C. Groeneveld, M. Banda, N. Kayeyi, ML. Mazaba, M. Kapina

Surveillance and Disease Intelligence Unit

Zambia National Public Health Institute

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Weekly Report

• Current outbreaks

• Cholera: Six suspected cases tested negative for Vibrio Cholreae tested negative for cholera
• Ebola Virus Disease: Zero cases were reported

Immediately notifiable

Acute Flaccid Paralysis (AFP): No cases were reported in the week under review.
Measles: A total of nine cases were reported this week from Lusaka (2), Northern (4), North Western (2) and Luapula (1) provinces. Three specimens were investigated for measles.
Maternal Deaths: Countrywide nine maternal deaths were registered from Lusaka (3), Eastern (2), Southern (1), North Western (1), Copperbelt (1) and Luapula (1) provinces.

Dengue: One case was confirmed from Lusaka province from a person who recently travelled West Africa

Other diseases

Dysentery: Nationwide 841 of cases of dysentery were recorded this week. Of the twelve samples tested 1 was positive for S. dysenteriae

Regional Public Health Events

NATIONAL IDSR HEALTH FACILITY REPORTING RATES, WEEK 29 2019

OUTBREAKS

Cholera Outbreak

VACCINE PREVENTABLE DISEASES
AFP Surveillance

AFP Surveillance

Measles and Rubella

HIGH BURDEN DISEASES

HIV

TB

Maternal Deaths

Dog Bites

Malaria

EARLY WARNING DISEASES
Ebola Virus, DRC and Uganda , 2018-2019

PUBLIC HEALTH ACTIONS

General Recommendations

All provinces and districts affected by the outbreaks should conduct laboratory tests on suspect- ed cases to confirm the outbreak. Samples from suspected outbreaks must be tested in the appropriate district or provincial laboratory and at a national reference laboratory.

Ebola Virus Disease Preparedness

All provinces to strengthen EVD surveillance among all health care providers and raise community awareness of EVD prevention

Provide weekly reports in IDSR reports of active searches including zero reposting in at-risk districts, including ports of entry

Ensure epidemic preparedness measures for detecting cases, sample testing/transportation and managing cases are effected

All border districts to strengthen point of entry EVD screening

Vaccine-Preventable Disease Surveillance in Silent Districts

Provinces to ensure silent districts not reporting AFP cases are supported for active surveillance

Provincial health offices to ensure sub regional attainment of the Non-Polio AFP rate of 2 cases per 100,000

Prioritize sample referral of suspected cases to the national reference laboratory

All suspected measles /AFP cases to be given a provisional clinical diagnosis before blood / stool samples are sent to the national reference laboratory for tests.

Active Surveillance in Cholera Hotspots

Known cholera prone regions to access risks and ensure epidemic preparedness and response measures in place for cholera prevention and control.
Regions that have reported Cholera outbreaks should conduct public education on preventative measures and work all relevant stakeholders to prevent cholera outbreaks

Reported by: Surveillance and Disease Intelligence Unit

Writers: Chanda Groeneveld, Muzala Kapin’a, Moses Banda, Nkomba Kayeyi, Mazyanga M Liwewe, Victor Mukonka and Zambia National Public Health Institute (ZNPHI)

C. Groeneveld, M. Banda, N. Kayeyi, ML. Mazaba, M. Kapina

Surveillance and Disease Intelligence Unit

Zambia National Public Health Institute

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Weekly Report

• Current outbreaks
• Cholera: Four suspected cholera cases from Mpulungu district tested negative for V. Cholerae Immediately notifiable
• Acute Flaccid Paralysis (AFP): Five cases from Eastern and Southern provinces are undergoing laboratory investigation for polioviruses
• Measles: A total of six cases were reported this week from Copperbelt (1), Lusaka (4) and Muchinga (1) province (1). Five specimens are being tested for measles and rubella
• Maternal Deaths: Countrywide six maternal deaths were registered from Lusaka (2), Southern, Northern (2) and Central (1) provinces
• Clustering of Illness: 817 respiratory tract infections were reported in Chipata district, no fatalities
• Other diseases

Typhoid: Seven cases were reported this week from Lusaka (1) province. Dysentery: the suspected cases of dysentery increased from 557 to 722 in this week compared to the previous week. Only Nine samples tested positive for Shigella dysenteria in the week.

Weekly Summary

NATIONAL IDSR HEALTH FACILITY REPORTING RATES, WEEK 29 2019

OUTBREAKS

Cholera Outbreak, Mpulungu District, Northern Province

• No cases of cholera were reported this week; the last reported cases was on the 5th June 2019
• Cumulatively 439 suspected cases have been reported from Lusaka, Nsama, Mpullungu districts from week 1, positivity
• The second round of the reactive Oral Cholera Vaccination (OCV) campaign converge is currently underway Mpulungu district.

VACCINE PREVENTABLE DISEASES
Cholera Outbreak, Mpulungu District, Northern Province
AFP Surveillance

Environmental Polio Surveillance

Measles and Rubella

HIGH BURDEN DISEASES

HIV

TB

Maternal Deaths

Dog Bites

Malaria

EARLY WARNING DISEASES
Ebola Virus, DRC and Uganda , 2018-2019

PUBLIC HEALTH ACTIONS

General Recommendations

All provinces and districts affected by the outbreaks should conduct laboratory tests on suspect- ed cases to confirm the outbreak. Samples from suspected outbreaks must be tested in the appropriate district or provincial laboratory and at a national reference laboratory.

Regional level

Provide technical guidance for outbreak investigation and response to affected regions.

Support the distribution of epidemic preparedness consumables to affected areas.

Vaccine-Preventable Disease Surveillance in Silent Districts

Provincial health offices to ensure sub regional attainment of the Non-Polio AFP rate of 2 cases per 100,000

Prioritize sample referral of suspected cases to the national reference laboratory

All suspected measles /AFP cases to be given a provisional clinical diagnosis before blood/stool samples are sent to the national reference laboratory for tests.

Districts to promote health worker & community awareness of VPDs and usage of immunization services

All provinces should geocode reported AFP cases

Active Surveillance in Cholera Hotspots

Known cholera prone regions to access risks and ensure epidemic preparedness and response measures in place for cholera prevention and control.
Regions that have reported Cholera outbreaks should conduct public education on preventative measures and work all relevant stakeholders to prevent cholera outbreaks

National Influenza Center – Pathology and Microbiology Department,
University Teaching Hospital, Virology Laboratory

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Methodology for Establishment of Epidemic Thresholds
Thresholds are calculated using Moving Epidemic Methods (MEM), a sequential analysis using R language available from: http//CRAN.R-project.org/web/package =mem) designed to calculate the duration, start and end of the annual influenza epidemic. MEM uses the 40th, 90th and 97.5th percentile established from available years of historical data to calculate threshold activities. Threshold activity for influenza is categorized as: below epidemic threshold, low, moderate, high or very high. Transmissibility of influenza can be inferred from ILI data while SARI data gives an indication of severity.

Summary

There was increased influenza activity in the first half of 2019 between epi-weeks 4 and 22. Rates of Influenza-Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) attributable to influenza virus infection remained within the low seasonal threshold. This first cycle of activity was of low transmissibility and low severity. Children below five years of age were most affected.

ILI Surveillance:
Specimens from 553 outpatients were received from two ILI surveillance sites. 455 (82%) were adequately sampled and tested. Influenza virus was detected in 37 of these samples of which, 27 were identified as Influenza B, 3 Influenza A H3N2, 3 Influenza A H1N1 (pandemic) and 4 as Influenza A unsubtypeable.

SARI Surveillance:
During this same period, specimens were received from 1055 patients admitted to four SARI surveillance sites. 651 (62%) were adequately sampled and tested. Influenza was detected in 29 specimens; 24 of which were identified as Influenza B, 1 as Influenza A H3N2, 1 as Influenza A H1N1 (pandemic) and 3 as Influenza A unsubtypeable.

Influenza Transmissibility
Fig 1: Percentage of Influenza Positive ILI Cases1 (Out-Patient Visit Surveillance) per Epi-Week Against Epidemic Thresholds Set Using 2013 – 2018 Data

30th June 2019: Influenza Severity (Impact)
Fig 2: Hospital Admission Surveillance1 – (SARI Surveillance) for Influenza Detection and Epidemic Thresholds *

Fig 3: Positives samples* by influenza types and detection rate by weeks in 2019.

Fig: 5: Cumulative number of influenza types and subtypes and total number of samples tested by sentinel sites.

BM Katemba, N Kayeyi, P Sakubita, A Ngomah Moraes, B Gianetti
Zambia National Public Health Institute ZNPHI

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Dysentery is bloody diarrhoea, i.e. any diarrhoeal episode in which the loose or watery stools contain visible red blood. Dysentery is most often caused by Shigella species (bacillary dysentery) or Entamoeba histolytica (amoebic dysentery) [1]. Over the past years, Dysentery has not stimulated public fear in the same way that Cholera has. Nonetheless, the disease can be extremely dangerous as it has the potential to affect a number of people in a short period of time. Just like Cholera, the disease is transmitted through ingestion of food or water that has been contaminated by the feces of a human carrier of the infective organism and can spread at a very fast rate. If not properly managed, Dysentery caused by Shigella dysenteriae type 1 (Sd1) can have a case fatality of up to 10% or more [2].

The disease has been recurrent in some parts of the world and is highly associated with high mortality in children [3]. Children below the age of 5 years and malnourished people [4] are mostly affected and are at a high risk of dying due to dysentery [5]. In 2015, Diarrhea diseases accounted for over 1.3 million deaths globally [6]. Dysentery caused by Shigella species (S. flexneri, S. sonnei, S. boydii, and S. dysenteriae) remains a major source of diarrhea in most developing countries.

In Africa, one of the earliest documented Dysentery cases caused by Sd1 was recorded in Burundi in 1943 [7]. Since then, Dysentery has remained a major public health problem in Sub-Saharan countries. In the 1980s, Rwanda and the Democratic Republic of Congo (DRC) recorded devastating dysentery cases that saw the community incidence of 5 % to 6.4%.

Since 1991, dysentery epidemics have occurred in eight countries in southern Africa (Angola, Burundi, Malawi, Mozambique, Rwanda, Tanzania, Zaire, and Zambia) [8]. In 1992, Zimbabwe was hit by dysentery outbreaks which affected almost all the provinces. However, 149 dysentery patients died (CFR 3%) out of 4 915 patients that presented themselves to two municipal hospitals [9].

A number of factors such as overcrowding and poor water and hygiene infrastructure [10], limited access to improved water supplies and sanitation facilities [11] are some of the prominent factors that contribute to dysentery outbreaks. Globally, contaminated water causes millions and millions of cases of dysentery every year [12].

In Zambia, there is little documentation and studies that have been done on dysentery. However, a few papers that have been done show that inter house sharing of latrines [13] and contact with a person who has dysentery are some of the risk factors to the spread of the disease. This paper presents dysentery trend analysis results analyzed from the Integrated Disease Surveillance and Response (IDSR) database.

Methodology

Reported dysentery suspected cases, confirmed and deaths were obtained from the IDSR weekly reports. Zambia is divided into 10 provinces; Lusaka, Western, Southern, Eastern, Copperbelt, Muchinga, Luapula, Northern, North-Western and Central province with a projected population of 16.8 million people [14].

In Zambia, Dysentery has been classified as a notifiable disease. All clinics and hospitals are required to report cases to the district surveillance officer. Data was entered and cleaned in Microsoft excel. Data on both clinical and laboratory confirmed cases were collected and analyzed in Microsoft excel. Additionally, this paper also retrospectively presents all dysentery related deaths as reported and confirmed in the IDSR reports. A spatial distribution of the three years in perspective was conducted using Tableau 2019.2. According to the IDSR, a suspected case is a person with diarrhea with visible blood in the stool while a confirmed case is a suspected case with stool culture positive for Shigella dysenteria type 1.

Results

In absolute terms, the highest number of cases have always been recorded in the fourth quarter of each year with 2016 recording 13450 suspected cases, 2017 (18866) and 2018 (15347). It’s generally observed that more confirmed cases (of the samples sent to the laboratory) are observed in Quarter 1 of each year; 2016 (88.2%), 2017 (72.6%) and 2018 (29.8%). According to the data collected, there was only one [1] dysentery related death for the period of three years (table 1)

Table 1 Descriptive Statistics of Reported Cases of Dysentery between 2016 and 2018 by quarter (Epi – 52 Weeks)

7
In absolute terms, three provinces (Central, Eastern and Southern) recorded above 20, 000 suspected dysentery cases between
2016 and 2018. Central province had the highest number of (28, 746) followed by Easter (25, 718) and Southern (22, 494) respectively.
Muchinga province recorded the lowest (4, 962) (Figure 2). From the samples sent for laboratory confirmation, Southern
province (381) recorded the highest number of positive cases while Central and Western province both had the lowest with 8 cases
(figure 2).

Discussion
Incidence
The incidence rate of dysentery suspected
cases during 2016 to 2018 in Zambia
showed an overall increase. The lowest
rate (25.1 per 10,000 population) was
observed in 2016. This incidence is relatively
high compared to other countries
that have made tremendous efforts towards
improving the living conditions
(sanitation, water supply system etc). For
instance, in 2009, the incidence of dysentery
varied considerably from place to
place in China, with the highest incidence
of 14.2 per 10,000 in Beijing, and lowest
incidence being reported in Jiangsu and
Guangdong Provinces(15).

Suspected cases vs. confirmed
The Zambia National Public Health Institute
throw its surveillance cluster has
continuously been collecting data on cases
from well-trained surveillance officers
and clinicians. Additionally, laboratory
technicians across the country have been
adequately trained to identify Shigella
species. Therefore, it is expected that data
presented on the cases is a true representative
picture of what is prevailing at provincial
level.

In countries with scarce resources like
Zambia, the role of the laboratory is to use
those resources to provide the best information
for developing treatment policy,
rather than to focus on the diagnosis of individual
patients. However, there is still a
huge disparity in the suspected cases and
samples sent for laboratory confirmation
(16). Continued sensitization of healthcare
workers about dysenetry case definitions
and reporting procedures could also
help increase the proportion of suspected
dysentery cases for whom samples are
collected and sent for laboratory confirmation.
Different studies have acknowledged how
difficult it is to clinically distinguish between
non-bloody diarrheas caused by
Shigella dysenteriae from diarrhea caused
by other enteric pathogens. This could
possibly explain the huge discrepancy between
suspected cases and samples sent
for laboratory confirmation.

Seasonality
Between 2016 and 2018, the majority of
dysentery cases were recorded during
summer months. A retrospective study
done in China for the years between 1991

to 2000 established that the majority of
the dysentery cases were recorded during
the months of summer(Wang, 2006). In
Vietnam, incidences of dysentery are significantly
high during the wet season particulary
between May and October (17)
(18) (19) (20).
Different studies have shown that the hot
season provides a suitable environment
for the growth of bacteria (17) (15) (21).
This study shows that the peak period for
dysentery suspected cases is in October
which is generally the peak of the hot season
in Zambia.

Geographic location
Central province has the highest recorded
suspected cases in all the three
years (2016-2018). According to the
koppen-Geiger climate classification of
1980-2016, this area is characterized by
dry winter and hot summer with temperature
ranging from 21.4°C to 29.3°C
(22). A study done in Kon Tam Province in
Vietnam from 1999 to 2013 showed that
there was a correlation between weather
change and dysentery cases. Findings of
the study showed that a 1 °C increase in
temperature increased the incidence of
dysentery cases by 6% (17).

Conclusion
The incidence of dysentery suspected
cases remains high in Zambia. With increasing
antimicrobial-resistant on Shigella
bacteria, there is need to scale up
preventive interventions to Central province
in order to see the much needed reduction
of dysentery cases. Prevention of
Shigella infections through vaccination or
improvements in safe drinking water and
sanitation would be the long-term solution.
However, as a short term measure,
continued health education on dysentery
risk factors and provision of clean and
safe water should be prioritized in areas
with high cases.

LIST OF REFERENCES
1. https://www.who.int/topics/dysentery/en/
2. http://www.who.int/emc
3. Barry EM, Pasetti MF, Sztein MB, Fasano A, Kotloff KL, Levine MM: Progress and pitfalls in Shigella vaccine research. Nat Rev Gastroenterol Hepatol. 2013, 10 (4): 245-255. 10.1038/nrgastro.2013.12.
4. https://rehydrate.org/dd/su55.htm
5 . Wilkins, L., 1927. The incidence of dysentery and diarrhea among white infants under two years of age. Am. J. Dis. Child. 33, 705–710. https://doi.org/10.1001/archpedi.1927.04130170003001
6. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015.
Lancet. 2016; 388: 1459-1544
7. Jadin J, Resseler J. La dysenterie bacillaire au Ruanda-Urundi et au Kivu. Annales de la Societ6 belge de M6decine tropicale, 1957, 37: 347-369.
8. https://www.infoplease.com/math-science/health/diseases/water-borne-diseases-cholera-and-dysentery-epidemic-dysentery
9.Mwenye, S. et al., (1997) Risk factors associated with contracting dysentery during shigella dysenteriae type 1 outbreak in Harare, 1993, Central African Journal of Medicine, vol. 43, no. 4, pp. 111-113. Harare: CAJM
10.WHO. Guidelines for the Control of Shigellosis, including Epidemics due to Shigella dysenteriae 1. Geneva, Switzerland: World Health Organization, 2005
11. https://www.infoplease.com/math-science/health/diseases/water-borne-diseases-cholera-and-dysentery-epidemic-dysentery
12. https://www.infoplease.com/math-science/health/diseases/water-borne-diseases-cholera-and-dysentery-epidemic-dysentery
13. Tuttle J, Ries AA, Chimba RM, Perera CU, Bean NH, Griffin PM. Antimicrobial-resistant epidemic Shigella dysenteriae type 1 in Zambia: modes of transmission. J Infect Dis 1995;171(2):371
14.Central statistical office (CSO) [Zambia], (2015). Population and Demographic Projections 2011 – 2035. Lusaka, Central statistics office
15. Li, Z., Wang, L., Sun, W., Hou, X., Yang, H., Sun, L., Xu, S., Sun, Q., Zhang, J., Song, H., Lin, H., 2013. Identifying high-risk areas of bacillary dysentery and associated meteorological factors in Wuhan, China. Sci. Rep. 3. https://doi.org/10.1038/srep03239
16. https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf
17. Lee, H.S., Ha Hoang, T.T., Pham-Duc, P., Lee, M., Grace, D., Phung, D.C., Thuc, V.M., Nguyen-Viet, H., 2017. Seasonal and geographical distribution of bacillary dysentery (shigellosis) and associated climate risk factors in Kon Tam Province in Vietnam from 1999 to 2013. Infect. Dis. Poverty 6. https://doi.org/10.1186/s40249-017-0325-z
18.Vu, D.T., Sethabutr, O., Von Seidlein, L., Tran, V.T., Do, G.C., Bui, T.C., Le, H.T., Lee, H., Houng, H.-S., Hale, T.L., Clemens, J.D., Mason, C., Dang, D.T., 2004. Detection of Shigella by a PCR assay targeting the ipaH gene suggests increased prevalence of shigellosis in Nha Trang, Vietnam. J. Clin. Microbiol. 42, 2031–2035. https://doi.org/10.1128/jcm.42.5.2031-2035.2004
19. Kelly-Hope, L.A., Alonso, W.J., Thiem, V.D., Canh, D.G., Anh, D.D., Lee, H., Miller, M.A., 2008. Temporal trends and climatic factors associated with bacterial enteric diseases in Vietnam, 1991-2001. Environ. Health Perspect. 116, 7–12. https://doi.org/10.1289/ehp.9658
20. Vu Nguyen, T., Le Van, P., Le Huy, C., Nguyen Gia, K., Weintraub, A., 2006. Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam. Int. J. Infect. Dis. IJID Off. Publ. Int. Soc. Infect. Dis. 10, 298–308. https://doi.org/10.1016/j.ijid.2005.05.009
21. Kelly-Hope, L.A., Alonso, W.J., Thiem, V.D., Anh, D.D., Canh, D.G., Lee, H., Smith, D.L., Miller, M.A., 2007. Geographical distribution and risk factors associated with enteric diseases in Vietnam. Am. J. Trop. Med. Hyg. 76, 706–712.

M HM Mantina
Zambia National Public Health Institute ZNPHI

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Since the first description of sickle cell disease (SCD) in 1910 in the United States of America (USA) in a young man of African descent [1], a lot of effort was dedicated to understanding the disorder such that within 40 years of its first description, it’s epidemiology and pathophysiology had been well described [2,3]. Despite this knowledge, it did not immediately translate into improved identification of and care for persons with SCD. This led to Ranney to remark in her 1972 editorial; “The fact that the biochemical abnormality and its pathological consequences are so much better delineated in sickling than in most other serious diseases has led to the notion that the most notable deficit in our care of sicklers is in the delayed application of our knowledge to the treatment of patients with sickle cell disease and to the detection of individuals with sickle cell trait.” [4].

As of 2019, Zambia is still grappling with the issues of diagnosis of the condition. We still have individuals being diagnosed with sickle cell anaemia well into their adulthood and we still do not know the prevalence of the sickle cell gene in our population. Twenty years ago, it was understandable to have a delayed diagnosis of sickle cell disease because the diagnosis required laboratory facilities. One needed at least a microscope or a centrifuge and a proficient laboratory person to diagnose the disease. Today the development of easy to use point of care test kits for sickle cell diagnosis makes it inexcusable for one to be diagnosed with the condition in adulthood let alone in late childhood. The World Health Organization (WHO) estimates that 5% of the global population carries the trait genes for sickle cell disease or thalassaemia, the major haemoglobin disorders and can be as high as 25% in some regions. It is further estimated that over 300,000 babies are born each year with a severe disorder of haemoglobin of which 200,000 are sickle cell disease [5]. Sickle cell disease is the major haemoglobin disorder in Africa while thalassaemia predominates in the Mediterranean and Asia. Many children with severe forms of sickle cell disease die before the age of 5 years either from severe anaemia, malaria and invasive bacterial infection [6].

Having realised that SCD is a major health burden on the African region, the World Health Organization adopted a strategy that aims to reduce the incidence, morbidity and mortality due to SCD [7]. Core to this strategy is i) Understanding the prevalence of the sickle cell gene in the population, ii) Early identification of persons with SCD and iii) Early interventions for persons with SCD to reduce morbidity and mortality.

We have easy to use point of care tests such as the SickleSCAN® test kit which has been evaluated for use in Zambia. This point of care device can be used by any healthcare provider to identify persons with the sickle cell gene or SCD [8]. With this kit we can then screen all antenatal mothers for the SCD, we can use this kit to screen all children presenting with anaemia at any health facility. In so doing we would be i) Generating information about the prevalence of the sickle cell gene in the Zambian population. We have health informatics systems that can be used to manage this data and feed into the overall Zambian strategy on SCD. ii) Identifying newborns that would require further testing for SCD, iii) Identifying children with SCD and intervening early.

We have a functioning system for the transportation of dried blood spot (DBS) specimens for early infant diagnosis of HIV infection. We can leverage this system to transport samples for infants and children requiring laboratory confirmation of the sickle cell status. It has been shown that DBS specimens can be used for haemoglobin (Hb) electrophoresis [9]

We have several health facilities that have the equipment for Hb electrophoreses such as UTH Adult, Ndola Teaching Hospital and Arthur Davison Children’s Hospital. These could be used as initial hubs for the SCD programme. Skilled laboratory personnel capable of doing Hb electrophoresis and quantification are there.

We have knowledgeable healthcare providers capable of providing comprehensive healthcare to persons living with SCD. This is evidenced by the establishment of specialized sickle cell clinics in facilities like ADH and Livingstone Teaching Hospital.

In her speech to the Minister of Health on World Sickle Cell Day, Lwimba Kasongo, a person living with SCD, made a passionate appeal for the institution of comprehensive healthcare services for persons living with SCD at all health care levels.

In his response, the Minister of Health represented by the Permanent Secretary – Technical Services, Dr Kennedy Malama, assured the SCD community that the condition was being given priority. He tasked technical experts led by Dr Catherine Chunda to come up with a Zambian Strategy for SCD.

Whilst we may not have all the resources to implement a fully functional “ well oiled” SCD programme, we do however have enough resources to implement activities that will have a positive impact on our knowledge of the condition in our population, on the reduction of childhood mortality from SCD and the quality of life persons living with SCD.

ITS JUST A MATTER OF GETTING THE ACT RIGHT

ML Mazaba
Zambia National Public Health Institute ZNPHI

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Authors, reviewers, editors and readers,

Welcome to the July 2019 THP-Z issue. In this issue, we share an article entitled ‘Trend and disease burden of dysentery in Zambia 2016-2018’. The article is informed by data emanating from the Integrated Disease Surveillance and Response (IDSR) program. The publication intimates a continued high incidence of suspected dysentery cases in Zambia. Our guest editor focused on Sickle Cell Disease (SCD), a condition identified over a century ago and yet still remains a major health burden especially on the African region. Noting that the major challenge in managing SCD lies in the inadequate capacity to diagnose the condition early enough and late intervening leading to increased morbidity and mortality, the guest editor encourages a strategy to implement a fully functional program. I encourage you to read through and get an interesting understanding of SCD and what should be done to improve the outcomes. We also publish the Influenza July monthly bulletin. Allow me to bring to the attention of Hepatitis disease. The WHO estimates about 325 million people worldwide are living with hepatitis B or C and yet approximately 80% have no access to testing and treatment, leading to 1.4 million deaths a year. The world celebrates and brings to the attention of all parties. It is for this reason THP-Z joined the rest of the world in creating awareness of hepatitis as a disease and the possible prevention and treatment strategies. Look out for a paper on hepatitis in the next issue. Meanwhile, feel free to look up the previous article on hepatitis in our archived issues: Nshimbi N, Ngoma A. Hepatitis B: Vaccinate. Stop It In Its Tracks!!! Addressing The Hepatitis B Prevalence In The Adult Population In Zambia. Health Press Zambia Bull. 2019; 3(3); pp 10-13.; Mulambya Nl, Moraes A, Mititiri M, Washington M. What The Hep Is Going On?: Protecting Future Generations By Addressing Hepatitis B Among Pregnant Women And Newborns In Zambia. Health Press Zambia Bull. 2019;3(1); Pp 3-6.; and Mazaba ML.Hepatitis. Health Press Zambia Bull. 2018;2(5); pp 1-2. We acknowledge Hepatitis as a public health problem and support the initiatives including continued surveillance, laboratory confirmation for effective treatment and prevention. Once again we invite you to submit your articles to THP-Z using the link https://mc.manuscriptcentral.com/thpz.