Showing papers by "University of Zambia published in 2007"

Gender Distribution of Adult Patients on Highly Active Antiretroviral Therapy (HAART) in Southern Africa: A Systematic Review

Abstract: HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men. A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports. The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males. In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.

Mental health and disclosure of HIV status in Zambian adolescents with HIV infection: Implications for peer-support programs.

Abstract: The objectives were to examine emotional and behavioural difficulties in HIV positive Zambian adolescents and to determine the relationship between disclosure of HIV status and mental health. The design used in the study was a cross-sectional survey. Participants were 127 HIV positive adolescents aged 11 to 15 years recruited through clinics in the Lusaka region. Mental health was assessed using the youth report version of the Strengths and Difficulties Questionnaire (SDQ). Caregivers completed the parent SDQ. Sixty-two participants were invited for a semi-structured interview which probed views on attending a peer support group. Compared to a British community sample participants had increased mental health problems (OR 2.1) particularly emotional symptoms (OR = 3.6) and peer problems (OR = 7.1). The majority of children (n = 94) were receiving antiretroviral (ARV) treatment but only 48 children (37.8%) had their HIV status disclosed. Those who had not had their HIV status disclosed were younger (P < 0.001) and less likely to be receiving ARV treatment (P < 0.001). Controlling for these factors they were also more likely to score in the abnormal range of the emotional difficulties subscale (OR = 2.63 95% CI: 1.11 to 6.26). Of 38 interviews transcribed content analysis showed that only 3 children were opposed to participation in a peer-group program with the majority (23/38) expressing reasoned and positive responses regardless of disclosure status. High rates of emotional and peer problems were found in this sample but disclosure of HIV status did not have a negative effect on mental health. Interventions to promote disclosure could facilitate access to emotional and peer support. (authors)

Mental Health Policy Development and Implementation in Four African Countries

Abstract: The purpose of the research programme introduced in this article is to provide new knowledge regarding comprehensive multisectoral approaches to breaking the negative cycle of poverty and mental ill-health. The programme undertakes an analysis of existing mental health policies in four African countries (Ghana, South Africa, Uganda, Zambia), and will carry out and evaluate interventions to assist in the development and implementation of mental health policies in those countries, over a five-year period. The four countries in which the programme is being conducted represent a variety of scenarios in mental health policy development and implementation.

High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission.

Abstract: National Institute of Child Health and Human Development; National Institutes of Health (R01 HD 39611, R01 HD 40777); Centers for Disease Control and Prevention; Global AIDS Program; Glaser Pediatric AIDS Foundation; USAID Country Research (GHS-A-00-00020-00)

The social and economic impact of epilepsy in Zambia: a cross-sectional study

Abstract: Summary Background Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa. Methods We did a cross-sectional study of people with epilepsy concurrently matched for age, sex, and site of care to individuals with a non-stigmatised chronic medical condition. Verbally administered questionnaires provided comparison data for demographic characteristics, education, employment status, housing and environment quality, food security, healthcare use, personal safety, and perceived stigma. Findings People with epilepsy had higher mean perceived stigma scores (1·8 vs 0·4; p vs 9·4 years; p vs 9·1 years; p vs 9·6 years; p=0·42). Housing and environmental quality were poorer for people with epilepsy, who had little access to water, were unlikely to have electricity in their home (19% vs 51%; p vs 15%; p=0·0007). Personal safety for people with epilepsy was also more problematic; rape rates were 20% among women with epilepsy vs 3% in the control group (p=0·004). Interpretation People with epilepsy in Zambia have substantially poorer social and economic status than do their peers with non-stigmatised chronic medical conditions. Suboptimum housing quality differentially exposes these individuals to the risk of burns and drowning during a seizure. Vulnerability to physical violence is extreme, especially for women with epilepsy.

Prevalence and distribution of HPV genotypes among HIV-infected women in Zambia

Abstract: We screened 145 HIV-infected non-pregnant women at a tertiary care centre in Lusaka, Zambia. Liquid-based cytology and human papillomavirus (HPV) genotyping with PGMY09/11 biotinylated primers (Roche Linear Array® HPV genotyping test) maximised sensitivity of cytology and HPV assessments. Among high-risk (HR) types, HPV 52 (37.2%), 58 (24.1%) and 53 (20.7%) were more common overall than HPV 16 (17.2%) and 18 (13.1%) in women with high-grade squamous intraepithelial lesions or squamous cell carcinoma (SCC) on cytology. High-risk HPV types were more likely to be present in women with CD4+ cell counts <200 μ l−1 (odds ratios (OR): 4.9, 95% confidence intervals (CI): 1.4–16.7, P=0.01) and in women with high-grade or severe cervical cytological abnormalities (OR: 8.0, 95% CI: 1.7–37.4, P=0.008). Human papillomavirus diversity in high-grade lesions and SCC on cytology suggests that HPV 16- and 18-based vaccines may not be adequately polyvalent to induce protective immunity in this population.

Promotion of couples' voluntary counselling and testing for HIV through influential networks in two African capital cities

Abstract: Most new HIV infections in Africa are acquired from cohabiting heterosexual partners. Couples' Voluntary Counselling and Testing (CVCT) is an effective prevention strategy for this group. We present our experience with a community-based program for the promotion of CVCT in Kigali, Rwanda and Lusaka, Zambia. Influence Network Agents (INAs) from the health, religious, non-governmental, and private sectors were trained to invite couples for CVCT. Predictors of successful promotion were identified using a multi-level hierarchical analysis. In 4 months, 9,900 invitations were distributed by 61 INAs, with 1,411 (14.3%) couples requesting CVCT. INAs in Rwanda distributed fewer invitations (2,680 vs. 7,220) and had higher response rates (26.9% vs. 9.6%), than INAs in Zambia. Context of the invitation event, including a discreet location such as the INA's home (OR 3.3–3.4), delivery of the invitation to both partners in the couple (OR 1.6–1.7) or to someone known to the INA (OR 1.7–1.8), and use of public endorsement (OR 1.7–1.8) were stronger predictors of success than INA or couple-level characteristics. Predictors of successful CVCT promotion included strategies that can be easily implemented in Africa. As new resources become available for Africans with HIV, CVCT should be broadly implemented as a point of entry for prevention, care and support.

Suicidal ideation and associated factors among school-going adolescents in rural Uganda

Abstract: Mental health is a neglected area of health research and practice in most of sub-Saharan African countries where the largest burden of morbidity is from infectious diseases. This even occurs despite the fact that some mental health problems may arise from infectious diseases. We conducted secondary analysis of the Uganda Global School-Based Health Survey-2003 to obtain the prevalence of, and assess factors that may be associated with suicidal ideation among school-going adolescents in rural Uganda. Assessment of association was conducted through both bi-variate and multivariate logistic regression analysis. Altogether 21.6% of the study participants, 21.3% males and 23.5% females had seriously considered committing suicide within the past 12 months. Loneliness, worry were positively associated with suicide ideation after adjusting for age, gender, smoking, drinking, and experience of having been bullied (OR = 1.59; 95% CI [1.12, 2.26] and OR = 1.19; 95% CI [1.12, 2.25]) respectively. Males were less likely to seriously consider committing suicide than females (OR = 0.70; 95% CI [0.50, 0.98]). Adolescent suicidal ideation is a major public health issue in rural Uganda. Measures aimed to prevent adolescent suicides in Uganda should incorporate our understanding of factors that are associated with suicide in rural Uganda such the gender disparity and the association observed with substance use.

An empirical economic assessment of impacts of climate change on agriculture in Zambia

Abstract: This report assesses the economic impacts of climate change on agriculture in Zambia, using the Ricardian method. A multiple linear regression model with net revenue per hectare as response variable has been fitted with climate, hydrological, soil, and socioeconomic variables as explanatory variables. There is one main cropping season in Zambia, lasting from November to April. Crop production in this period depends solely on rains. Considering crop progression in three stages-germination, growing, and maturing, which require different amounts of water and temperature-the climate variables included in the model are long-term averages of the temperature and wetness index for the periods November to December, January to February, and March to April. Assuming a nonlinear relationship of farm revenue with the climate variables, quadratic terms for climate variables were also included in the model. The results indicate that most socioeconomic variables are not significant, whereas some climate variables and the corresponding quadratic variables are significant in the model. Further findings are that an increase in the November-December mean temperature and a decrease in the January-February mean rainfall have negative impacts on net farm revenue, whereas an increase in the January-February mean temperature and mean annual runoff has a positive impact.

Prevalence and associated factors of physical fighting among school-going adolescents in Namibia

Abstract: Interpersonal physical violence is an important global public health concern that has received limited attention in the developing world. There is in particular a paucity of data regarding physical violence and its socio-demographic correlates among in-school adolescents in Namibia. We analysed cross-sectional data from the Namibia Global School-Based Health Survey (GSHS) conducted in 2004. We aimed to estimate the prevalence and socio-demographic correlates of physical fighting within the last 12 months. We obtained frequencies of socio-demographic attributes. We also assessed the association between self-reported history of having engaging in a physical fight and a selected list of independent variables using logistic regression analysis. Of the 6283 respondents, 50.6% (55.2% males and 46.2% females) reported having been in a physical fight in the past 12 months. Males were more likely to have been in a physical fight than females (OR = 1.71, 95% CI (1.44, 2.05)). Smoking, drinking alcohol, using drugs and bullying victimization were positively associated with fighting (OR = 1.91, 95% CI (1.49, 2.45); OR = 1.48, 95% CI (1.21, 1.81); OR = 1.55, 95% CI (1.22, 1.81); and OR = 3.12, 95% CI (2.62, 3.72), respectively). Parental supervision was negatively associated with physical fighting (OR = 0.82, 95% CI (0.69, 0.98)). Both male and female substance users (cigarette smoking, alcohol and drug use) were more likely to engage in physical fighting than non-substance users (OR = 3.53, 95% CI (2.60, 4.81) for males and OR = 11.01, 95% CI (7.25, 16.73) for females). Parental supervision was negatively associated with physical fighting (OR = 0.85, 95% CI (0.72, 0.99)). Prevalence of physical fighting within the last 12 months was comparable to estimates obtained in European countries. We also found clustering of problem behaviours or experiences among adolescents who reported having engaged in physical violence in the past 12 months. There is a need to bring adolescent violent behaviour to the fore of the public health agenda in Namibia.

Prevalence and distribution of gastrointestinal helminths and their effects on weight gain in free-range chickens in Central Zambia

Abstract: Examination of helminths from gastrointestinal tracts of 125 free-range chickens in Zambia revealed a 95.2% prevalence rate. The species and their prevalences were: Allodapa suctoria (85.6%), Tetrameres americana (80.8%), Ascaridia galli (28.8%), Gonglonema ingluvicola (50.4%), Raillietina spp. (81.6%) and Heterakis gallinarum (32.8%). No trematodes or Syngamus trachea were found. Mixed infections accounted for 88.2% as compared to 7.2% of single infections. Effects of helminthoses on weight gain were investigated in 100 growing chickens randomly assigned to treatment (levamisole) and untreated control groups. There was a significant mean (±SEM) weight gain (grams) of 812.8 ± 51.4 in the treatment group and 623 ± 57.4 in the control group (p < 0.01). The mean (±SEM) worm burdens from the control group and the treatment group were 96.3 ± 5.61 and 22.05 ± 2.61, respectively. These results confirm the higher risk of helminth infections in free-range systems and may explain the deleterious effects in chickens.

The distribution of sexually-transmitted Human Papillomaviruses in HIV positive and negative patients in Zambia, Africa

Abstract: Human Papillomaviruses (HPV) are double-stranded DNA viruses, considered to be the primary etiological agents in cervical intraepithelial neoplasias and cancers. Approximately 15–20 of the 40 mucosal HPVs confer a high-risk of progression of lesions to invasive cancer. In this study, we investigated the prevalence of sexually transmitted HPVs in Human Immunodeficiency Virus (HIV) positive and negative patients in Zambia, Africa. The rate of high-risk HPV genotypes worldwide varies within each country. Thus, we sought to investigate the rates of HPV infection in sub-Saharan Africa and the potential role of HIV in affecting the HPV genotype distribution. This retrospective cross-sectional study reports findings on the association and effects of HIV on HPV infections in an existing cohort of patients at University Teaching Hospital (UTH) Lusaka, Zambia. The objective of this study was to assess HPV prevalence, genotype distribution and to identify co-factors that influence HPV infection. Polymerase chain reaction (PCR) with two standard consensus primer sets (CpI/II and GP5+/6+) was used to test for the presence of HPV DNA. Primers specific for β-actin were used to monitor DNA quality. Vaginal lavage samples, collected between 1998-1999 from a total of 70 women, were part of a larger cohort that was also analyzed for HIV and human herpesvirus infection. Seventy of the samples yielded usable DNA. HIV status was determined by two rapid assays, Capillus and Determine. The incidence of HIV and HPV infections and HPV genotype distributions were calculated and statistical significance was determined by Chi-Squared test. We determined that most common HPV genotypes detected among these Zambian patients were types 16 and 18 (21.6% each), which is approximately three-fold greater than the rates for HPV16, and ten-fold greater than the rates for HPV18 in the United States. The worldwide prevalence of HPV16 is approximately 14% and HPV18 is 5%. The overall ratio of high-risk (HR) to low-risk (LR) HPVs in the patient cohort was 69% and 31% respectively; essentially identical to that for the HR and LR distributions worldwide. However, we discovered that HIV positive patients were two-times as likely to have an HR HPV as HIV negative individuals, while the distribution of LR HPVs was unaffected by HIV status. Interestingly, we observed a nine-fold increase in HPV18 infection frequency in HIV positive versus HIV negative individuals. The rate of oncogenic HPVs (type 16 and 18) in Zambia was much higher than in the U.S., potentially providing an explanation for the high-rates of cervical cancer in Zambia. Surprisingly, we discovered a strong association between positive HIV status and the prevalence of HR HPVs, and specifically HPV18.

Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine.

Abstract: The objective was to determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response death or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI). Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines. Peripartum NVP exposure status was known for 6740 women initiating NNRTI-containing ART of whom 751 (11%) reported prior use of NVP for PMTCT. There was no significant difference in mean CD4 cell change between those exposed or unexposed to NVP at 6 (+202 versus +182 cells/ml; P=0.20) or 12 (+201 versus +211 cells/ml; P=0.60) months. Multivariable analyses showed no significant differences in mortality [adjusted hazard ratio (HR) 1.2; 95% confidence interval (CI) 0.8-1.8] or clinical treatment failure (adjusted HR 1.1; 95% CI 0.8-1.5). Comparison of recent NVP exposure with remote exposure suggested a less favorable CD4 cell response at 6 (+150 versus +219 cells/ml; P=0.06) and 12 (+149 versus +215 cells/ml; P=0.39) months. Women with recent NVP exposure also had a trend towards elevated risk for clinical treatment failure (adjusted HR 1.6; 95% CI 0.9-2.7). Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes. However evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes highlighting the importance of ART screening and initiation early in pregnancy. (authors)

Associations between sexual behaviour change in young people and decline in HIV prevalence in Zambia

Abstract: Evidence suggests that HIV prevalence amongst young Zambians has declined recently, especially in higher-education groups. We studied trends in key sexual behaviour indicators among 15–24 year-olds from 1995 to 2003, including the associations between sexual behaviour change and education. The data stem from a series of three population-based surveys conducted in 1995 (n = 1720), 1999 (n = 1946) and 2003 (n = 2637). Logistic regression and Extended Mantel Haenszel Chi Square for linear trends were used to compare the three surveys. Men and lower-education groups reported more than one sexual partner in the year immediately prior to the survey more frequently than did women and higher-education groups (p < 0.01), but these proportions declined regardless of sex and residence. Substantial delays in child-bearing were observed, particularly among higher-education and urban respondents. Condom use at least for casual sexual intercourse increased from 1995 to 2003; the level was highest among urban and higher-education groups. The number of women reporting frequent dry sex using traditional agents fell during the period. Participants from the rural area and those with less education reported more sexual experience than urban and higher-education participants in 2003. The reported number of sexual partners during the year immediately prior to the survey was a factor that reduced the association between HIV and survey times among sexually active young urban men and women. High risk behaviours clearly decreased, especially in higher-educated and urban groups, and there is a probable association here with the decline in HIV prevalence in the study population. Fewer sexual partners and condom use were among the core factors involved for both sexes; and for women a further factor was delayed child-bearing.

Effect of cotrimoxazole on causes of death hospital admissions and antibiotic use in HIV-infected children.

Abstract: Cotrimoxazole prophylaxis reduces morbidity and mortality in HIV-1-infected children but mechanisms for these benefits are unclear. CHAP was a randomized trial comparing cotrimoxazole prophylaxis with placebo in HIV-infected children in Zambia where background bacterial resistance to cotrimoxazole is high. We compared causes of mortality and hospital admissions and antibiotic use between randomized groups. Of 534 children (median age 4.4 years; 32% 1-2 years) 186 died and 166 had one or more hospital admissions not ending in death. Cotrimoxazole prophylaxis was associated with lower mortality both outside hospital (P = 0.01) and following hospital admission (P = 0.005). The largest excess of hospital deaths in the placebo group was from respiratory infections [22/56 (39%) placebo versus 10/35 (29%) cotrimoxazole]. By 2 years the cumulative probability of dying in hospital from a serious bacterial infection (predominantly pneumonia) was 7% on cotrimoxazole and 12% on placebo (P = 0.08). There was a trend towards lower admission rates for serious bacterial infections in the cotrimoxazole group (19.1 per 100 child-years at risk versus 28.5 in the placebo group P = 0.09). Despite less total follow-up due to higher mortality more antibiotics (particularly penicillin) were prescribed in the placebo group in year one [6083 compared to 4972 days in the cotrimoxazole group (P = 0.05)]. Cotrimoxazole prophylaxis appears to mainly reduce death and hospital admissions from respiratory infections supported further by lower rates of antibiotic prescribing. As such infections occur at high CD4 cell counts and are common in Africa the role of continuing cotrimoxazole prophylaxis after starting antiretroviral therapy requires investigation. (authors)

Use of Traditional Medicine among Pregnant Women in Lusaka, Zambia

Abstract: Objective: We studied the prevalence of and predictors for traditional medicine use among pregnant women seeking care in the Lusaka, Zambia public health system. Subjects: We surveyed 1128 pregnant women enrolled in a clinical trial of perinatal human immunodeficiency virus (HIV) prevention strategies at two district delivery centers. Outcome measures: Postpartum questionnaires were administered to determine demographic characteristics, behavioral characteristics, HIV knowledge, and prior use of traditional medicines. Results: Of the 1128 women enrolled, 335 (30%) reported visiting a traditional healer in the past; 237 (21%) reported using a traditional healer during the current pregnancy. Overall, 54% believed that admitting to a visit to a traditional healer would result in worse medical care. When women who had used traditional medicines were compared to those who had not, no demographic differences were noted. However, women who reported use of traditional medicine were more likely to drink alcohol du...

Early growth of infants of HIV-infected and uninfected Zambian women.

Abstract: Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth an indicator of overall health of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health. HIV-infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV-uninfected mothers (n = 184) and those infants of HIV-infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2-4 years (n = 85). Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV-infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04) even after adjustment for their lower gestational age at birth compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length and maternal subclinical mastitis primiparity and weight during pregnancy. Early growth of infants of HIV-infected mothers is less than that of uninfected mothers in part associated with subclinical mastitis and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding. (authors)

Prevalence and associated factors of suicidal ideation among school-going adolescents in Guyana: results from a cross sectional study

Abstract: Adolescent suicidal behaviour is a neglected public health issue especially in middle- and low-income countries. Informed policy decision-making on suicidal behaviour will need reliable information on the prevalence and correlates of suicidal ideation which is a determinant of suicidal behaviour. We estimated the prevalence and associated factors of suicidal ideation among school-going adolescents using data from the Global School-Based Health Survey conducted in 2004 in Guyana. Of the 1197 respondents, 18.4% (14.9% males and 21.6% females)reported having seriously considered committing suicide in the last12 months. Males were less likely to seriously consider committingsuicide than females (OR = 0.45; 95% CI [0.30, 0.67]). Subjects whoreported having been bullied were more than twice as likely tocontemplate committing suicide as those who had not been bullied (OR = 2.46 [1.71, 3.54]). History of depression was positivelyassociated with suicidal ideation (OR = 2.67; 95% [1.87, 3.81] whilehaving close friends and understanding parents were negativelyassociated with suicide ideation (OR = 0.51; 95% CI [0.28, 0.94] and OR = 0.51; 95% CI [0.35, 0.76] respectively). Suicidal ideation is a significant public health issue among in-school adolescents in Guyana that requires attention. The design, implementation and evaluation of suicidal behaviour interventions should incorporate our knowledge of these associated factors.

Prevalence and correlates of truancy among adolescents in Swaziland: findings from the Global School-Based Health Survey

Abstract: Educational attainment is an important determinant of diverse health outcomes. Truancy among adolescents jeopardizes chances of achieving their educational goals. Truant behaviors are also associated with various psychosocial problems. There is however limited data on the prevalence and factors associated with truancy among adolescents in Africa. We used data from the Swaziland Global School-Based Health Survey (GSHS) conducted in 2003 to estimate the prevalence of self-reported truancy within the last 30 days among adolescents. We also assessed the association between self-reported truancy and a selected list of independent variables using logistic regression analysis. A total of 7341 students participated in the study. In analysis of available data, 2526 (36.2%) and 4470 (63.8%) were males and females respectively. The overall prevalence of truancy within the last 30 days preceding the study was 21.6%. Prevalence of truancy was 27.4% (605) and 17.9% (723) in males and females respectively. In multivariate logistic regression analysis, being a male, having been bullied, lower school grades, and alcohol use were positively associated with truancy. Adolescents who perceived themselves as having parental support were less likely to have reported being truant. Truancy among adolescents in Swaziland should be regarded as an important social problem as it is relatively prevalent. The design and implementation of intervention programs aimed to reduce truant behaviours should incorporate our knowledge of the factors identified as associated with bullying.

The Impact of Daily Cotrimoxazole Prophylaxis and Antiretroviral Therapy on Mortality and Hospital Admissions in HIV-Infected Zambian Children

Abstract: Data on the population effectiveness of cotrimoxazole prophylaxis and antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected African children are few. A total of 534 Zambian children with HIV infection were randomized to receive daily cotrimoxazole prophylaxis or placebo in the Children with HIV Antibiotic Prophylaxis trial. Following trial closure children who received the placebo initiated cotrimoxazole prophylaxis and all children were observed in a closed cohort. Mortality and hospital admission rates were compared over calendar time in 9-month periods: trial recruitment (March 2001 to April 2002 May 2002 to January 2003) trial follow-up to closure (February 2003 to October 2003) initial follow-up posttrial (November 2003 to July 2004) and early and later ART availability (August 2004 to April 2005 and May 2005 to May 2006 respectively). A total of 546 child-years of follow-up 40 deaths and 80 hospital admissions were observed between the time of trial closure and June 2006. A total of 117 of 283 children who were alive at trial closure received ART in the posttrial period (median child age at first use of ART 8.8 years). Rates decreased in both groups during the trial period suggesting a survivorship effect. Mortality and hospital admission rates before trial closure were 14 (95% confidence interval [CI] 9-21) deaths per 100 child-years and 24 (95% CI 15-39) hospital admissions per 100 child-years respectively for children who were receiving cotrimoxazole and were 23 (95% CI 16-34) deaths per 100 child-years and 35 (95% CI 23-53) hospital admissions per 100 child-years respectively for children who were receiving the placebo. After trial closure rates remained stable in the cotrimoxazole group but decreased to 15 (95% CI 8-26) deaths per 100 child-years and 19 (95% CI 10-41) hospital admissions per 100 child-years respectively for the group of children who received placebo and then initiated cotrimoxazole prophylaxis. In both groups combined mortality rates decreased to 6 (95% CI 3-11) deaths per 100 child-years and then 2 (95% CI 0.8-6) deaths per 100 child-years during periods of ART availability; hospital admission rates decreased to 17 (95% CI 11-27) hospital admissions per 100 child-years and 8 (95% CI 4-15) hospital admissions per 100 child-years respectively. The benefits of once-daily cotrimoxazole prophylaxis continued throughout the trial and after trial closure. Mortality and hospital admissions decreased (by ~6-fold and ~3-fold respectively) following ART availability similar to findings observed in resource-rich countries. (authors)

Flood risk in unplanned settlements in Lusaka

Abstract: Flooding in unplanned settlements in Lusaka is expected, even in years of normal rainfall. There is always much discussion of needed action when fl ooding occurs but, as soon as the seasonal rains stop, the incidents are forgotten. Most of the households affected by flare poor and the fl ooding damages or destroys their homes and belongings, which might have taken years to accrue. Poorer groups may be faulted for settling on sites at risk from fl ooding, but this is usually because they can fi nd no safer alternative. In addition, as this paper shows, reducing fl ood risks in one settlement can increase fl ood risks in others. Local authorities need to be vigilant in stopping settlement in unstable zones and they need to increase awareness of the need for action in settlements already built in fl ood-prone areas. Ways also need to be sought to provide low- income households with alternatives to informal settlements in flsites. It is hard to stop people from erecting houses where they see vacant land. Since rain in Zambia is seasonal, many marshy areas have been built on during dry periods only to be fl ooded when the rains come. In the end, it is the poor who lose and a solution needs to be found before more lives and property are lost.