Showing papers by "University of Zambia published in 2005"
TL;DR: Children born to HIV-infected mothers with advanced disease who escaped perinatal or early breastfeeding-related HIV infection are nonetheless at high risk of mortality and morbidity during the first few months of life.
Abstract: Infants born to HIV-infected mothers are at risk of acquiring HIV infection. The risk is serious, but it can be substantially reduced with antiretroviral drugs [1–3]. Yet, even in the absence of interventions, the majority of infants born to HIV-infected mothers do not acquire infection. However, these infants risk losing their mother (and father) to HIV infection during childhood, with the social dislocation of orphanhood posing obvious dangers to their well-being [4–6]. But do HIV-uninfected children have other risks associated with having an HIV-infected mother?
There is surprisingly little known about morbidity and mortality among HIV-exposed, HIV-uninfected infants. Demographic studies estimate that mortality among children born to HIV-infected mothers is higher than that among children born to mothers without HIV infection, but interpretation is limited because the proportion of HIV-infected children is not known [6–9]. Factors affecting morbidity and mortality in general (e.g., lack of breastfeeding, unhygienic living conditions, and malaria exposure) are also likely to be important among HIV–exposed, HIV-uninfected infants. In addition, HIV exposure directly or indirectly in utero, intrapartum, and during breastfeeding may confer risks to infants, even in the absence of vertical transmission.
Perinatal transmission and disease progression among infected infants are higher among those born to mothers with more advanced HIV disease [10–12]. The effect, if any, on uninfected offspring is unclear. Here, we investigate whether advanced HIV disease and/or immune dysfunction among HIV-infected mothers increases mortality and morbidity among their uninfected infants. Any effect will have substantial public health consequences, because the absolute number of reproductive-aged women with HIV infection continues to increase.
193 citations
TL;DR: Successful perinatal HIV prevention requires each mother–infant pair to negotiate a cascade of events that begins with offering HIV testing and continues through adherence to the prescribed regimen, resulting in reduced coverage and diminished program effectiveness.
Abstract: Objective: To determine the population effectiveness of a city-wide perinatal HIV prevention program. Design: An anonymous surveillance of newborn cord blood for HIV serology and nevirapine (NVP). Methods: All 10 public-sector delivery centers in Lusaka, Zambia participated. All mother-infant pairs delivering during the 12-week surveillance period at the participating centers and who received antenatal care at a public-sector facility in Lusaka were included in the study. The main outcome measure was population NVP coverage, defined as the proportion of HIV-infected women and HIV-exposed infants in the population that ingested NVP. Results: Of 8787 women in the surveillance population, 7204 (82%) had been offered antenatal HIV testing, of which 5149 (71%) had accepted, and of which 5129 (99%) had received a result. Overall, 2257 of 8787 (26%) were cord seropositive. Of the 1246 (55%) cord blood seropositive women who received an antenatal HIV test result, 1112 (89%) received a positive result; the other 134 comprise seroconverters and clerical errors. Only 751 of 1112 (68%) women who received a positive antenatal test result and a NVP tablet for ingestion at labor onset had NVP detected in the cord blood (i.e., maternal non-adherence rate was 32%). A total of 675 infants born to 751 adherent mothers (90%) received NVP before discharge. Thus, only 675 of 2257 (30%) seropositive mother-infant pairs in the surveillance population received both a maternal and infant dose of NVP. Conclusions: Successful perinatal HIV prevention requires each mother-infant pair to negotiate a cascade of events that begins with offering HIV testing and continues through adherence to the prescribed regimen. This novel surveillance demonstrates that failures occur at each step, resulting in reduced coverage and diminished program effectiveness.
142 citations
TL;DR: The technical quality of care, as represented by the thoroughness of examination, to be the most important quality attribute, followed by staff attitudes and drug availability, and the disutility of cost was found to decrease with higher socioeconomic status, as was the value of drug availability.
Abstract: This study reports on the results of a discrete choice experiment undertaken in Zambia to assess the factors influencing the demand for hospital care in Zambia, in particular the role of (perceived) quality and trade-offs between price and quality. Valuations of quality were evaluated for the treatment of two acute medical conditions, cerebral malaria in adults and acute pneumonia in children. Marginal utilities and willingness-to-pay for attributes of quality of hospital care were estimated, together with the influence of socioeconomic characteristics on these valuations and the extent of non-linearities in valuations of time and money. We find the technical quality of care, as represented by the thoroughness of examination, to be the most important quality attribute, followed by staff attitudes and drug availability. Valuations of examination thoroughness increase with increasing socioeconomic status. The disutility of cost was found to decrease with higher socioeconomic status, as was the value of drug availability. The implications of the findings for Zambian hospital sector reforms are discussed.
135 citations
01 Nov 2005-Journal of Veterinary Medicine Series B-infectious Diseases and Veterinary Public Health
TL;DR: Results indicate that Fasciola gigantica infection is an important condition that leads to high liver condemnations and/or trimmings in cattle tendered for slaughter in Zambia.
Abstract: The aim of this study was to determine the prevalence and some factors influencing occurrence of fasciolosis in cattle, carried out at selected major abattoirs in Zambia. Of 841 cattle livers inspected and 677 faecal samples analysed, prevalence rates of 53.9% and 48.9%, respectively, were found. Cumulative prevalence of 60.9% (n = 677) was recorded. According to age, no significant difference of infection was found. Female cattle on liver inspection (59.3%) and coprological examination (65.2%) had significantly higher (P < 0.001) rates than males (44.5% and 36.3% respectively). Origin of cattle had a significant influence (P < 0.001) on the prevalence rate. According to fluke egg count classification, 68.5% of cattle had light infection, 20.9% moderate, 4.4% heavy and 6.2% severe. These results indicate that Fasciola gigantica infection is an important condition that leads to high liver condemnations and/or trimmings in cattle tendered for slaughter.
104 citations
TL;DR: Fresh-cut organic mixed vegetables and green beans produced in Zambia were analysed for aerobic plate counts, coliforms, Enterobacteriaceae, Escherichia coli, Bacillus cereus, Clostridium perfringens, Listeria monocytogenes, Salmonella spp.
86 citations
TL;DR: Short stimuli containing only one rise time produced associations with phonological skills and reading, even in a language where the perception of rise time contrasts are not crucial for the signaling of phonemic contrast.
82 citations
TL;DR: The results reveal an association between B* 57 supertype (B*57s, which includes B*57 and B*58 alleles) and delayed progression to AIDS and the presence of the inhibitory allele KIR3DL1 in combination with the HLA-B* 57s alleles that contain the Bw4-I80 epitope has a highly protective effect against progression toAIDS in Zambian patients.
82 citations
TL;DR: The current status of TB management is summarized and recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence are described.
Abstract: Over recent years, tuberculosis (TB) and disease caused by human immunodeficiency virus (HIV) have merged in a synergistic pandemic. The number of new cases of TB is stabilizing and declining, except in countries with a high prevalence of HIV infection. In these countries, where HIV is driving an increase in the TB burden, the capacity of the current tools and strategies to reduce the burden has been exceeded. This paper summarizes the current status of TB management and describes recent thinking and strategy adjustments required for the control of TB in settings of high HIV prevalence. We review the information on anti-TB drugs that is available in the public domain and highlight the need for continued and concerted efforts (including financial, human and infrastructural investments) for the development of new strategies and anti-TB agents.
82 citations
TL;DR: The objective of determining the difference in termite damage to maize in various land use systems between monoculture maize, maize grown using traditional fallows and improved fallows was to establish a baseline for comparison.
Abstract: 1 Termites cause significant damage to maize and other crops in southern Africa. Several studies were conducted with the objective of determining the difference in termite damage to maize in various land use systems between monoculture maize, maize grown using traditional fallows and improved fallows.
2 In an experiment conducted at four sites on noncoppicing fallows, maize planted after Tephrosia candida 02971 fallows had lower termite damage compared with fully fertilized monoculture maize. However, the termite suppression was not low enough to warrant rotation of noncoppicing fallows for termite management..
3 In four experiments comparing termite damage to maize grown in monoculture and in coppicing fallows, fully fertilized monoculture maize had a higher percentage of lodged plants compared with maize grown in pure Leucaena leucocephala, Gliricidia sepium and Acacia anguistissima fallows or in a mixture of A. anguistissima + Sesbania sesban or Tephrosia vogelii + S. sesban.
4 More than 50–75% of the variance in maize yield was explained by preseason inorganic nitrogen and termite damage. However, termite damage to maize was not influenced by inorganic nitrogen, which represents nitrogen readily available to maize. The decomposition rate of biomass (related to lignin + polyphenol to nitrogen ratio) and water retention under fallows also appeared to influence termite damage.
5 It is concluded that maize grown in L. leucocephala, G. sepium, A. anguistissima and S. sesban fallows suffers less termite damage and produces maize yields comparable with conventionally tilled and fully fertilized monoculture maize.
80 citations
TL;DR: In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity.
Abstract: Background
Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented.
63 citations
TL;DR: After intervention, female high intensity participants reported higher rates of condom use, more positive condom attitudes, safer sex intentions, and less alcohol use, which highlights the influence of male partners in implementation of effective risk reduction interventions.
Abstract: Sexual risk behavior interventions in sub-Saharan Africa focus predominantly on individual and couples counseling. This cognitive-behavioral group intervention was adapted from an urban US context to urban Zambia. Preliminary data analyses assessed the influence of partner participation on sexual risk behavior among HIV-positive Zambian women. Female participants (n=180) attended four group intervention sessions and received sexual behavior skill training and male and female condoms; male partners (n=152) were randomly assigned to high- or low-intensity gender-concordant group intervention sessions. Sexual risk behavior, strategies, attitudes, and knowledge were assessed at baseline, 6, and 12 months. At baseline, 19% of males reported using alcohol before sex, 10% reported using alcohol to cope, and negative coping was associated with sexual risk behavior. In contrast, 1% of women reported using alcohol before sex, and 15% used alcohol as an HIV-coping strategy. Consistent barrier use was reported by 48% of women and 74% of men. After intervention, female high intensity participants reported higher rates of condom use (F=5.68, P=.02), more positive condom attitudes, safer sex intentions, and less alcohol use. These findings highlight the influence of male partners in implementation of effective risk reduction interventions.
TL;DR: It is proposed on the basis of a linearized tree analysis that the Bathybatini comprise two distinct lineages, the genera Hemibates and Bathybates, that seeded the primary lacustrine Tanganyika radiation independently.
Abstract: The cichlid species flock of Lake Tanganyika represents a polyphyletic assemblage of eight ancestral lineages, which colonized the emerging lake independently. Our study is focused on one of these lineages, the Bathybatini, a tribe of specialized piscivorous cichlids of the deep pelagic zone. By analyzing three mtDNA gene segments of all eight species of the tribe and two species of the closely related Trematocarini, we propose on the basis of a linearized tree analysis that the Bathybatini comprise two distinct lineages, the genera Hemibates and Bathybates, that seeded the primary lacustrine Tanganyika radiation independently. The genus Hemibates is likely to represent a distinct lineage that emerged simultaneously with the tribe Trematocarini and the genus Bathybates and should be therefore treated as a distinct tribe. Within the genus Bathybates, B. minor clearly represents the most ancestral split and is likely to have diverged from the remaining species in the course of the “primary lacustrine Tanganyika radiation” during which also the radiations of the Lamprologini and the H-lineage took place. The remaining “large” Bathybates species also diversified almost simultaneously and in step with the diversification of other Tanganyikan lineages—the Limnochromini and Cyprichromini—with B. graueri occupying the most ancestral branch, suggesting that these were induced by the same environmental changes. The lack of geographic color morphs suggests that competition and resource partitioning, rather than allopatric speciation, promoted speciation within the genus Bathybates.
TL;DR: The results show modest effects of the maize price increases on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001–2002, which is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant.
Abstract: Objective: To investigate the effects on maternal micronutrient status and infant growth of the increased maize prices that resulted from the southern African drought of 2001–2002. Design: Longitudinal cohort study. Setting: A maternal and child health clinic in Lusaka, Zambia. Subjects: Maternal and infant health and nutrition data and maternal plasma were being collected for a study of breast-feeding and postpartum health. Samples and data were analysed according to whether they were collected before (June to December 2001), during (January 2002 to April 2003) or after (May 2003 to January 2004) the period of increased maize price. Season and maternal HIV status were controlled for in analyses. Results: Maize price increases were associated with decreased maternal plasma vitamin A during pregnancy (P ¼ 0.028) and vitamin E postpartum (P ¼ 0.042), with the lowest values among samples collected after May 2003 (vitamin A: 0.96mmol l 21 , 95% confidence interval (CI) 0.84–1.09, n ¼ 38; vitamin E: 30.8mmol mmol 21 triglycerides, 95% CI 27.2–34.8, n ¼ 64) compared with before January 2002 (vitamin A: 1.03mmol l 21 , 95% CI 0.93–1.12, n ¼ 104; vitamin E: 38.9mmol mmol 21 triglycerides, 95% CI 34.5–43.8, n ¼ 47). There were no significant effects of sampling date on maternal weight, haemoglobin or acute-phase proteins and only marginal effects on infant weight. Infant length at 6 and 16 weeks of age decreased progressively throughout the study (P-values for time of data collection were 0.51 at birth, 0.051 at 6 weeks and 0.026 at 16 weeks). Conclusions: The results show modest effects of the maize price increases on maternal micronutrient status. The most serious consequence of the price increases is likely to be the increased stunting among infants whose mothers experienced high maize prices while pregnant. During periods of food shortages it might be advisable to provide micronutrient supplements even to those who are less food-insecure.
TL;DR: Of 154 variables evaluated by logistic regression analyses, only three risk factors have emerged as independent predictors of HHV‐8 positive serology: diagnosis of genital warts, HIV‐1 co‐infection and primary education.
Abstract: Comprehensive data describing epidemiological characteristics of the human herpesvirus-8 or Kaposi's sarcoma-associated herpesvirus (HHV-8 or KSHV) infection among pregnant women in a central sub-Saharan Africa are not available. This study determined virus prevalence estimates and the risk factors associated with HHV-8 infection. Cross-sectional, enrollment visit data were analyzed from a prospective cohort study of perinatal transmission of HHV-8 in Lusaka, Zambia. Exposure data were obtained via structured interview, physical examination, medical chart review, and laboratory testing. Among 3,160 antenatal women serologically screened for HHV-8 between September 1998 and October 2000, 40.2% were seropositive. The HHV-8 positive women were more likely to be co-infected with HIV-1 than those who were HHV-8 negative (34% vs. 26%; P < 0.0001). Of 154 variables evaluated by logistic regression analyses, only three risk factors, have emerged as independent predictors of HHV-8 positive serology: diagnosis of genital warts, HIV-1 co-infection and primary education. The association of HHV-8 infection with genital warts and HIV-1 co-infection suggests heterosexual transmission of HHV-8. HIV-1 infection may also act as a marker for particular behaviors, which could be sexual in nature, that are associated with both HIV-1 and HHV-8 transmission. Since HHV-8 facilitates development of AIDS-related Kaposi's sarcoma (KS), the results of this study could be utilized to identify specific population groups of pregnant women who are at increased risk for this disease.
TL;DR: Human immunodeficiency virus has resulted in a major change in the presentation and behaviour of certain common diseases in Africa and the implications for management are discussed.
Abstract: The experience of surgeons in Africa with patients infected with human immunodeficiency virus (HIV) suggests 5 trends: 1) an increased incidence of surgical sepsis--most commonly in the female genital tract the pleural cavity large joints and the anorectal area--in HIV-infected patients; 2) an increase in surgical tuberculosis of spine bone joints lymph nodes and the peritoneal cavity concomitant with an increased incidence of pulmonary tuberculosis in high-incidence countries; 3) impaired healing of wounds wound breakdown and the development of skin lesions and ulcers; 4) tumors whose aggressiveness is accelerated by HIV infection; and 5) new pathologies such as nonspecific cystitis chronic osteitis and vascular disease. In many cases HIV infection has not been identified until after hospital patients have demonstrated a rapid progressive decline after routine surgery. To date only 1 study has attempted to determine the extent to which HIV infection influences the outcome of surgery. Mortality in an intensive care unit at the University Teaching Hospital in Lusaka Zambia differed significantly between HIV-positive and seronegative patients only in terms of pneumonia; however seropositive patients also have an elevated albeit nonsignificant risk of mortality from severe gynecologic sepsis.
TL;DR: Out-of-school adolescents, adolescents from rural areas, and married adolescents were identified as at most risk for HIV and prevention programs that emphasize the use of condoms should be implemented for these groups.
Abstract: AIDS-related knowledge, attitudes, self-efficacy, and behavior were examined among 3,360 adolescents aged 10–19 years old in Zambia, including in-school and out-of-school, rural and urban, and married and unmarried adolescents. The adolescents reported a moderate to high AIDS knowledge; positive attitudes towards prevention; and low to moderate self-efficacy about AIDS prevention. Although these factors were significantly related to adolescents’ engagement in high-risk behavior, the results indicated that these variables add only 3% of explained variance beyond the socio-demographic variables, which explains 14% of the variance. Three groups were identified as at most risk for HIV: out-of-school adolescents, adolescents from rural areas, and married adolescents. Prevention programs that emphasize the use of condoms should be implemented for these groups and future studies should evaluate their effectiveness in reducing risk.
TL;DR: It is concluded that HIV‐associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.
Abstract: The relative importance of human immunodeficiency virus (HIV)-associated lymphadenopathy amongst patients presenting for lymph node biopsy in Central Africa is unknown. HIV-1 serology and histology of patients undergoing superficial lymph node biopsy during 1989-1990 in Lusaka, Zambia, were examined in a prospective cohort study of HIV serology and by retrospective review of laboratory records. Of 727 lymph nodes biopsied in Lusaka in 1989-1990, 380 (52 per cent) showed tuberculous lymphadenitis, 160 (22 per cent) histology suggestive of primary HIV lymphadenopathy and 66 (9 per cent) nodal Kaposi's disease. HIV serology was tested in 280 adults and was positive in 91 per cent (255 patients), including 89 per cent (153 of 171) of those with tuberculous lymphadenitis, 98 per cent (63 of 64) of those with histology suspicious of primary HIV lymphadenopathy and all (24 of 24) with nodal Kaposi's disease. Other HIV-associated lymphadenopathy included nodal lymphomas and lymphoepithelial cysts. HIV serology was tested in 22 children and was positive in eight, including four of 14 with tuberculous lymphadenitis. It is concluded that HIV-associated lymphadenopathy, especially tuberculous lymphadenitis, is very common amongst patients presenting for lymph node biopsy in Central Africa.
TL;DR: Judging by the results obtained in this study, pollution from the mining activity around the Kafue River drainage area in the Copperbelt region has not significantly influenced the trace element concentrations in tissues of the crocodiles in the Kafu National Park.
TL;DR: It may be concluded that Fasciola gigantica was present throughout the year in cattle in Zambia but the abundance was highest in the post-rainy season and lowest in the cold dry season.
TL;DR: HLA-B*5703 seems to be a protective allele against the progression of HIV infection but could influence the increased incidence of SpA observed in this population of individuals from Zambia.
Abstract: Objective
To analyze the HLA distribution in a population of individuals from Zambia in order to establish a possible relationship between the progression of human immunodeficiency virus (HIV) infection and the development of spondylarthropathy (SpA).
Methods
A large epidemiologic analysis of rheumatology patients living in Zambia was performed in order to identify those who had SpA. We selected 64 patients with SpA and found that 54 also had HIV type 1 (HIV-1) infection; only 10 were HIV negative. Additionally, we selected 57 HIV-infected individuals without SpA and 43 healthy controls. Among all of the HIV-1–infected patients, 25 SpA-positive and 24 SpA-negative patients were classified as slow progressors to acquired immunodeficiency syndrome (AIDS), and 8 SpA-positive and 26 SpA-negative patients were classified as rapid progressors. All patients were typed for HLA–B alleles.
Results
Of the 64 patients with SpA, HIV infection was observed in 54 (84%). The frequency of B*5703 was increased in patients who were SpA positive and HIV positive compared with patients who were SpA negative and HIV positive (P = 0.0002, odds ratio [OR] 8.28). Among patients who were slow progressors to AIDS, this allele was overrepresented in those with SpA compared with those without SpA (corrected P = 0.001, OR 26.25).
Conclusion
HLA–B*5703 seems to be a protective allele against the progression of HIV infection but could influence the increased incidence of SpA observed in this population.
TL;DR: A significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence and serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.
Abstract: In the Maheba Refugee Settlement, in the clinics supported by Medecins Sans Frontieres, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.
TL;DR: The clear-cut genetic biogeographic structure points to the dominance of geographic speciation in this lineage of riverine cichlid fishes, contrasting the importance of in situ diversification observed in lake cichLids.
Abstract: Haplochromine cichlids form the most species-rich lineage of cichlid fishes that both colonized almost all river systems in Africa and radiated to species flocks in several East African lakes The enormous diversity of lakes is contrasted by a relatively poor albeit biogeographically clearly structured species diversity in rivers The present study analyzed the genetic structure and phylogeographic history of species and populations of the genus Pseudocrenilabrus in Zambian rivers that span two major African drainage systems, the Congo- and the Zambezi-system The mtDNA phylogeny identifies four major lineages, three of which occur in the Congo-system and one in the Zambezi system Two of the Congo-clades (Lake Mweru and Lunzua River) comprise distinct albeit yet undescribed species, while the fish of the third Congo-drainage clade (Chambeshi River and Bangweulu swamps), together with the fish of the Zambezi clade (Zambezi and Kafue River) are assigned to Pseudocrenilabrus philander Concerning the intraspecific genetic diversity observed in the sampled rivers, most populations are highly uniform in comparison to lacustrine haplochromines, suggesting severe founder effects and/or bottlenecking during their history Two bursts of diversification are reflected in the structure of the linearized tree The first locates at about 39% mean sequence divergence and points to an almost simultaneous colonization of the sampled river systems Subsequent regional diversification (with about 1% mean sequence divergence) occurred contemporaneously within the Kafue River and the Zambezi River The clear-cut genetic biogeographic structure points to the dominance of geographic speciation in this lineage of riverine cichlid fishes, contrasting the importance of in situ diversification observed in lake cichlids
TL;DR: A large number of adults with acquired immune deficiency syndrome and persistent diarrhoea in Zambia have intestinal infection, predominantly protozoa.
Abstract: Summary
Background: Adults with acquired immune deficiency syndrome and persistent diarrhoea in Zambia have intestinal infection, predominantly protozoa.
Aim: To search for treatment which can be offered with minimal investigation, we carried out a double-blind, randomized-controlled trial of nitazoxanide (a drug with a range of activity against parasites and bacteria).
Methods: Patients with diarrhoea of 1 month duration or longer were randomized to receive nitazoxanide (1000 mg twice daily) or placebo for 2 weeks. End-points were clinical response, parasitological clearance and mortality.
Results: Two hundred and seven adults were randomized; 42 died during the study. The primary assessment of efficacy was made after 17 days. Clinical response was observed in 56 (75%) of 75 patients receiving nitazoxanide and 45 (58%) of 77 patients receiving placebo (P = 0.03). The rate of improvement was markedly higher in patients with CD4 counts under 50 cells/μL receiving nitazoxanide (P = 0.007). The benefit was largely restricted to the period when the drug was being administered. No difference was seen in parasitological clearance between the two groups. Mortality was 19% by 4 weeks of follow-up and did not differ with treatment allocation.
Conclusions: Nitazoxanide given orally for 14 days was associated with clinical improvement in Zambian acquired immune deficiency syndrome patients with diarrhoea, especially those with very low CD4 counts.
TL;DR: In this paper, five rainwater harvesting systems were installed in two peri-urban areas of Lusaka, the capital city of Zambia, consisting of six ferrocement tanks.
Abstract: Five rainwater harvesting systems were installed in two peri-urban areas of Lusaka, the capital city of Zambia, consisting of six ferrocement tanks. Water samples were collected from the direct rain, roof and tank. In order to compare the rainwater quality with water from other sources, samples were also collected from piped water, boreholes and shallow wells. Rainwater was of higher quality than catchment and storage rainwater. However, harvested rainwater in tanks showed the best bacteriological quality probably due to the elimination of contamination by the first flush. The pH in the storage water was higher than that in rainwater and catchment water due to the reaction with the ferrocement tank. However, it was expected that as the ferrocement tanks matured, pH would drop in the storage water and probably meet the World Health Organisation (WHO) guidelines.
TL;DR: In this paper, the authors report the findings of a study conducted to identify the appropriate policy strategies for cleaner production in Zambia, through direct consultation with industry and other stakeholders, it was observed that the major constraints that hindered the implementation of cleaner production were financial problems, poor/weak enforcement of environmental laws, lack of knowledge and lack of awareness.
TL;DR: In this article, the authors determined the coefficient of condition (CC) relative to copper levels in fish muscle and sediment collected during the dry and rainy seasons, from sites upstream, within and downstream to the copper mining area along the Kafue River.
Abstract: The Kafue River is the major source of drinking water and commercial fish for most towns in Zambia although few reports exist concerning toxic effects of pollutants on organisms dependent on the River. The objective of this study was to determine the coefficient of condition (CC) relative to copper levels in fish muscle and sediment collected during the dry and rainy seasons, from sites upstream, within and downstream to the copper mining area along the river. The CC of fish was calculated to determine plumpness and robustness while copper levels were determined using atomic absorption spectrophotometer. Copper levels in water from all sites during the dry and rainy seasons were below the detection limit of 0.001 mg/L thus lower than the average for lakes and rivers of 0.004 mg/L. Rainy season levels in sediment were not significantly different among all sites (p > 0.05). However, dry season levels in sediment were significantly higher (p<0.001) at Chipata (23.4 mg/kg) and Kumasamba (91.93 mg/kg), within the mining area, compared to other sites.
TL;DR: Meticulous technique, combining the appropriate operation for bladder neck reinforcement with the initial flap‐splitting repair, contributed to the low incidence of postoperative stress incontinence.
Abstract: The results of treatment of' 11 gynaecological fistulae and 150 obstetrical fistulae over a period of 6¼ years is presented. Postoperative stress incontinence was the most serious complication. Its incidence following repair of obstetrical fistulae has been reduced to 7.3 per cent in this series. Meticulous technique, combining the appropriate operation for bladder neck reinforcement with the initial flap-splitting repair, contributed to the low incidence of postoperative stress incontinence. Suprapubic operations were utilized in 20 cases (13.3 per cent). Gross vesical contraction associated with incontinence in 7 cases responded to ileocystoplasty or sigmoidocystoplasty. The final functional cure rate in the series was 873 per cent. Closure was accomplished in about 95 per cent of fistulae. In 8 cases closure was unsuccessful; 4 of these were inoperable. There was I death due to endotoxic shock after ureterosigmoidostomy.
TL;DR: Examining annual cases of these diseases in Zambian miners including comparison of periods before (1960–1970) and after (1992–2002) the arrival of the HIV/AIDS pandemic found a marked increase in cases of TB.
Abstract: Silicosis and tuberculosis (TB) are significant mining-related illnesses in developing countries. The purpose of this study was to examine annual cases of these diseases in Zambian miners, including comparison of periods before (1960-1970) and after (1992-2002) the arrival of the HIV/AIDS pandemic. The Occupational Health and Safety Research Bureau of Zambia reported 2114 cases from 1945 to 2002. Of these, 22.7% were silicosis, 65.4% TB, and the remaining 11.9% silicotuberculosis. While silicosis cases decreased from 28.6% to 12.4% with the arrival of HIV/AIDS, there was a large increase in tuberculosis cases (37.1% to 86.1%), with a corresponding decrease in silicotuberculosis cases (34.3% to 1.6%). Although silicosis remains an occupational health issue in Zambian miners, the most significant problem appears to be the marked increase in cases of TB.
TL;DR: Results indicate that ICAN is an efficient, sensitive and simple system to detect invA of Salmonella species in developing countries such as Zambia.
Abstract: The isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) is a new isothermal DNA amplification method composed of exo Bca DNA polymerase, RNaseH and DNA-RNA chimeric primers. We detected invA of Salmonella from chicken carcasses, egg yolk and cattle fecal samples. Fifty-three of 59 isolates were invA-positive in ICAN-chromatostrip detection. The result was consistent with those obtained by standard PCR. Salmonella invA was detected in 12 of 14 carcass rinses by ICAN, while in 7 of 14 rinses by standard PCR. These results indicate that ICAN is an efficient, sensitive and simple system to detect invA of Salmonella species in developing countries such as Zambia.
TL;DR: A measure of the economic benefits of an improved malaria treatment programme in Zambia is elicited and the theoretically anticipated association between WTP and several socio-economic factors is reported.
Abstract: Background
Zambia is facing a double crisis of increasing malaria burden and dwindling capacity to deal with the endemic malaria burden. The pursuit of sustainable but equity mechanisms for financing malaria programmes is a subject of crucial policy discussion. This requires that comprehensive accounting of the economic impact of the various malaria programmes. Information on the economic value of programmes is essential in soliciting appropriate funding allocations for malaria control.