Showing papers by "University of Zambia published in 2008"

'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia

Abstract: Appropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach. The study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas. Breastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices. The message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.

Vibrio cholerae O1 hybrid El Tor strains, Asia and Africa.

Abstract: To the Editor: Vibrio cholerae is a water-borne pathogen that causes a severe watery diarrhea disease known as cholera. On the basis of variable somatic O antigen composition, >200 serogroups of V. cholerae have been recognized. Classical and El Tor are 2 well-established biotypes within the V. cholerae O1 serogroup, and they can be distinguished by differences in their biochemical reactions or phenotypic traits (1). In addition to phenotypic traits, genetic markers have recently been used in the identification of the biotypes of V. cholerae. For example, the major toxin-coregulated pilus (TCP) gene, tcpA, of the TCP cluster possesses classical- and El Tor–specific alleles that encode identical functions but differ in their DNA sequence composition; however, the rtxC gene of the repeat in toxin (RTX) cluster is present in El Tor strains only and absent in classical strains (2,3). The cholera toxin, encoded by the ctxA and ctxB genes, is the principal toxin produced by V. cholerae O1 and O139 and is responsible for the disease cholera. Heterogeneity within the ctxB gene and protein was first reported in the early 1990s, and, on this basis, 3 ctxB genotypes of the V. cholerae O1 strains have been identified. Based on amino acid residue substitutions at positions 39, 46, and 68, all classical and US Gulf Coast El Tor strains have been categorized as genotype 1, the Australian El Tor strains as genotype 2, and the El Tor strains of the seventh pandemic and the Latin American epidemic as genotype 3. Genotyping of ctxB has indicated that the classical strains harbor a unique cholera toxin gene that is not in the El Tor strains except for the US Gulf Coast El Tor clone (4). The US Gulf Coast hybrid El Tor strains that harbor the classical cholera toxin have been associated with sporadic outbreaks in the United States (5) and, until recently, had not been reported anywhere else in the world. Then in 2004, hybrid El Tor strains that encode the classical cholera toxin were isolated from cholera patients in Matlab, Bangladesh (6), and in Beira, Mozambique (7). In 2006, Nair et al. reported that the current seventh pandemic prototype El Tor strains had been replaced by hybrid El Tor strains in Bangladesh (8). We now report how far the hybrid El Tor strains have spread in Asia and Africa. We examined 41 clinical V. cholerae strains from Asia and Africa that were isolated from 1991 through 2004 (Table) and confirmed as serogroup O1 by O-antigen biosynthesis gene (rfbO1)-specific PCR. Biotyping was performed by using standard procedures, and all strains were confirmed as El Tor (Table). All strains were PCR-positive for the El Tor–specific 451-bp tcpA and 263-bp rtxC amplicons but negative for the classical-specific 620-bp tcpA amplicon. All 41 strains were PCR-positive for ctxAB (1,037 bp) and produced cholera toxin, as demonstrated by the VET-RPLA Toxin Detection Kit (Oxoid, Basingstoke, UK). Sequence comparison of the PCR-amplified ctxB gene (460 bp) of each strain with the reference strains (569B and N16961) showed that 30 strains harbored classical cholera toxin (with histidine at position 39, phenylalanine at position 46, and threonine at position 68), whereas the remaining 11 strains carried the El Tor cholera toxin gene (with tyrosine at position 39, phenylalanine at position 46, and isoleucine at position 68) (Table). The overall analysis showed that all test strains are El Tor biotype but that most harbor the classical cholera toxin gene. Table Phenotypic and genotypic traits of Vibrio cholerae O1 clinical strains isolated from Asia and Africa, 1991–2004* The major finding of this study is that El Tor strains that harbor the classical cholera toxin gene are not limited to the US Gulf Coast, Bangladesh, and Mozambique; they have spread to several other countries in Asia and Africa. Since 1817, 7 cholera pandemics have occurred around the world. Firm evidence indicates that the fifth and sixth cholera pandemics were caused by the classical biotype whereas the most extensive and ongoing seventh pandemic is caused by the El Tor biotype. Since the onset of El Tor dominance in 1961, the classical strains have been gradually replaced by the El Tor strains and are now believed to be extinct. However, reports from Bangladesh (6), Mozambique (7), and this study have provided sufficient evidence to indicate that the classical cholera toxin gene has reappeared but that for these cases its carrier has been El Tor. Although how the classical cholera toxin in El Tor strains would affect V. cholerae pathogenicity is unclear, cholera caused by the classical biotype is more severe, whereas the El Tor biotype is considered to be better able to survive in the environment (1,9). Given that cholera toxin is directly responsible for the major clinical sign of the disease, such a genetic change could result in substantial alteration in the clinical manifestation of cholera. Additionally, this subtle genetic change may also influence the effectiveness of current cholera vaccines, which could stimulate both antitoxic and antibacterial immunity.

Intimate partner violence among pregnant women in Rwanda

Abstract: Background Intimate partner violence (IPV), defined as actual or threatened physical, sexual, psychological, and emotional abuse by current or former partners is a global public health concern. The prevalence and determinants of intimate partner violence (IPV) against pregnant women has not been described in Rwanda. A study was conducted to identify variables associated with IPV among Rwandan pregnant women.

Baseline renal insufficiency and risk of death among HIV-infected adults on antiretroviral therapy in Lusaka, Zambia

Abstract: Objective: To examine the association between baseline renal insufficiency and mortality among adults initiating antiretroviral therapy (ART) in an urban African setting. Design: Open cohort evaluation. Methods: We examined mortality according to baseline renal function among adults initiating ART in Lusaka Zambia. Renal function was assessed by the Cockcroft-Gault method the Modification of Diet in Renal Disease equation and serum creatinine. Results: From April 2004 to September 2007 25 779 individuals started ART with an available creatinine measurement at baseline. When creatinine clearance was calculated by the Cockcroft-Gault method 8456 (33.5%) had renal insufficiency: 73.5% were mild (60-89 ml/min) 23.4% moderate (30-59 ml/min) and 3.1% severe (<30 ml/ min). Risk for mortality at or before 90 days was elevated for those with mildly [adjusted hazard ratio (AHR) = .7; 95% confidence interval (95% CI) = 1.5-1.9] moderately (AHR = 2.3; 95% CI = .0-2.7) and severely (AHR = 4.3; 95% CI = 3.1-5.5) reduced creatinine clearance. Mild (AHR = 1.4; 95% CI = 1.2-1.6) moderate (AHR = 1.9; 95% CI = 1.5-2.3) and severe (AHR = 3.6; 95% CI = 2.4-5.5) insufficiency were also associated with increased mortality after 90 days when compared with those with normal renal function. Trends were similar when renal function was estimated with Modification of Diet in Renal Disease or serum creatinine. Conclusion: Renal insufficiency at time of ART initiation was prevalent and associated with increased mortality risk among adults in this population. These results have particular relevance for settings like Zambia where tenofovir -a drug with known nephrotoxicity - has been adopted as part of first-line therapy. This emphasizes the need for resource-appropriate screening algorithms for renal disease both as part of ART eligibility and pretreatment assessment. (authors)

Integrated vector management: The Zambian experience

Abstract: The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006–2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Crop Input Response Functions with Stochastic Plateaus

Abstract: Agronomic research on crop response to nitrogen fertilizer suggests that a plateau function may be appropriate, but the plateau varies across fields and years. Available models that treat the plateau as a stochastic variable are not readily extendable to handle field or year random effects as seems to be appropriate based on the agronomic data. This article develops a method of estimating a response function with a stochastic plateau that can capture random effects. The method is then used to determine economically optimal levels of nitrogen fertilizer for wheat (Triticum aestivum). Copyright 2008, Oxford University Press.

Variables associated with physical fighting among US high-school students

Abstract: Violence among adolescents is an important public health problem in the United States. This study was conducted to estimate the prevalence of having been engaged in physical fighting on school property and associated factors of the behavior among school-going adolescents in the United States. This study was based on secondary analysis of the United States Youth Risk Behavior Survey (YRBS) conducted in 2005. The sampling frame included all private and public school in the country, stratified by region and urbanicity based on the US census bureau data. Frequencies and proportions were obtained for the outcome and explanatory variables. Logistic regression analysis was used to estimate the level of association between explanatory variables and the outcome (having been involved in a physical fight). Of the 13,857 respondents, 13.5% (18.2% for males and 8.8% for females) reported physical fighting onschool property in the last 12 months to the survey. Males were more likely to have been in a physical fight than females (OR = 2.23; 95% CI [1.89, 2.63]). Respondents aged 17 years or older were less likely to report physical fighting than those who were 14 years or younger. Compared to Whites, American Indians or Alaska Natives, Blacks, Native Hawaii or other Pacific Islanders, and Hispanics were more likely to report physical fighting on school property (OR = 2.11; 95% CI [1.22, 3.66], OR = 1.72; 95% CI [1.42, 2.0], OR = 2.18; 95% CI [1.01, 4.79], and OR = 1.74; 95% CI [1.41, 2.16] respectively). Physical fighting on school property was also positively associated with cigarette smoking (OR = 1.70; 95% CI [1.37, 2.10]), drinking alcohol (OR = 1.45; 95% CI [1.20, 1.76]), use of illegal drugs (OR = 1.73; 95% CI [1.42, 2.12]), having had property stolen or deliberately damaged on school property (OR = 2.06; 95% CI [1.74, 2.44]), having been threatened or injured with a weapon on school property (OR = 2.63; 95% CI [2.06, 3.34]), and playing videogame three or more hours a day (OR = 1.29; 95% CI [1.07, 1.56]). These findings suggest that physical fighting among US High School students is widespread and positively associated with victimization (having been threatened or injured with a weapon on school property) and other risky behaviors such as smoking, alcohol and drugs use. Intervention programs to prevent/control those risky behaviors as well as further attention on the association between physical fighting and victimization at school through longitudinal research are warranted.

Prevalence and correlates of being bullied among in-school adolescents in Beijing: results from the 2003 Beijing Global School-Based Health Survey

Abstract: Bullying has public health importance. It has been reported that both the victims and perpetrators of bullying are more likely to have suicidal ideation and other suicidal behaviours. Moreover, bullying can be a precursor for school violence and can contribute to poor academic performance. The purpose of the study was to raise awareness on the subject in China. We, therefore conducted an analysis of secondary data to determine the prevalence and correlates of having been bullied among in-school adolescents. The data was taken from the Beijing Global School-Based Health Survey conducted in 2003. A weighted analysis to reduce bias due to differing patterns of non-response was conducted using statistical software (SPSS version 14.0). We conducted a backward logistic regression analysis to determine independent predictors for being bullied. Out of a total of 2,348 in-school adolescents who participated in the survey, 20% (23% males, and 17% females) reported having been bullied. Risk factors for having been bullied were loneliness (adjusted odds ratio (AOR) = 1.44; 95% confidence interval (CI) 1.42–1.45), being worried (AOR = 1.30; 95% CI 1.29–1.32), being sad or having feelings of hopelessness (AOR = 1.21; 95% CI 1.19–1.22), smoking cigarettes (AOR = 1.09; 95% CI 1.08–1.11), drinking alcohol (AOR = 1.31; 95% CI 1.29–1.32), and being truant (AOR = 1.24; 95% CI 1.22–1.27). Meanwhile protective factors were having close friends (AOR = 0.84; 95% CI 0.83–0.86), receiving parental supervision (AOR = 0.80; 95% CI 0.80–0.81), and ever been drunk (AOR = 0.86; 95% CI 0.84–0.87). We believe the results of this study will raise awareness among school health practitioners and administrators, paediatric psychiatrists and psychologists on the prevalence and correlates of bullying among adolescents in Beijing, China.

Harmful lifestyles' clustering among sexually active in-school adolescents in Zambia.

Abstract: HIV is a leading cause of morbidity and mortality in Zambia. Like many other African nations with high HIV burden, heterosexual intercourse is the commonest mode of HIV spread. The estimation of prevalence and factors associated with sexual intercourse among in-school adolescents has potential to inform public health interventions aimed at reducing the burden of sex-related diseases in Zambia. We carried out secondary analysis of the Zambia Global School-Based Health Survey (GSHS) 2004; a cross sectional survey that aims to study health-related behaviors among in-school adolescents. We estimated frequencies of relevant socio-demographic variables. The associations between selected explanatory variables and self-reported history of sexual intercourse within the last 12 months were assessed using logistic regression analysis. Data from 2136 in-school adolescents who participated in the Zambia Global School-Based Health Survey of 2004 were available for analysis. Out of these respondents, 13.4% reported that they had sexual intercourse in the past 12 months prior to the survey; 16.4% and 9.7% among males and females respectively. In multivariable logistic regression analysis, with age less than 15 years as the referent the adjusted odds ratio (AOR) of having engaged in sexual intercourse in adolescents of age 15 years, and those aged 16 years or more were 1.06 (95% CI 1.03–1.10) and 1.74 (95% 1.70–1.79) respectively. Compared to adolescents who had no close friends, adolescents who had one close friend were more likely to have had sexual intercourse, AOR = 1.28 (95% CI 1.24–1.32). Compared to adolescents who were not supervised by their parents, adolescents who were rarely or sometimes supervised by their parents were likely to have had sexual intercourse, and adolescents who were most of the time/always supervised by their parents were less likely to have had sexual intercourse; AORs 1.26 (95% CI 1.23–1.26) and 0.92 (95% CI 0.90–0.95) respectively. Compared to adolescents who did not smoke dagga, adolescents who smoked dagga 1 or 2 times, and those who smoked dagga 3 or more times in their lifetime were 70% and 25% more likely to have had sexual intercourse, respectively. Adolescents who drank alcohol in 1 or 2 days, and those who took alcohol in 3 or more days in a month preceding the survey were 12% and 9% more likely to have had sexual intercourse, respectively, compared to adolescents who did not drink alcohol in the 30 days prior to the survey. Furthermore, adolescents who had been drunk 1 or 2 times, and who had been drunk 3 or more times in a life time were 14% and 13% more likely to have had sexual intercourse compared to those who have never been drunk in their lifetime. We identified a constellation of potentially harmful behaviours among adolescents in Zambia. Public health interventions aimed at reducing prevalence of sexual intercourse may be designed and implemented in a broader sense having recognized that sexually active adolescents may also be exposed to other problem behaviours.

Factors associated with adolescent cigarette smoking in Greece: results from a cross sectional study (GYTS Study).

Abstract: Data about the predictors of smoking among adolescents in Greece are sparse. We tried to identify factors associated with current cigarette smoking among in-school adolescents in Greece in the context of GYTS study. A secondary analysis of data from a questionnaire study using the Global Youth Tobacco Survey methodology was conducted to identify factors associated with smoking among adolescents in Greece. Data were collected in 2004–2005. The outcome variable was cigarette smoking within the past 30 days preceding the survey while independent variables included age, gender, parental educational status, parental smoking, perception of harmfulness of smoking, and the amount of pocket money at the adolescent's disposal. 6141 adolescents (51.5% males and 48.5% females) participated in the study. In multivariate analysis, cigarette smoking was associated with male gender (OR: 1.62; 95% CI: 1, 08–3.08), parental smoking (OR: 2.59; 95% CI: 1.45–5.89), and having pocket money ≥ 16 Euros (OR: 2.64; 95% CI: 1.19–5.98). Male gender, parental smoking, and having pocket-money ≥ 16 Euros were independently associated with current smoking among Greek students. These findings could be taken into account in order to formulate a comprehensive anti-smoking strategy in Greece.

Farmers’ perceptions of tree mortality, pests and pest management practices in agroforestry in Malawi, Mozambique and Zambia

Abstract: Pest management research within the context of agroforestry is in its infancy, and it is often difficult to say when a particular pest justifies investment in research to establish facts. Understanding the potentials and drawbacks of farmers’ indigenous ecological knowledge (ethnoecology) may form the basis for constructive collaboration between farmers, agroforestry scientists and extension staff. Therefore, the objectives of the study were to (1) assess farmers’ knowledge and perceptions of pests, (2) prioritize pest problems that limit tree planting and maize production based on farmers’ own criteria and (3) to identify farmers’ indigenous pest management practices for priority pests. Data were collected using community meetings, individual interviews and direct observation by the first author. The farmers involved in this study in eastern Zambia had over ten years of experience, while most of the farmers in Mozambique and parts of southern Malawi were new to agroforestry. Farmers perceived insects as the major causes of tree mortality, followed by drought, bush fires and browsing by livestock. Among the biological constraints to maize production, insects (particularly termites and stalk bores) and weeds (particularly Striga asiatica) were more important in farmers’ minds than crop diseases. Fundamentally, the farmers’ perception of the causes of tree mortality and crop pests agreed with researchers’ perceptions and the literature. Both termite and witch weed problems were associated with low soil quality, and farmers use various indigenous control practices to control these pests. Some farmers did not know the causes of tree mortality, and hence do not take action. Farmer’s perception of tree mortality was found to be a function of operator-specific variables such as sex, level of education and years of experience with tree species.

Prevalence of Taenia solium porcine cysticercosis in the Eastern, Southern and Western provinces of Zambia

Abstract: Tongue examination and detection of circulating antigen (Ag-ELISA) were used to establish the prevalence of Taenia solium porcine cysticercosis in free-range pigs in selected districts of Eastern, Southern and Western provinces of Zambia, and to determine if prevalence of porcine cysticercosis was associated with age, breed and sex. Households with pigs were identified using the snowballing technique. A total of 1691 pigs were examined out of which 183 (10.8%) were positive on tongue examination. Ag-ELISA gave a sero-prevalence of 23.3%. When considering the factors in a logistic regression analysis, only breed type was significantly associated with porcine cysticercosis (OR = 0.72; 95%CI = 0.63–0.81). The crossbred pigs were 72% more likely to have had cysticercosis than the Nsenga (dwarf local) breed as determined by Ag-ELISA. The result that crossbred pigs had a higher prevalence of T. solium cysticercosis suggests that pig breeds may display different susceptibility to cysticercosis. The limited use of latrines in these areas implies that people use the nearby bush for defecation, resulting in pigs having access to human faeces. Therefore, investigation of taeniosis and cysticercosis in humans is warranted to better comprehend the local epidemiology and transmission risks. This should then be followed by extension programs to communities so that the control plans that could be instituted are more sustainable.

ZAMSTAR, The Zambia South Africa TB and HIV Reduction study: Design of a 2 × 2 factorial community randomized trial

Abstract: Background: TB and HIV form a deadly synergy in much of the developing world, especially Africa. Interventions to reduce the impact of these diseases at community level are urgently needed. This paper presents the design of a community randomised trial to evaluate the impact of two complex interventions on the prevalence of tuberculosis (TB) in high HIV prevalence settings in Zambia and South Africa. Methods: The interaction between TB and HIV is reviewed and possible interventions that could reduce the prevalence of TB in HIV-endemic populations are discussed. Two of these interventions are described in detail and the design of a 2 × 2 factorial community randomised trial to test these interventions is presented. The limitations and challenges of the design are identified and discussed. Conclusion: There is an urgent need to reduce the prevalence of TB in communities highly affected by HIV. Potential interventions are complex and require innovative trial designs to provide the rigorous evidence needed to inform health policy makers and to ensure that resources are used optimally.

Correlates of weapon carrying among high school students in the United States

Abstract: Deaths and injuries arising from interpersonal violence among adolescents are major public health concerns in the United States. The bearing of weapons among adolescents is a critical factor in many of these deaths and injuries. A secondary analysis of the 2005 United States Youth Risk Behavior Surveillance System Survey data was carried out to examine the variables associated with self-reported history of weapon carrying on school property among high school students. We used logistic regression analysis to assess the associations. Of the 13,707 respondents who participated in the survey, 10.2% of males and 2.6% of females reported carrying a weapon on school property. In multivariate logistic regression analysis, males were more likely to report having carried a weapon than females (odds ratio (OR) = 5.58; 95% confidence interval (CI) [4.23, 7.62]). Self-reported race/ethnicity was also associated with weapon carrying. Other variables positively associated with weapon carrying at school were substance use (OR = 1.77; 95% CI [1.16, 2.68]), depression (OR = 1.44; 95% CI [1.10, 1.89]), suicidal ideation (OR = 1.64; 95% CI [1.23, 2.19]), having had property stolen or deliberately damaged at school (OR = 1.55; 95% CI [1.21, 1.98]), having been raped (OR = 1.70; 95% CI [1.22, 2.37]), having been threatened or injured with a weapon on school property (OR = 2.19; 95% CI [1.63, 2.95]), and having engaged in physical fighting (OR = 2.02; 95% CI [1.56, 2.63]). This research identifies factors that are associated with weapon bearing among adolescents in the United States. These factors may be important in the design of interventions aimed at improving school safety and adolescent health.

Effects of anti-tick cocktail vaccine against Rhipicephalus appendiculatus.

Abstract: Rhipicephalus appendiculatus serpin-3 (RAS-3), R. appendiculatus serpin-4 (RAS-4) and a 36-kDa immuno-dominant protein of R. appendiculatus (RIM36) were reported as candidate antigens for the anti-tick vaccine to control ixodid ticks. In the present study, we generated recombinant proteins of RAS-3 (rRAS-3), RAS-4 (rRAS-4) and RIM36 (rRIM36), and assessed their potency as an anti-tick cocktail vaccine in cattle model. RT-PCR analysis showed that RAS-3, RAS-4 and RIM36 transcripts were detected in both adult male and female ticks during feeding. Immunization of cattle with the combination of rRAS-3, rRAS-4 and rRIM36 had raised antibodies against all recombinants and anti-sera had reacted with the molecules from the tick salivary gland extract. Tick infestation challenge demonstrated protective immunity against female ticks, resulting in mortality rates of 39.5 and 12.8 % for the vaccinated and control groups, respectively. Moreover, the mortality rate of Theileria parva -infected female ticks was 48.5 and 10.8 % in the vaccinated and control group, respectively. In order to evaluate the levels of pathogen transmission capacity by T. parva-infected ticks fed on immunized cattle, the occurrence of T. parva in the bovine parotid lymph node and peripheral blood was also determined and quantified by real-time PCR. Although the infection with T. parva could not be protected by the vaccine, the occurrence of pathogen in peripheral blood was delayed 1 to 2 days after the infestation challenge in vaccinated group. These results suggest that this cocktail vaccine plays a role in the prevention of tick infestation.

From chloroquine to artemether-lumefantrine: the process of drug policy change in Zambia.

Abstract: Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT). All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. These data were supplemented by the authors' observations of the policy change process. The information has been structured to capture the timing of events, the challenges encountered, and the resolutions reached in order to achieve implementation of the new treatment policy. A decision was made to change national drug policy to artemether-lumefantrine (AL) in the first quarter of 2002, with a formal announcement made in October 2002. During this period, efforts were undertaken to identify funding for the procurement of AL and to develop new malaria treatment guidelines, training materials, and plans for implementation of the policy. In order to avoid a delay in implementation, the policy change decision required a formal adoption within existing legislation. Starting with donated drug, a phased deployment of AL began in January 2003 with initial use in seven districts followed by scaling up to 28 districts in the second half of 2003 and then to all 72 districts countrywide in early 2004. Drug policy changes are not without difficulties and demand a sustained international financing strategy for them to succeed. The Zambian experience demonstrates the need for a harmonized national consensus among many stakeholders and a political commitment to ensure that new policies are translated into practice quickly. To guarantee effective policies requires more effort and recognition that this becomes a health system and not a drug issue. This case study attempts to document the successful experience of change to ACT in Zambia and provides a realistic overview of some of the painful experiences and important lessons learnt.

Correlates of current cigarette smoking among school-going adolescents in Punjab, India: results from the Global Youth Tobacco Survey 2003

Abstract: Smoking is a leading cause of morbidity and mortality globally. There is therefore need to identify relevant factors associated with smoking among adolescents in order to better tailor public health interventions aimed at preventing smoking. We used data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Punjab, India, on 2014 adolescents of whom 58.9% were males. We conducted a weighted logistic regression analysis, adjusting for age and sex, to determine associations between predictor variables and current tobacco smoking status. A total of 2014 adolescents participated in the survey in 2003, and of these 58.9% were males. Male respondents tended to be older than females (21.2% of males, and 13.1% of females were of age 16 years or above). The percent of males and females in the other age groups were: 23.0% and 28.6% for <14 years, 27.3% and 31.0% for 14 years, and 28.4% and 27.0% for 15 years, respectively. The following factors were positively associated with smoking: adolescents who received pocket money; adolescents who had parents who smoked, chewed or applied tobacco; adolescents who said that boys or girls who smoke or chew tobacco have more friends; adolescents who said that smoking or chewing tobacco makes boys look less attractive; adolescents who said that there is no difference in weight between smokers and non-smokers; adolescents who said that smoking makes one gain weight; and adolescents who had most or all of their closest friends who smoked. The factors that were negatively associated with smoking were: adolescents who said that boys or girls who smoke or chew tobacco have less number of friends; adolescents who said that girls who smoke or chew tobacco are less attractive; and adolescents who had some of their closest friends who smoked. The observed associations between current smoking on one hand and peer smoking, and perception that boys who smoke are less attractive on the other, deserve further studies. The factors reported in the current study should be considered in the design of public health interventions aimed to reduce adolescent cigarette smoking.

Declining HIV prevalence among young pregnant women in Lusaka, Zambia

Abstract: Objective HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV seroincidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. Methods We analysed HIV seroprevalence trends from two Lusaka sources: (i) antenatal data from a city-wide programme to prevent mother-to-child HIV transmission, and (ii) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005–2006, where specimens from > 97% of public-sector births in each period were obtained and analysed. Findings Between July 2002 and December 2006, the Lusaka district tested 243 302 antenatal women for HIV; 54 853 (22.5%) were HIV infected. Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006 (P < 0.001). The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006. Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005–2006 (P = 0.001). Among women ≤ 17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015). Conclusion HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka. The decline is most dramatic among women ≤ 17 years of age, suggesting a reduction in sero-incidence in this important age group. Bulletin of the World Health Organization 2008;86:697–702.

The Relationship Between Alcohol Consumption and Unprotected Sex Among Known HIV-discordant Couples in Rwanda and Zambia

Abstract: Although alcohol abuse is highly prevalent in many countries in sub-Saharan Africa, little is known about the relationship between alcohol consumption and risky sexual behavior in these settings. An understanding of this relationship is particularly important given the high prevalence of HIV that exists in many of these countries. This study analyzes data collected from members of cohabiting HIV-discordant couples regarding alcohol consumption and self-reported condom use. After controlling for demographic and socioeconomic co-factors, alcohol use by male partners of HIV-discordant couples was associated with self-reported unprotected sex at follow-up. Counseling about alcohol use should be part of HIV testing and counseling programs, particularly among those found to be HIV-positive.

Seasonal variation and regional distribution of cleft lip and palate in Zambia.

Abstract: Objective: To assess variations in seasonality and regional distribution of orofacial clefts in babies born in Zambia. Design: A retrospective chart review was done using records of all cleft procedures performed by the only plastic surgeon in Zambia (G.J.). Delivery data from the University Teaching Hospital (UTH) were also examined to estimate the birth prevalence of orofacial clefts (55,108 live births between 2001 and 2005). Patients: All cleft patients operated in Zambia from 2000 to 2006 (413 patients). Results: A low birth prevalence of clefts (1/4239 live births) was found using UTH delivery data. Surgical data showed no difference for the frequency of one gender over another overall (M:F ratio is 1.04; p = .70). More bilateral clefts occurred in cleft lip and palate (CLP) patients than in cleft lip (CL) patients (p < .01), and more unilateral left-sided clefts occurred in CL than in CLP patients (p = .03). The data reflected seasonal variation in month of birth of cleft lip with or w...

Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics

Abstract: The authors respond to a recent article “Male circumcision is not the ‘vaccine’ we have been waiting for!” Green et al. claim that the incorporation of male circumcision (MC) as an additional HIV prevention strategy is based on ‘incomplete evidence and is premature and ill-advised’.