeneous variability in risk within these locations may need further investigation

Prevalence and Factors Associated with Renal Dysfunction in HIV Positive and Negative Adults at the University Teaching Hospital, in Lusaka

Background: Despite having the highest disease burden of HIV, Sub-Saharan Africa has limited data on HIV related kidney disease with most available data coming from the developed countries. Kidney disease is a recognised complication in HIV infected patients presenting with acute renal failure (ARF) or chronic kidney disease (CKD). This study investigated the prevalence and risk factors associated with renal dysfunction among hospitalised HIV infected patients at the University Teaching Hospital (UTH), Lusaka.Methodology:We conducted a cross sectional study at the University Teaching Hospital Lusaka, in Zambia. Inclusion criteria were hospitalised patients aged 16years and above who consented to the study. Both HIV infected and uninfected patients were included in the study. After obtaining demographic information, study participants were screened for HIV upon their consenting for the test. Afull clinical history and examination was done by study physician to determine factors associated with renal dysfunction.Results: Of the 300 recruited hospitalised patients in this cross sectional study, 142(47%) were HIV infected. We observed a high prevalence of renal dysfunction among hospitalised HIV infected patients compared to uninfected patients (42% vs. 27%, adjusted OR 1.99, 95% CI 1.20-3.28). They had a twofold increased likelihood of developing kidney dysfunction (OR 1.96,95 CI%; 1.21-3.17). The presence of vomiting was strongly associated with renal dysfunction in both HIV positive (AOR 7.77, 95% CI 2.46-24-53) and negative (AOR4.83, 95%CI 1.40-16.66) subgroups. WHO stage III was associated with renal dysfunction in HIV infected patients. Tenofovir use, (a first line antiretroviral drug in Zambia) and hypotension were not significant factors associated with kidney disease after adjusting for other clinical parameters.Conclusion: Renal dysfunction is significantly higher among hospitalised HIV infected compared to uninfected, however tenofovir and hypotension were not associated with renal dysfunction.Keywords: Renal dysfunction, HIV, acute renal failure, vomitin

Variations on the Planar Landau Problem: Canonical Transformations, A Purely Linear Potential and the Half-Plane

The ordinary Landau problem of a charged particle in a plane subjected to a perpendicular homogeneous and static magnetic field is reconsidered from different points of view. The role of phase space canonical transformations and their relation to a choice of gauge in the solution of the problem is addressed. The Landau problem is then extended to different contexts, in particular the singular situation of a purely linear potential term being added as an interaction, for which a complete purely algebraic solution is presented. This solution is then exploited to solve this same singular Landau problem in the half-plane, with as motivation the potential relevance of such a geometry for quantum Hall measurements in the presence of an electric field or a gravitational quantum well

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

Identification of the plague reservoir in an endemic area of Zambia

Yersinia pestis, the bacterial agent of plague, is primarily a parasite of wild rodents that persists in permanent, discrete enzootic foci throughout the world. The disease is transmitted in humans by bites from fleas of wildlife rodent species. Therefore surveillance is the ultimate public health solution through plague detection in domestic dogs, other carnivores and wild rodents. The investigations of die-offs amongst plague-susceptible colonial rodents are also significant to determine the presence of Y. pestis in a susceptible population.This study details the identification of the plague reservoir in a suspected endemic area of Zambia. The study was undertaken through rodent investigation for the presence of Y. pestis. A total of 105 rodents were sampled routinely and during a suspected plague period. On dissection 4 (3.81%, 95% CI: 1.23−10.0) rodents sampled during an outbreak showed signs of spleen enlargement. The blood, liver, lymph nodes and spleen of each rodent were subjected to culture on 6% sheep blood agar and MaCconkey agar. Colonies obtained were identified as Y. pestis by colony morphologic features, biochemical profiles, mouse inoculation assay and polymerase chain reaction (PCR). The PCR primers used targeted the Y. pestis plasminogen activator gene, chromosomal ferric iron uptake regulation gene and the outer membrane protein B gene.The isolates were also subjected to antibiotic sensitivity tests using the disk diffusion method on Mueller-Hinton agar with sensitivity being observed with ampicillin, amoxicillin, chloramphenicol, gentamycin, streptomycin, tetracycline and trimethoprim-sulfamethoxazole. The findings, identifies a natural reservoir of Y. pestis in Zambia providing the public health officials with a definite host for the control strategy.</jats:p

Serological Survey of Foot-and-Mouth Disease Virus in Buffaloes ( Syncerus caffer

A study was conducted to determine the serotypes of foot-and-mouth disease viruses (FMDV) circulating in African buffaloes (Syncerus caffer) from selected areas in Zambia. Sera and probang samples were collected between 2011 and 2012 and analysed for presence of antibodies against FMDV while probang samples were used to isolate the FMDV by observing cytopathic effect (CPE). Samples with CPE were further analysed using antigen ELISA. High FMD seroprevalence was observed and antibodies to all the three Southern African Territories (SAT) serotypes were detected in four study areas represented as follows: SAT2 was 72.7 percent; SAT1 was 62.6 percent; and SAT3 was 26.2 percent. Mixed infections accounted for 68.6 percent of those that were tested positive. For probang samples, CPE were observed in three of the samples, while the antigen ELISA results showed positivity and for SAT1 (n=1) and SAT2 (n=2). It is concluded that FMDV is highly prevalent in Zambian buffaloes which could play an important role in the epidemiology of the disease. Therefore livestock reared at interface with the game parks should be included in all routine FMDV vaccination programmes

Foot-and-mouth disease control in Zambia: A review of the current situation

Zambia has been experiencing low livestock productivity as well as trade restrictions owing to the occurrence of foot-and-mouth disease (FMD) and contagious bovine pleura pneumonia (CBPP). Foot-and-mouth disease was first recorded in Zambia in 1933 in the Western Province and since then the country has experienced repeated outbreaks. Bearing in mind the pressure that may be existing on the many risk factors for FMD including climate change, there is need to review our knowledge on FMD control. We present the spatial distribution of the FMD outbreaks that have been recorded in Zambia in the last twenty years, and the effect of the vaccinations and movement control that have been applied. We propose further strain characterisation of previous FMD outbreaks, including full sequence of VP1 gene and the 5’UTR site. The data will be geo-coded and populated with risk factor attributes. We also present preliminary findings of the buffalo and cattle probang sampling that was conducted in Lochnivar and Kafue National Park. We further probang sampled 25 buffalo at each interface area in Sioma Ngwezi, Lukusuzi and Lower Zambezi national parks. Villages in close proximity to the buffalo populations as well as those not in close proximity will be multistage cluster sampled for comparison. The data will be geo-coded and populated with risk factor and foot-and-mouth disease virus (FMDV) characterisation attributes. Data collected using a pre-tested structured questionnaire will be geo-coded and populated with identified risk factors and stored in a database and will be spatially modelled to determine their effect on FMD occurrence and control measures. New outbreaks of FMD that may occur will be investigated to find out if there are new strains involved, species affected and predisposing risk factors. The authors conclude that impacts of FMD on livelihoods if appropriate control measures are not put in place are far more devastating especially at community level. Presented with the current poverty levels failure to institute result oriented control measures will exacerbate the already life-threatening situation

Risk factors and outcomes of sepsis-associated acute kidney injury in intensive care units in Johannesburg, South Africa

Background. Sepsis-associated acute kidney injury (SA-AKI) has been shown to be a significant contributor to morbidity and mortality in both children and adults with critical illness. In sub-Saharan Africa, there is a lack of information on factors associated with development of SA-AKI and outcomes after intensive care unit (ICU) admission. Objectives. To assess the rate of SA-AKI, factors associated with its development, and predictors of mortality at 90 days in critically ill patients admitted to the ICU with sepsis. Methods. This was a prospective observational study conducted at two of the biggest teaching hospitals in Johannesburg, South Africa, from 15 February 2016 to 15 February 2020. The study included consecutive patients with confirmed sepsis who were admitted to the ICU within 24 hours of admission to hospital. The primary outcome of the study was development of SA-AKI (defined according to Kidney Disease Improving Global Outcome (KDIGO) criteria), and secondary outcomes were risk factors for SA-AKI and predictors of mortality at 90 days. Multivariate logistic regression analysis was employed to determine the factors associated with SA-AKI and 90-day mortality. Results. In total, 327 critically ill patients with sepsis admitted to the ICUs were included in the study. The median (interquartile range) age was 39 (30 - 52) years, and 185 patients (56.6%) developed SA-AKI. Of these patients, blacks and whites comprised 91.0% and 6.1%, respectively, and the prevalent comorbidities were HIV/AIDS (19.3%), hypertension (14.2%) and diabetes mellitus (10.1%). Patients with SA-AKI were likely to be older and of male gender, and to have cardiovascular disease, malignancies, hypotension and a low serum albumin level. In multivariate analysis, the predictors of SA-AKI were age ≥55 years (odds ratio (OR) 2.43; 95% confidence interval (CI) 1.27 - 4.65), inotropic support (OR 3.61; 95% CI 2.18 - 5.96) and a low serum albumin level (OR 2.93; 95% CI 1.40 - 6.13). SA-AKI and need for inotropic support were respectively associated with 1.9-fold and 1.7-fold increased mortality at 90 days after ICU admission. Conclusion. SA-AKI was found to be frequent in this study in two tertiary hospital ICUs in Johannesburg, and the need for inotropic support predicted mortality after ICU admission

Characterization of a Novel Bat Adenovirus Isolated from Straw-Colored Fruit Bat (Eidolon helvum).

Bats are important reservoirs for emerging zoonotic viruses. For extensive surveys of potential pathogens in straw-colored fruit bats (Eidolon helvum) in Zambia, a total of 107 spleen samples of E. helvum in 2006 were inoculated onto Vero E6 cells. The cell culture inoculated with one of the samples (ZFB06-106) exhibited remarkable cytopathic changes. Based on the ultrastructural property in negative staining and cross-reactivity in immunofluorescence assays, the virus was suspected to be an adenovirus, and tentatively named E. helvum adenovirus 06-106 (EhAdV 06-106). Analysis of the full-length genome of 30,134 bp, determined by next-generation sequencing, showed the presence of 28 open reading frames. Phylogenetic analyses confirmed that EhAdV 06-106 represented a novel bat adenovirus species in the genus Mastadenovirus. The virus shared similar characteristics of low G + C contents with recently isolated members of species Bat mastadenoviruses E, F and G, from which EhAdV 06-106 diverged by more than 15% based on the distance matrix analysis of DNA polymerase amino acid sequences. According to the taxonomic criteria, we propose the tentative new species name "Bat mastadenovirus H". Because EhAdV 06-106 exhibited a wide in vitro cell tropism, the virus might have a potential risk as an emerging virus through cross-species transmission