Author: Kwame Shanaube

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Citation Style For This Article: Shanaube K. Prevalence and correlates of depressive symptoms among adolescents in a population with high prevalence of TB/HIV in Zambia and South Africa: HPTN 071 (PopART) for Youth study.. The Health Press Zambia Bull. 2020; 4(4); pp 28

Background

Mental health is a critical and neglected public health challenge for adolescents in sub-Sahara Africa. Poor mental health accounts for a large proportion of the disease burden among adolescents. Data on potential risk factors of depression among HIV-infected and uninfected adolescents in SSA are scarce. We aimed to determine the prevalence and correlates of depressive symptoms among adolescents aged 15-19 years in 7 control communities of the HPTN071 (PopART) trial (4 in Zambia and 3 in South Africa (SA).

Methods

A cross-sectional survey was done from August-November 2017 enrolling approximately 1400 adolescents, 200-350 from each community. Communities were subdivided into blocks, each block consisted on average 50 (~40-60) households in Zambia and 80 (~70-90) households in SA. Blocks visited were randomly assigned to the study. All households within a sampling block and all adolescents aged 15-19 years residing in these households were eligible for inclusion. Written informed consent was obtained. The questionnaire was self-administered for the mental health section. HIV status was self-reported. Depression was measured by a 13-questions self-administered short Mood and Feelings Questionnaire (SMFQ). Each individual was scored by summing the 13 questions and a ≥12 cutoff of the scale response (0-26) was used to determine underlying depressive symptoms. To determine the correlates of depressive symptoms, a binomial regression model was fitted and further a subgroup analysis among those who self-reported to have engaged in sexual intercourse. Sensitivity analysis was done for different outcome definitions.

Results

On average, 15-17 blocks with 15-22 adolescents per community were visited in Zambia and SA. A total of 1,453 and 667 adolescents in Zambia and SA respectively were administered the SMFQ and overall responses are shown in figure 1.  Overall the prevalence of depressive symptoms was 432/1453; 29.7% (95% Confidence-Interval [CI]: 27.4%-32.2%) in Zambia and 152/667; 22.8% (95% CI: 19.7%-26.2%) in SA.

Community, sex, sexual intercourse, and having Presumptive-Tuberculosis (PrTB) symptoms were identified as correlates of depressive symptoms across the two countries with HIV-related stigma being specific to Zambia (Table 1). After adjusting for potential confounders; there are differences in odds of depression among communities (Table 1).  In Zambia, adolescent girls were at least one and a half times more likely to experience depressive symptoms compared to boys (Odds ratio (OR)=1.58 (95%CI:1.23-2.02, p-value<0.0001). In SA, adolescents with PrTB symptoms were twice more likely to experience depressive symptoms (OR=2.25(95%CI: 1.51-3.37), p-value<0.0001), however, there was borderline evidence in Zambia (OR=1.28 (95%CI:1.0-1.65), p-value=0.05).

Adolescents who reported use of alcohol/drugs during their last sexual encounter were twice more likely to experience depressive symptoms in both countries (Zambia: OR=1.96 (95%CI:1.08-3.56), p-value=0.027; SA: OR=2.67(95%CI:1.29-5.54), p-value=0.008) as were those who did not use condoms (OR=2.29(95%CI:1.29-4.07), p-value=0.005) in SA.  There was borderline evidence of depressive symptoms among adolescents who reported HIV-related stigma (OR=1.41 (95%CI: 1.09-1.82), p-value=0.009) in Zambia. Sensitivity analysis showed that the prevalence and correlates of depressive symptoms change with the change of the cut-off.

Conclusion

Depressive symptoms among adolescents seem to be associated with sexual and reproductive health-related issues and risk factors are different by country.

Author: Haakonde Titus

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Citation Style For This Article: Haakonde T. Preliminary Assessment of Uranium Contamination in Drinking Water Sources in the Vicinity of Uranium Mine in Siavonga District, Zambia and the Associated Health Risks. The Health Press Zambia Bull. 2020; 4(4); pp 27

Background

Contamination of drinking water by Uranium (U) has attracted global attention owing to its chemical toxicant and radio-toxicant behaviour in humans. Concentrations of U in water were assessed and health risks due to exposure through consumption of contaminated were determined.

Methods

In the current study, 120 drinking water samples collected from different water sources in some parts of Siavonga District in Zambia were measured using inductively coupled plasma mass spectrometry. United States Environmental Protection Agency (USEPA) deterministic risk approaches were used to determine the health risks associated with exposure to U through the consumption of contaminated water.

Results

The mean concentration of U in water sources showed the decreasing trend: streams (135.30µg/L) > dams (115.62µg/L) > boreholes (111.31 µg/L) > shallow wells (110.03 µg/L). The levels of U in all the samples exceeded the safe limit for drinking water recommended by WHO indicating that the water in the studied area is not safe for drinking and cooking purposes. The estimated chronic daily intakes of U through water consumption showed the decreasing order: streams (3.62 µg/kg- bw/day) > dams (2.79 µg/kg- bw/day) > boreholes (2.68 µg/kg- bw/day) > shallow well (2.65 µg/kg- bw/day). Equally, the current study showed that the mean target hazard quotients (THQ) in all water samples exceeded the safe limit (THQ > 1) implying that the consumers of such water were at a greater risk of potential health effects. The carcinogenic risks from U at most of the drinking water sources were higher than acceptable ranges (10-6), indicating an increased risk of cancer for the population in the study area.

Conclusion/Recommendation

The current levels of U in drinking water sources stretching from the shores of Lake Kariba to Chirundu- Siavonga Border in Siavonga district in the Southern Province of Zambia implies that the condition is much frightening and severely affecting humans, animals and aquatic life.

Authors: Dr Musole Chipoya, 1. Muzala Kapina (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health) 2. Dien Francis Mwansa (Zambia Ministry of Health) 3. Albertina Ngomah (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health) 4. Belem Matapo (World Health Organisation, Lusaka, Zambia) 5. Kennedy Matanda (Zambia Ministry of Health; Chienge District Health Office) 6. Lwara Kalembe Musa (Zambia Ministry of Health; Mansa District Health Office) 7. Mwaka Monze (Zambia Ministry of Health; Virology Laboratory University Teaching Hospital Zambia) 8. Keith Shaba (World Health Organization, Regional Office for Africa) 9. Mazyanga Liwewe (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health) 10. Raymond Hamoonga (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health) 11. Nicola Watt (Public Health England, Lusaka, Zambia) 12. David Simwaba (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health) 13. Alexis Sciarratta (U.S. Centers for Disease Control and Prevention) 14. Kayeyi Nkomba (Population Council of Zambia, Zambia Ministry of Health) 15. Angela Gama (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia Ministry of Health) 16. LCDR Danielle Barradas (U.S. Public Health Service) 17. Jonas Hines (U.S. Public Health Service) 18. Nyambe Sinyange (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Field Epidemiology Training Program, Lusaka, Zambia; Zambia Ministry of Health) 19. Victor Mukonka (Zambia National Public Health Institute, Lusaka, Zambia; Zambia Ministry of Health).

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Citation Style For This Article: Chipoya M, Kapina M , Mwansa et al. Outbreak of Circulating Vaccine Derived Polio Virus Type-2 Chienge District, Luapula Province, Zambia, September 2019. The Health Press Zambia Bull. 2020; 4(4); pp 26

Background

Africa has seen a significant rise in circulating vaccine-derived polioviruses type 2 DPV2) outbreaks following the switch to bivalent oral polio vaccine (OPV) in 2016. In September 2019, the World Health Organisation (WHO) country office notified the Zambian Ministry of Health of a case of VDPV-2 in Chienge District, Luapula Province. This paper describes the investigation and public health response.

Methods

An Investigation was conducted per WHO standard operating procedures, where cVDPV is defined as VDPV demonstrating person-to-person transmission in the community or evidence from human and/or environmental detections of related viruses. The patient’s grandmother and mother were interviewed and blood samples were collected from the patient and 36 stool samples were collected from direct and community contacts aged <5 years from the two villages where the patient resided. Genetic sequencing for intrathymic differentiation was used to determine the relatedness of poliovirus samples.

Results

The patient was an unvaccinated two-year-old boy of Chienge District bordering the Democratic Republic of Congo (DRC); he had spent time in both countries, although his last trip to DRC was in >1 year ago. History indicated the patient developed sudden weakness in his lower limbs following a fever of <24hours in July. The sequencing results of the case showed VDPV2 with nine nucleotide differentiation from Sabin-2. Of the 36 stool samples, three isolated polioviruses (one Sabin-like-type 1 and two poliovirus-type 2[PV2]). The sequencing results of the two PV2 indicated genetic linkage to the index case but no established link to any ongoing cVDPV2 outbreaks in the DRC.

Conclusion

The confirmed presence of the cVDPV2 outbreak in Zambia represents another novel emergence of cVDPV2 since switching to bOPV. A mass vaccination campaign with monovalent OPV2 has been completed in Luapula Province following this outbreak. Furthermore, a catch-up vaccination was conducted in June 2020 countrywide to provide IPV coverage among children aged 3 to 59 months old children who missed type 2 containing polio vaccine from 2015 to March 2020.

Recommendations

Following this outbreak and the finding above we recommend strengthening AFP surveillance systems in rural-border towns with limited environmental surveillance, the establishment of more environmental surveillance sites within the country to investigate the presence of polioviruses in wastewater samples which would indicate the presence of polioviruses in those communities. Furthermore, we recommend improving vaccination coverage for both bivalent Oral Polio Vaccine (bOPV) and Inactivated Polio Vaccine (IPV) in all areas of the country to prevent further outbreaks of VDPV.

Authors: Dr Nsofwa Sukwa, Michelo Simuyandi (CIDRZ), Masuzyo Chirwa (CIDRZ), Yvonne Mutombo Kumwimba (CIDRZ), Obvious N Chilyabanyama (CIDRZ), Natasha Laban(CIDRZ), Aybüke Koyuncu (CIDRZ), Roma Chilengi (CIDRZ)

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Citation Style For This Article: Sukwa N, Simuyandi M, Chirwa M, et al .Incidence and clinical presentation of Congenital Syphilis, in a Rotavirus vaccine cohort study in Lusaka: a case series report. The Health Press Zambia Bull. 2020; 4(4); pp 25

Background

Despite an otherwise robust national antenatal clinic program, Maternal and congenital syphilis remain an important public health issue in Zambia. This case series reports the clinical presentation of seven infants diagnosed with Congenital Syphilis in Lusaka, Zambia.

Methods

The cases in this series were incidental findings from a cohort of infants enrolled in a rotavirus vaccine immunogenicity study recruiting infants at 6 weeks of age. As part of clinical care for enrolled participants, we screened mothers of children who presented with adverse events of (i) repeated upper respiratory tract infections/coryza, (ii) skin lesions, and (iii) poor weight gain, for syphilis using Rapid Plasma Reagin (RPR) test.

Results

From a cohort of 214 mother-infant pairs enrolled between September and December 2018, a total of 115 (44.4%) of the mothers reported to have not been screened during antenatal care. Of these, 4 (3.5%) reported to have tested positive; and only two received treatment.  Seven out of 57 (26.6%) children meeting the screening criteria had a positive RPR test result. The mean age at diagnosis was 4.5 months (1.3 SD), and the common presenting features included:  coryza (6/7), skin lesions (4/7), conjunctivitis (3/7), pallor/anemia (5/7), wasting (2/7), and 5/7 were underweight. Regarding maternal HIV infection, 3 of the 7 infants (3/7) were exposed to HIV. Following diagnosis, all 7 cases received standard treatment according to national treatment guidelines i.e. 6/7 cases received inpatient care with benzylpenicillin for ten days, while 1/7 was treated as an outpatient and received daily procaine penicillin for ten days. Conclusion: These findings suggest that though screening for syphilis is part of the standard of care for antenatal in Zambia, it is not offered optimally. There is an urgent need to address programmatic shortcomings in syphilis screening and treatment to avoid long-term sequelae. Additionally, Clinicians need to raise their index of suspicion and rule out syphilis when confronted with these clinical symptoms regardless of the mother’s HIV status

Authors: Kaunda, Yamba (UTH), Evans Mpabalwani (UTH), Ruth Nakazwe (UTH), Evans Mulendele (UTH) Goitom Weldegebriel (WHO), Jason M Mwenda (WHO), Reggis Katsande (WHO), Linda de Gouveia (NICD), Elizabeth Chizema-Kawesha (MOH), Raphael Chanda (UTH), Belem Matapo (MOH), James C L Mwansa (Apex University), Chileshe Lukwesa-Musyani (UTH).

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Citation Style For This Article: Yamba K, Mpabalwani E, Nakazwe R, et al. Title: Impact of PCV10 in Children <5 years hospitalized for Bacterial Meningitis at the Children’s Hospital, Lusaka, Zambia, 2010-2019. Health Press Zambia Bull. 2020; 4(4); pp 24

Background

Invasive Bacterial Diseases (IBDs) are still a public health concern in Africa, causing childhood morbidity and mortality despite the availability of vaccines. We investigated the characteristics of aetiological agents causing IBDs in children ≤5 years in the pre-and post-vaccination period in Zambia.

Method

Identification of Streptococcus pneumonia (Spn), Haemophilus influenza (Hi), and Neisseria meningitides (Nm) from cerebrospinal fluid (CSF) was achieved by microscopy, culture, antigen detection, and chemical analysis. Real-time polymerase chain reaction (RT-PCR) was performed on positive samples for the detection/confirmation of Spn, Hi, and Nm with serotyping (Spn, Hi) and serogrouping (Nm).

Results

During the period of review (2010-2019), 3810 suspected, 658 probable and 231 confirmed bacterial meningitis cases were reported. Spn, Nm, and Hi accounted for 65% (151/231), 20% (45/231) and 15% (35/231) respectively. Pneumococcal serotypes included PCV10 serotypes 52% and non-PCV10 serotypes 48% of which 14% were PCV13 serotypes and 34% non-vaccine serotypes (NVS). Of note is the 20% reduction in confirmed S. pneumonia 60% (90/151) in the pre-vaccination period (2010-2014) to 40% (61/151) in the post-vaccination period (2014-2019) and a decrease in PCV10 serotypes from 77% (36/47) to 23% (11/47). All serotyped Nm and Hi belonged to serogroup W and H. influenza type b respectively. Reduced pneumococcal susceptibility to penicillin 67% and ceftriaxone 98% was observed.

Conclusion/Recommendations

There was a decrease in the frequency of pneumococcal bacterial meningitis and PCV10 serotypes in the post-vaccination period. However, the Spn and Nm serotype/serogroup replacement and the increased penicillin resistance warrants for continued surveillance to inform and guide treatment and vaccination policies, the introduction of PCV13 in our setting, and strengthening vaccination programs.

Authors: Ms. Moomba Thornicroft, Mary Kagujje, Kabaghe Tamiwe, Tamala Zgambo, Sisa Hatwiinda, Sara Nyangu, Moonga Clement, Monde Muyoyeta.

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Citation Style For This Article: Thornicroft M, Kagujje M, Tamiwe K, et al. Identifying Barriers to Accessing Health Services: Detention Period For Juvenile Offenders In Adult Correctional Facilities Zambia. Health Press Zambia Bull. 2020; 4(4); pp 23

Background

The juvenile act of the laws of Zambia stipulates that as much as possible, authorities should avoid detention of juveniles and if juveniles are detained, as much as possible, they should be prevented from associating with adults who are charged with an offence. Juveniles in conflict with the law in Zambia are detained in adult correctional facilities before they are ordered (sentenced). Detention in adult correctional facilities which are often overcrowded not only exposes juveniles to certain criminal behaviour but also increases their risk for sexual abuse, mental health disorders, malnutrition, and infectious diseases including HIV and TB.  A survey was conducted to understand the average period of detention of juveniles in adult correctional facilities and the reasons for delayed transfer to juvenile appropriate facilities.

 Methods

Data was collected from 10 correctional facilities as part of the baseline assessment by the Elton John AIDS Foundation EJJOH project. A desk review of admission files was done to determine the average detention period in adult correctional facilities. 224 juveniles aged between 14 and 19 were interviewed in the presence of a correctional officer to understand the reasons why they were still detained in adult correctional facilities.

Results

A total of 224 juveniles were found in adult correctional facilities. The juvenile detention period in adult correctional facilities ranged from 54- 1,324 days. Of the juveniles interviewed, 130 (58%) had delayed High Court confirmations for 6 months or longer, 38 (17%) lost documentation or transferred from other districts without the necessary documentation, 20 (9%) had been waiting for transfer to Reformatory/ Approved schools for 6 months or longer, 26 (12%) awaiting trial or committal to the high court, 10(4%) had no guardian/ Social Welfare representation during hearings, no witnesses, age determination reports,

Conclusions

Juveniles stay in adult correctional facilities for extended durations; the factors contributing to prolonged detention in adult correctional facilities are primarily system factors. Without these factors being addressed, prolonged stay of juveniles in adult correctional facilities will continue to be a structural barrier to accessing appropriate health services

Recommendations:

• Juvenile offenders should be given alternative corrective measures without incarceration

• Correction services should have deliberate health policies for incarcerated juveniles

• Juvenile offenders should be separated from adult inmates at all costs

Keywords: Juvenile, Detention period, barriers to health services, Correctional service

Authors: John Mwaba1,2, Amanda K.Debes3, Patrick Shea3, Victor Mukonka4, Orbrie Chewe4, Caroline Cleopatra Chisenga1, Michelo Simuyandi1, Geoffrey Kwenda2, David Sack3, Roma Chilengi1, Mohammad Ali3.  1Center for Infectious Disease Research in Zambia, Lusaka 2Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia 3Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States 4 Zambia National Public Health Institute, Lusaka, Zambia

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Citation Style For This Article: Mwaba J,Debes AK, Shea P, et al. Identification of Cholera Hotspots in Zambia: A Spatiotemporal Analysis of Cholera Data from 2008 to 2017 Health Press Zambia Bull. 2020; 4(4); pp 22

Background

The global burden of cholera is increasing, with the majority (60%) of the cases occurring in sub-Saharan Africa. In Zambia, widespread cholera outbreaks have occurred since 1977, predominantly in the capital city of Lusaka. During both the 2016 and 2018 outbreaks, the Ministry of Health implemented cholera vaccination in addition to other preventative and control measures, to stop the spread and control the outbreak. Given the limitations in vaccine availability and the logistical support required for vaccination, the oral cholera vaccine (OCV) is now recommended for use in high-risk areas (“hotspots”) for cholera. Hence, the aim of this study was to identify areas with an increased risk of cholera in Zambia.

Methods

Retrospective cholera case data from 2008 to 2017 was obtained from the Ministry of Health, Department of Public Health, and Disease Surveillance. The Zambian Central Statistical Office provided district-level population data, socioeconomic and water, sanitation, and hygiene (WaSH) indicators. To identify districts at high risk, we performed a discrete Poisson-based space-time scan statistic to account for variations in cholera risk across both space and time over a 10-year study period. A zero-inflated negative binomial regression model was employed to identify the district-level risk factors for cholera. The risk map was generated by classifying the relative risk of cholera in each district, as obtained from the space-scan test statistic.

Results

In total, 34,950 cases of cholera were reported in Zambia between 2008 and 2017. Cholera cases varied spatially by year. During the study period, Lusaka District had the highest burden of cholera, with 29,080 reported cases. The space-time scan statistic identified 16 districts to be at a significantly higher risk of having cholera. The relative risk of having cholera in these districts was significantly higher and ranged from 1.25 to 78.87 times higher when compared to elsewhere in the country. Proximity to water bodies was the only factor associated with the increased risk for cholera (P<0.05).

Conclusion/Recommendations

This study provides a basis for the cholera elimination program in Zambia. Outside Lusaka, the majority of high-risk districts identified were near the border with the DRC, Tanzania,   Mozambique, and Zimbabwe. This suggests that cholera in Zambia may be linked to the movement of people from neighbouring areas of cholera endemicity. A collaborative intervention program implemented in concert with neighbouring countries could be an effective strategy for the elimination of cholera in Zambia, while also reducing rates at a regional level.

Authors: Mrs Kalo Musukuma-Chifulo. Tracy N. Phiri1, Michelo Simuyandi1, Mutinta Muchimba1 Chikumbutso Chipeta1, Kawana Wamundila2, Obvious N. Chibanyama1, Caroline C. Chisenga1, Paul Somwe1, Cheryl Rudd1, Melissa C. Kapulu3,4, Michael Vinikoor5, Samuel Bosomprah1,6, and Roma Chilengi11 Centre for Infectious Disease Research in Zambia (CIDRZ) 2 The University of Zambia (UNZA) 3 KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya 4 Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK  5 the University of Alabama at Birmingham (UAB) 6 Department of Biostatistics, School of Public health, University of Ghana.

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Citation Style For This Article: Musukuma-Chifulo K. Phiri TN, Simuyandi M, et al. Hepatitis B virus among health care workers: exposure, prevalence, and predictors of a lifetime and current infection in a cohort from Kalulushi District, Zambia. Health Press Zambia Bull. 2020; 4(4); pp 21

Background

Infection with the Hepatitis B virus (HBV) among health care workers (HCWs) is an occupational hazard that can be mitigated by HBV vaccination which offers ~90-95% protective efficacy when combined with other preventive measures. Exposure to the virus elicits an antibody response which when sufficient can prevent infection from establishing. On the other hand, antibodies to the core antigen serve as a marker of lifetime infection (i.e., if ever exposed), while an acute or chronic infection is marked by the detection and presence of the surface antigen. However, the level of exposure and risk factors are currently not understood in our setting that would allow for vaccine introduction in HCWs. We thus set out to evaluate the exposure, prevalence, and describe the predictors of a lifetime and current infection of HBV amongst HCWs.

Methods

We recruited a cohort of consenting HCWs across 23 health facilities and two nursing schools from Kalulushi District, Copperbelt Province, Zambia. Current or previous infection with HBV was determined by the detection of surface antigen (HBsAg), core antibody (anti-Hbc), and surface antibody (anti-HBs) using established enzyme-linked immunosorbent assay (ELISA) methods. All HBsAg positive volunteers were referred for clinical care. Social demographic characteristics [age, sex, institution type, and category of staff] were collected for each participating HCW. All categorical variables were summarized using proportions. Chi-square or fisher’s exact test was used to test for association between the volunteer’s social demographic characteristics, and HBsAg, and anti-HBc status. In addition, univariate and multivariate logistic regression was used to determine risk factors of HBsAg and anti-HBc status. All statistical analysis was done using STATA version 16.0 and statistical significance was set at p< 0.05.

Results

A total of 673 HCWs were recruited to participate in the study. The median age was 28 (IQR: 24-36) with the majority being female (72.4%, 487/673). Out of these, 15.5% (104/673) were not included in the analysis due to missing demographic or volunteer characteristic data. The majority of the volunteers were from the general hospital (34.1%, 194/569) whilst 29.7%  (169/569) were from the nursing school; 13.7% (78/569) from health posts, and 22.5% (128 /569) from health centers with the majority of these being students (24.1%, 137/569); 47.5% (270/569) medical staff; and 28.5% (162/569) support staff. For Hepatitis B exposure, 66.8% (380/569) were anti-HBc positive while 4.6% (26/567) were HBsAg positive. Using the cut-off of 10 IU/ml, 79.8% (454/569) were eligible for vaccination. A health care worker was more likely to have higher exposure to Hepatitis B as determined by anti-HBc, if they were a student [OR 1.8(95%CI  1.1-2.9) p =0.012] in the univariate analysis, however, this was not significant in the adjusted model.

Conclusion/Recommendations

Lifetime HBV infection is high among HCWs, similar to previous reports in the region; however, only a minority of individuals, regardless of prior HBV infection, have immunity based on antibody concentration. Following this, the program will provide vaccination and describe the profile of antibody responses post-vaccination, and implementation outcomes to inform a national scale-up of HBV testing, treatment, and prevention for Zambian HCWs. 

Authors: Tracy Naomi Phiri*1, Kalo Musukuma-Chifulo1, Michelo Simuyandi1, Caroline C. Chisenga1, Peter Alabi1, Sody Munsaka2, Michael Vinikoor1 Roma Chilengi,1  1Centre for Infectious Disease Research in Zambia, Lusaka, Zambia 2Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia Corresponding Author*: Tracy.Phiri@cidrz.org

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Citation Style For This Article: Phiri TN, Musukuma-Chifulo K, Simuyandi M, et al . Hepatitis B and C Screening During the 2019 World Hepatitis Day at Cosmopolitan Mall in Lusaka, Zambia. . Health Press Zambia Bull. 2020; 4(4); pp 20

Background

Viral hepatitis is the leading cause of liver cirrhosis and liver cancer in Africa. The prevalence of chronic hepatitis B virus (HBV) infection in the Zambian population is around 3.5 % (0-59 years) and can be as high as 12.3% in the HIV-positive adult population whilst that of the hepatitis C virus (HCV) is <1%. Most cases of Fibrosis, Cirrhosis, and Hepatocellular carcinoma are caused by HBV and HCV. Sadly, most people that have viral hepatitis especially type B and C may not know until they have developed liver disease.

Methods

On the 28th of July 2019, Zambia celebrated World Hepatitis Day, a day that saw the screening of 148 individuals at Cosmopolitan Mall in Lusaka for both hepatitis B surface antigen (HBsAg) and hepatitis C antibodies. This was done using the ALLTEST Rapid Diagnostic Test kits (manufactured by AllBIOTECH). Demographic information and general knowledge of hepatitis B data were collected using a pre-tested data capture form. All data collected was presented in tables and analyzed using STATAä, version 14.

Results

Though 61% of our participants had heard about hepatitis B, very few knew their HBV status (16.0%), and only 7.7% were vaccinated. Occupation (p = 0.001) and education (p = 0.002) were significantly associated with knowledge of HBV while there was no association between vaccination status and ever been tested with any factors assessed. The majority of our participants were female and only 4 (4.3%) tested positive for HBsAg, and none was positive for HCV. All hepatitis B positives were males aged between 35 and 45 years. All were married except 1; two were self-employed and one was in informal employment. One was co-infected with HIV whereas the other three had HBV only. All were asymptomatic and previously unaware of their infection. All three mono-infected individuals had normal Full Blood Count (FBC), as well as the Liver Function Test (LFT) results. However, the abdominal ultrasound that was done in one showed mild fibrosis.

Conclusion/recommendations

In conclusion, these findings are suggestive of a lack of sensitization and awareness, low rates of HBV screening, and vaccination. Only males were positive despite testing more females. While this is possible because of a small and potentially biased sample, the male sex has been linked to higher HBV positivity than females. It is also of great public health importance as they were all asymptomatic and potentially infectious and at risk of developing liver complications. There is a need for frequent screening for both HCV and HBV and making HBV vaccines available and affordable.

Up to five keywords; Prevalence; Hepatitis B and C; World hepatitis day; general population; knowledge

Author: Martha Malasa

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Citation Style For This Article: Malasa M . Factors associated with malaria transmission; a comparative study of Munyumbwe and Sompani Rural Health Centres in Gwembe district, Zambia. . Health Press Zambia Bull. 2020; 4(4); pp 19

Background

Malaria remains a MAJOR public health problem in Zambia. Malaria hotspots pose a challenge to attaining malaria elimination by 2021. Identifying predictors of malaria in hotspots and geographically adjacent areas might reveal important information about how to achieve this goal. Munyumbwe and Sompani Rural Health Centres (RHCs) in Southern Province have been receiving the same intervention package since 2014, yet malaria incidence in 2019 were 6/1000 and 117/1000, respectively. We investigated factors associated with malaria transmission in these two RHC catchment areas.

Methods

A cross-sectional study was undertaken at Munyumbwe and Sompani RHCs, where a pre-tested structured questionnaire was administered to 340 consenting participants tested for malaria during January-February 2020. Data collected included: age; education level; malaria knowledge; insecticide-treated nets (ITN) possession and use; indoor residual spraying (IRS); travel history; index case follow-up; outdoor activities; and presence of stagnant water. Multiple logistic regression analysis was done using Stata.

Results

At Sompani RHC, 50% (85/170) of participants had malaria during January-February 2020 compared to Munyumbwe with 5.9% (10/170) (AOR=0.22; p=0.004). Travelling outside the district at Sompani was associated with malaria (AOR=29.5; p<0.0001). In both areas, participants who utilized ITNs had reduced odds of acquiring malaria than those who never utilized (Munyumbwe: AOR=0.03 p=0.042; Sompani: AOR=0.11, p=0.006). Index case follow-up was lower in Sompani (6%) than Munyumbwe (90%) (p<0.0001)

Conclusion/Recommendation

Travelling outside the district for Sompani was a unique predictor of malaria. Most people who had malaria in Sompani reported having travelled to high malaria burden areas. Additionally, only a minority of index cases are followed up in Sompani, in contrast to Munyumbwe. Providing malaria prophylaxis to travellers and strengthening index case follow-up are potential strategies to control malaria in Sompani and possibly elsewhere in Zambia.