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Showing papers by "University of Zambia published in 2017"


Journal ArticleDOI
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.

10,401 citations


Journal ArticleDOI
Ting Shi1, David A. McAllister2, Katherine L. O'Brien3, Eric A. F. Simões4, Shabir A. Madhi5, Bradford D. Gessner, Fernando P. Polack, Evelyn Balsells1, Sozinho Acácio6, Claudia Aguayo, Issifou Alassani, Asad Ali7, Martin Antonio8, Shally Awasthi9, Juliet O. Awori10, Eduardo Azziz-Baumgartner11, Eduardo Azziz-Baumgartner12, Henry C. Baggett12, Vicky L. Baillie5, Angel Balmaseda, Alfredo Barahona, Sudha Basnet13, Sudha Basnet14, Quique Bassat6, Quique Bassat15, Wilma Basualdo, Godfrey Bigogo10, Louis Bont16, Robert F. Breiman17, W. Abdullah Brooks11, W. Abdullah Brooks3, Shobha Broor18, Nigel Bruce19, Dana Bruden12, Philippe Buchy20, Stuart Campbell1, Phyllis Carosone-Link20, Mandeep S. Chadha21, James Chipeta22, Monidarin Chou23, Wilfrido Clara12, Cheryl Cohen24, Cheryl Cohen5, Elizabeth de Cuellar, Duc Anh Dang, Budragchaagiin Dash-Yandag, Maria Deloria-Knoll3, Mukesh Dherani19, Tekchheng Eap, Bernard E. Ebruke8, Marcela Echavarria, Carla Cecília de Freitas Lázaro Emediato, Rodrigo Fasce, Daniel R. Feikin12, Luzhao Feng25, Angela Gentile26, Aubree Gordon27, Doli Goswami11, Doli Goswami3, Sophie Goyet20, Michelle J. Groome5, Natasha B. Halasa28, Siddhivinayak Hirve, Nusrat Homaira11, Nusrat Homaira29, Stephen R. C. Howie30, Stephen R. C. Howie8, Stephen R. C. Howie31, Jorge Jara32, Imane Jroundi15, Cissy B. Kartasasmita, Najwa Khuri-Bulos33, Karen L. Kotloff34, Anand Krishnan18, Romina Libster28, Romina Libster35, Olga Lopez, Marilla G. Lucero36, Florencia Lución26, Socorro Lupisan36, Debora N. Marcone, John P. McCracken32, Mario Mejia, Jennifer C. Moïsi, Joel M. Montgomery12, David P. Moore5, Cinta Moraleda15, Jocelyn Moyes5, Jocelyn Moyes24, Patrick K. Munywoki37, Patrick K. Munywoki10, Kuswandewi Mutyara, Mark P. Nicol38, D. James Nokes39, D. James Nokes10, Pagbajabyn Nymadawa40, Maria Tereza da Costa Oliveira, Histoshi Oshitani41, Nitin Pandey9, Gláucia Paranhos-Baccalà42, Lia Neu Phillips17, Valentina Picot42, Mustafizur Rahman11, Mala Rakoto-Andrianarivelo, Zeba A Rasmussen43, Barbara Rath44, Annick Robinson, Candice Romero, Graciela Russomando45, Vahid Salimi46, Pongpun Sawatwong12, Nienke M Scheltema16, Brunhilde Schweiger47, J. Anthony G. Scott10, J. Anthony G. Scott48, Phil Seidenberg49, Kunling Shen50, Rosalyn J. Singleton12, Rosalyn J. Singleton51, Viviana Sotomayor, Tor A. Strand52, Tor A. Strand13, Agustinus Sutanto, Mariam Sylla, Milagritos D. Tapia34, Somsak Thamthitiwat12, Elizabeth Thomas43, Rafal Tokarz53, Claudia Turner54, Marietjie Venter55, Sunthareeya Waicharoen56, Jianwei Wang57, Wanitda Watthanaworawit54, Lay-Myint Yoshida58, Hongjie Yu25, Heather J. Zar38, Harry Campbell1, Harish Nair1, Harish Nair59 
University of Edinburgh1, University of Glasgow2, Johns Hopkins University3, University of Colorado Boulder4, University of the Witwatersrand5, International Military Sports Council6, Aga Khan University7, Medical Research Council8, King George's Medical University9, Kenya Medical Research Institute10, International Centre for Diarrhoeal Disease Research, Bangladesh11, Centers for Disease Control and Prevention12, University of Bergen13, Tribhuvan University14, University of Barcelona15, Utrecht University16, Emory University17, All India Institute of Medical Sciences18, University of Liverpool19, Boston Children's Hospital20, National Institute of Virology21, University of Zambia22, University of Health Sciences Antigua23, National Health Laboratory Service24, Chinese Center for Disease Control and Prevention25, Austral University26, University of Michigan27, Vanderbilt University28, University of New South Wales29, University of Auckland30, University of Otago31, Universidad del Valle de Guatemala32, University of Jordan33, University of Maryland, Baltimore34, National Scientific and Technical Research Council35, Research Institute for Tropical Medicine36, Pwani University College37, University of Cape Town38, University of Warwick39, Academy of Medical Sciences, United Kingdom40, Tohoku University41, École normale supérieure de Lyon42, John E. Fogarty International Center43, Charité44, Universidad Nacional de Asunción45, Tehran University of Medical Sciences46, Robert Koch Institute47, University of London48, University of New Mexico49, Capital Medical University50, Alaska Native Tribal Health Consortium51, Innlandet Hospital Trust52, Columbia University53, Mahidol University54, University of Pretoria55, Thailand Ministry of Public Health56, Peking Union Medical College57, Nagasaki University58, Public Health Foundation of India59
TL;DR: In this paper, the authors estimated the incidence and hospital admission rate of RSV-associated acute lower respiratory infection (RSV-ALRI) in children younger than 5 years stratified by age and World Bank income regions.

1,470 citations



Journal ArticleDOI
TL;DR: The meaning of “resistance” related to leishmaniasis and its molecular epidemiology are discussed, particularly for Leishmania donovani that causes visceral leish maniasis, and how resistance can affect drug combination therapies are discussed.
Abstract: Reevaluation of treatment guidelines for Old and New World leishmaniasis is urgently needed on a global basis because treatment failure is an increasing problem. Drug resistance is a fundamental determinant of treatment failure, although other factors also contribute to this phenomenon, including the global HIV/AIDS epidemic with its accompanying impact on the immune system. Pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis since the first half of the 20th century, but the last 10 to 20 years have witnessed an increase in clinical resistance, e.g., in North Bihar in India. In this review, we discuss the meaning of “resistance” related to leishmaniasis and discuss its molecular epidemiology, particularly for Leishmania donovani that causes visceral leishmaniasis. We also discuss how resistance can affect drug combination therapies. Molecular mechanisms known to contribute to resistance to antimonials, amphotericin B, and miltefosine are also outlined.

511 citations


Journal ArticleDOI
Ryan M Barber1, Nancy Fullman1, Reed J D Sorensen1, Thomas J. Bollyky  +757 moreInstitutions (314)
TL;DR: In this paper, the authors use the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

427 citations


Journal ArticleDOI
03 Oct 2017-JAMA
TL;DR: A protocol for early resuscitation with administration of intravenous fluids and vasopressors increased in-hospital mortality compared with usual care among adults with sepsis and hypotension in Zambian adults presenting to the emergency department at a 1500-bed referral hospital.
Abstract: Importance The effect of an early resuscitation protocol on sepsis outcomes in developing countries remains unknown. Objective To determine whether an early resuscitation protocol with administration of intravenous fluids, vasopressors, and blood transfusion decreases mortality among Zambian adults with sepsis and hypotension compared with usual care. Design, Setting, and Participants Randomized clinical trial of 212 adults with sepsis (suspected infection plus ≥2 systemic inflammatory response syndrome criteria) and hypotension (systolic blood pressure ≤90 mm Hg or mean arterial pressure ≤65 mm Hg) presenting to the emergency department at a 1500-bed referral hospital in Zambia between October 22, 2012, and November 11, 2013. Data collection concluded December 9, 2013. Interventions Patients were randomized 1:1 to either (1) an early resuscitation protocol for sepsis (n = 107) that included intravenous fluid bolus administration with monitoring of jugular venous pressure, respiratory rate, and arterial oxygen saturation and treatment with vasopressors targeting mean arterial pressure (≥65 mm Hg) and blood transfusion (for patients with a hemoglobin level Main Outcomes and Measures The primary outcome was in-hospital mortality and the secondary outcomes included the volume of intravenous fluid received and receipt of vasopressors. Results Among 212 patients randomized to receive either the sepsis protocol or usual care, 3 were ineligible and the remaining 209 completed the study and were included in the analysis (mean [SD] age, 36.7 [12.4] years; 117 men [56.0%]; 187 [89.5%] positive for the human immunodeficiency virus). The primary outcome of in-hospital mortality occurred in 51 of 106 patients (48.1%) in the sepsis protocol group compared with 34 of 103 patients (33.0%) in the usual care group (between-group difference, 15.1% [95% CI, 2.0%-28.3%]; relative risk, 1.46 [95% CI, 1.04-2.05];P = .03). In the 6 hours after presentation to the emergency department, patients in the sepsis protocol group received a median of 3.5 L (interquartile range, 2.7-4.0 L) of intravenous fluid compared with 2.0 L (interquartile range, 1.0-2.5 L) in the usual care group (mean difference, 1.2 L [95% CI, 1.0-1.5 L];P Conclusions and Relevance Among adults with sepsis and hypotension, most of whom were positive for HIV, in a resource-limited setting, a protocol for early resuscitation with administration of intravenous fluids and vasopressors increased in-hospital mortality compared with usual care. Further studies are needed to understand the effects of administration of intravenous fluid boluses and vasopressors in patients with sepsis across different low- and middle-income clinical settings and patient populations. Trial Registration clinicaltrials.gov Identifier:NCT01663701

265 citations


Journal ArticleDOI
TL;DR: A comprehensive assessment of the water quality status, both microbial and chemical, of urban groundwater in SSA across a range of hydrogeological terrains and different groundwater point types is provided.
Abstract: Groundwater resources are important sources of drinking water in Africa, and they are hugely important in sustaining urban livelihoods and supporting a diverse range of commercial and agricultural activities. Groundwater has an important role in improving health in sub-Saharan Africa (SSA). An estimated 250 million people (40% of the total) live in urban centres across SSA. SSA has experienced a rapid expansion in urban populations since the 1950s, with increased population densities as well as expanding geographical coverage. Estimates suggest that the urban population in SSA will double between 2000 and 2030. The quality status of shallow urban groundwater resources is often very poor due to inadequate waste management and source protection, and poses a significant health risk to users, while deeper borehole sources often provide an important source of good quality drinking water. Given the growth in future demand from this finite resource, as well as potential changes in future climate in this region, a detailed understanding of both water quantity and quality is required to use this resource sustainably. This paper provides a comprehensive assessment of the water quality status, both microbial and chemical, of urban groundwater in SSA across a range of hydrogeological terrains and different groundwater point types. Lower storage basement terrains, which underlie a significant proportion of urban centres in SSA, are particularly vulnerable to contamination. The relationship between mean nitrate concentration and intrinsic aquifer pollution risk is assessed for urban centres across SSA. Current knowledge gaps are identified and future research needs highlighted.

176 citations



Journal ArticleDOI
23 Jun 2017
TL;DR: G gaps in care are described that result in patients with PNES not having adequate access to healthcare provisions in less developed countries.
Abstract: An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.

118 citations


Journal ArticleDOI
TL;DR: Acceptance of HIV testing among those consenting to the intervention was high, although linkage to care and ART initiation took longer than expected, and coverage was lower among young men and women than in older age groups.
Abstract: BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART) trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention. METHODS AND FINDINGS: The PopART intervention comprises annual rounds of home-based HIV testing delivered by community HIV-care providers (CHiPs) who also support linkage to care, ART retention, and other services. Data from four communities in Zambia receiving the full intervention (including immediate ART for all individuals with HIV) were used to determine proportions of participants who knew their HIV status after the CHiP visit; proportions linking to care and initiating ART following referral; and overall proportions of HIV-infected individuals who knew their status (first 90 target) and the proportion of these on ART (second 90 target), pre- and post-intervention. We are not able to assess progress towards the third 90 target at this stage of the study. Overall, 121,130 adults (59,283 men and 61,847 women) were enumerated in 46,714 households during the first annual round (December 2013 to June 2015). Of the 45,399 (77%) men and 55,703 (90%) women consenting to the intervention, 80% of men and 85% of women knew their HIV status after the CHiP visit. Of 6,197 HIV-positive adults referred by CHiPs, 42% (95% CI: 40%-43%) initiated ART within 6 mo and 53% (95% CI: 52%-55%) within 12 mo. In the entire population, the estimated proportion of HIV-positive adults who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated proportion of known HIV-positive individuals on ART increased overall from 54% after the CHiP visit to 74% by the end of the round for men and from 53% to 73% for women. The estimated overall proportion of HIV-positive adults on ART, irrespective of whether they knew their status, increased from 44% to 61%, compared with the 81% target (the product of the first two 90 targets). Coverage was lower among young men and women than in older age groups. The main limitation of the study was the need for assumptions concerning knowledge of HIV status and ART coverage among adults not consenting to the intervention or HIV testing, although our conclusions were robust in sensitivity analyses. CONCLUSIONS: In this analysis, acceptance of HIV testing among those consenting to the intervention was high, although linkage to care and ART initiation took longer than expected. Knowledge of HIV-positive status increased steeply after 1 y, almost attaining the first 90 target in women and approaching it in men. The second 90 target was more challenging, with approximately three-quarters of known HIV-positive individuals on ART by the end of the annual round. Achieving higher test uptake in men and more rapid linkage to care will be key objectives during the second annual round of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT01900977.

105 citations


Journal ArticleDOI
TL;DR: In this article, the authors performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries.
Abstract: Background The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction. Methods We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs). Results Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children. Conclusions Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea.

Journal ArticleDOI
TL;DR: In this article, the authors analyzed time series from continuously recording GPS stations in Nepal spanning the pre- and post-seismic period associated to the M_w7.8 Gorkha earthquake which ruptured the Main Himalayan Thrust (MHT) fault on April 25th, 2015.

Journal ArticleDOI
Henry C. Baggett1, Nora L. Watson, Maria Deloria Knoll, W. Abdullah Brooks2, W. Abdullah Brooks3, Daniel R. Feikin1, Laura L. Hammitt4, Stephen R. C. Howie5, Stephen R. C. Howie6, Stephen R. C. Howie7, Karen L. Kotloff8, Orin S. Levine9, Shabir A. Madhi10, Shabir A. Madhi6, David R. Murdoch11, David R. Murdoch5, J. Anthony G. Scott12, J. Anthony G. Scott4, Donald M. Thea13, Martin Antonio14, Martin Antonio12, Martin Antonio6, Juliet O. Awori4, Vicky L. Baillie6, Vicky L. Baillie10, Andrea DeLuca3, Amanda J. Driscoll, Julie Duncan15, Bernard E. Ebruke6, Doli Goswami2, Melissa M. Higdon, Ruth A. Karron3, David P. Moore6, David P. Moore10, Susan C. Morpeth4, Susan C. Morpeth12, Susan C. Morpeth16, Justin M Mulindwa15, Daniel E. Park17, Wantana Paveenkittiporn, Barameht Piralam, Christine Prosperi, Samba O. Sow, Milagritos D. Tapia8, Khalequ Zaman2, Scott L. Zeger3, Katherine L. O'Brien, Nicholas Fancourt3, Wei Fu3, E Wangeci Kagucia3, Mengying Li3, Zhenke Wu3, Jane Crawley, Hubert P. Endtz18, Lokman Hossain18, Yasmin Jahan18, Hasan Ashraf18, Jessica McLellan2, Eunice Machuka2, Arifin Shamsul2, Syed M. A. Zaman2, Grant A. Mackenzie2, Alice Kamau6, Sidi Kazungu6, Micah Silaba Ominde6, Mamadou Sylla4, Boubou Tamboura4, Uma Onwuchekwa4, Nana Kourouma4, Aliou Toure4, Peter V. Adrian, Locadiah Kuwanda, Azwifarwi Mudau, Michelle J. Groome, Nasreen Mahomed, Somsak Thamthitiwat10, Susan A. Maloney10, Charatdao Bunthi10, Julia Rhodes10, Pongpun Sawatwong10, Pasakorn Akarasewi10, Lawrence Mwananyanda1, James Chipeta1, Phil Seidenberg1, James Mwansa1, Somwe Wa Somwe1, Geoffrey Kwenda1, Trevor P. Anderson, Joanne L. Mitchell 
TL;DR: Upper airway pneumococcal colonization density among children hospitalized with World Health Organization–defined pneumonia was associated with microbiologically confirmed pneumococCal pneumonia (MCPP) and the optimal colonization density threshold was ≥7 log10 copies/mL.
Abstract: Background Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this potential association Methods PERCH is a case-control study in 7 countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia Cases were children aged 1-59 months hospitalized with World Health Organization-defined severe or very severe pneumonia Controls were randomly selected from the community Microbiologically confirmed pneumococcal pneumonia (MCPP) was confirmed by detection of pneumococcus in a relevant normally sterile body fluid Colonization density was calculated with quantitative polymerase chain reaction analysis of nasopharyngeal/oropharyngeal specimens Results Median colonization density among 56 cases with MCPP (MCPP cases; 1728 × 106 copies/mL) exceeded that of cases without MCPP (non-MCPP cases; 075 × 106) and controls (060 × 106) (each P 69 log10 copies/mL; overall, the sensitivity was 64% and the specificity 92%, with variable performance by site The threshold was lower (≥44 log10 copies/mL) when MCPP cases were distinguished from controls who received antibiotics before specimen collection Among the 4035 non-MCPP cases, 500 (12%) had pneumococcal colonization density >69 log10 copies/mL; above this cutoff was associated with alveolar consolidation at chest radiography, very severe pneumonia, oxygen saturation Conclusions Pneumococcal colonization density >69 log10 copies/mL was strongly associated with MCPP and could be used to improve estimates of pneumococcal pneumonia prevalence in childhood pneumonia studies Our findings do not support its use for individual diagnosis in a clinical setting

Journal ArticleDOI
Melissa M. Higdon1, Tham T Le1, Tham T Le2, Katherine L. O'Brien1, David R. Murdoch3, David R. Murdoch4, Christine Prosperi1, Henry C. Baggett5, W. Abdullah Brooks1, W. Abdullah Brooks6, Daniel R. Feikin1, Daniel R. Feikin7, Laura L. Hammitt8, Laura L. Hammitt1, Stephen R. C. Howie9, Stephen R. C. Howie4, Stephen R. C. Howie10, Karen L. Kotloff2, Orin S. Levine1, Orin S. Levine11, J. Anthony G. Scott8, J. Anthony G. Scott12, Donald M. Thea13, Juliet O. Awori8, Vicky L. Baillie14, Vicky L. Baillie10, Stephanie Cascio1, Somchai Chuananon, Andrea DeLuca1, Amanda J. Driscoll1, Bernard E. Ebruke10, Hubert P. Endtz6, Hubert P. Endtz15, Anek Kaewpan5, Geoff Kahn1, Angela Karani8, Ruth A. Karron1, David P. Moore10, David P. Moore14, Daniel E. Park1, Daniel E. Park16, Mohammed Ziaur Rahman6, Rasheed Salaudeen10, Rasheed Salaudeen17, Phil Seidenberg13, Phil Seidenberg18, Somwe Wa Somwe19, Mamadou Sylla, Milagritos D. Tapia2, Scott L. Zeger1, Maria Deloria Knoll1, Shabir A. Madhi10, Shabir A. Madhi14, Nicholas Fancourt, Wei Fu, E Wangeci Kagucia, Mengying Li, Zhenke Wu, Nora L. Watson, Jane Crawley, Khalequ Zaman, Doli Goswami, Lokman Hossain, Yasmin Jahan, Hasan Ashraf, Martin Antonio, Jessica McLellan, Eunice M. Machuka, Arifin Shamsul, Syed M. A. Zaman, Grant A. Mackenzie, Susan C. Morpeth, Alice Kamau, Sidi Kazungu, Micah Silaba Ominde, Samba O. Sow, Boubou Tamboura, Uma Onwuchekwa, Nana Kourouma, Aliou Toure, Peter V. Adrian, Locadiah Kuwanda, Azwifarwi Mudau, Michelle J. Groome, Nasreen Mahomed, Somsak Thamthitiwat, Susan A. Maloney, Charatdao Bunthi, Julia Rhodes, Pongpun Sawatwong, Pasakorn Akarasewi, Lawrence Mwananyanda, James Chipeta, James Mwansa, Geoffrey Kwenda, Trevor P. Anderson, Joanne L. Mitchell 
TL;DR: Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH, suggesting CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral- associated pneumonia needs further study.
Abstract: textBackground Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study Methods We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia) Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases Results Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases The ROC analysis produced an area under the curve of 087, indicating very good discrimination; a cut-point of 371 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%) CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity Conclusions Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study

Journal ArticleDOI
TL;DR: Antibiotic exposure and blood culture volume affect detection of bacterial pathogens in children with pneumonia and should be accounted for in studies of etiology and in clinical management.
Abstract: Background Antibiotic exposure and specimen volume are known to affect pathogen detection by culture Here we assess their effects on bacterial pathogen detection by both culture and polymerase chain reaction (PCR) in children Methods PERCH (Pneumonia Etiology Research for Child Health) is a case-control study of pneumonia in children aged 1-59 months investigating pathogens in blood, nasopharyngeal/oropharyngeal (NP/OP) swabs, and induced sputum by culture and PCR Antibiotic exposure was ascertained by serum bioassay, and for cases, by a record of antibiotic treatment prior to specimen collection Inoculated blood culture bottles were weighed to estimate volume Results Antibiotic exposure ranged by specimen type from 435% to 817% in 4223 cases and was detected in 23% of 4863 controls Antibiotics were associated with a 45% reduction in blood culture yield and approximately 20% reduction in yield from induced sputum culture Reduction in yield of Streptococcus pneumoniae from NP culture was approximately 30% in cases and approximately 32% in controls Several bacteria had significant but marginal reductions (by 5%-7%) in detection by PCR in NP/OP swabs from both cases and controls, with the exception of S pneumoniae in exposed controls, which was detected 25% less frequently compared to nonexposed controls Bacterial detection in induced sputum by PCR decreased 7% for exposed compared to nonexposed cases For every additional 1 mL of blood culture specimen collected, microbial yield increased 051% (95% confidence interval, 047%-054%), from 2% when volume was ≤1 mL to approximately 6% for ≥3 mL Conclusions Antibiotic exposure and blood culture volume affect detection of bacterial pathogens in children with pneumonia and should be accounted for in studies of etiology and in clinical management

Journal ArticleDOI
TL;DR: In the Pneumonia Etiology Research for Child Health study, abnormal chest radiographs in cases were associated with hypoxemia, crackles, tachypnea, and fever and Consolidation on CXR was associated with an increased risk of mortality.
Abstract: Background: Chest radiographs (CXRs) are frequently used to assess pneumonia cases Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented Methods: The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)-defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia) At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable Results: CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%-64%) Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < 05) CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (135%) compared to other infiltrate (47%) or normal (49%) CXRs Conclusions: Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge

Journal ArticleDOI
TL;DR: Findings that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services.
Abstract: Objective: Optimal utilisation of maternal health care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilisation of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. Methods: A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 – 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the Lot Quality Assurance Sampling method. Using multilevel modelling, we accounted for individual and community level factors associated with utilisation of maternal health care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Results: Utilisation rates of focused ANC, SBA and PNC within 48 hours were 30%, 37%, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results, and uptake of Intermittent Preventive Treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 hours after delivery. Women who live in centralised rural areas were more likely to use SBA than those living in remote rural areas. Conclusion: Utilisation of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalised communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non skilled health care providers.

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TL;DR: Study of children in Lusaka, Zambia, with severe acute malnutrition (SAM) and persistent diarrhea using endoscopy, biopsy and analysis of markers and protective proteins in blood and intestinal secretions found malnutrition enteropathy is associated with intestinal barrier failure and immune dysregulation.

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TL;DR: This manuscript looks critically into currently existing control options and provides suggestions on which (combination of) tools would be most effective in the control of T. solium taeniasis/cysticercosis in sub-Saharan Africa.

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TL;DR: The aims of the study were to quantify aflatoxins, the potent carcinogens associated with stunting and immune suppression, in maize and groundnut across Zambia's three agroecologies and to determine the vulnerability to aflatoxin increases after purchase.
Abstract: Aims Quantify aflatoxins, the potent carcinogens associated with stunting and immune suppression, in maize and groundnut across Zambia's three agroecologies and determine vulnerability to aflatoxin increases after purchase. Methods and Results Aflatoxin concentrations were determined for 334 maize and groundnut samples from 27 districts using lateral-flow immunochromatography. Seventeen percent of crops from markets contained aflatoxin concentrations above allowable levels in Zambia (10 μg kg−1). Proportions of crops unsafe for human consumption differed significantly (P<0.001) among agroecologies with more contamination (38%) in the warmest (Agroecology I) and the least (8%) in cool, wet Agroecology III. Aflatoxin in groundnut (39 μg kg−1) and maize (16 μg kg−1) differed (P=0.032). Poor storage (31°C, 100% RH, 1 week) increased aflatoxin in safe crops by over 1,000 fold in both maize and groundnut. The L morphotype of A. flavus was negatively correlated with post-harvest increases in groundnut. Conclusions Aflatoxins are common in Zambia's food staples with proportions of unsafe crops dependent on agroecology. Fungal community structure influences contamination suggesting Zambia would benefit from biocontrol with atoxigenic A. flavus. Significance and Impact of Study Aflatoxin contamination across the three agroecologies of Zambia are detailed and the case for aflatoxin management with atoxigenic biocontrol agents provided. The first method for evaluating the potential for aflatoxin increase after purchase is presented. This article is protected by copyright. All rights reserved.

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TL;DR: In this paper, a residential energy hub model for a smart home as a modified framework of conventional energy hubs in a smart grid with consideration of heat pump water heater, coordination of sources and carbon emissions is presented.

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TL;DR: In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation.
Abstract: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers’ job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before–after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group. Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program. Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity. In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction.

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TL;DR: The results reveal the complex evolutionary ecology that underpins the reservoirs of infection for Cryptococcal meningitis, and likely other, deadly pathogenic fungi.
Abstract: Emerging infections caused by fungi have become a widely recognized global phenomenon and are causing an increasing burden of disease. Genomic techniques are providing new insights into the structure of fungal populations, revealing hitherto undescribed fine-scale adaptations to environments and hosts that govern their emergence as infections. Cryptococcal meningitis is a neglected tropical disease that is responsible for a large proportion of AIDS-related deaths across Africa; however, the ecological determinants that underlie a patient's risk of infection remain largely unexplored. Here, we use genome sequencing and ecological genomics to decipher the evolutionary ecology of the aetiological agents of cryptococcal meningitis, Cryptococcus neoformans and Cryptococcus gattii, across the central African country of Zambia. We show that the occurrence of these two pathogens is differentially associated with biotic (macroecological) and abiotic (physical) factors across two key African ecoregions, Central Miombo woodlands and Zambezi Mopane woodlands. We show that speciation of Cryptococcus has resulted in adaptation to occupy different ecological niches, with C. neoformans found to occupy Zambezi Mopane woodlands and C. gattii primarily recovered from Central Miombo woodlands. Genome sequencing shows that C. neoformans causes 95% of human infections in this region, of which over three-quarters belonged to the globalized lineage VNI. We show that VNI infections are largely associated with urbanized populations in Zambia. Conversely, the majority of C. neoformans isolates recovered in the environment belong to the genetically diverse African-endemic lineage VNB, and we show hitherto unmapped levels of genomic diversity within this lineage. Our results reveal the complex evolutionary ecology that underpins the reservoirs of infection for this, and likely other, deadly pathogenic fungi.

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04 May 2017-Agrekon
TL;DR: In this article, the impacts of conservation farming (CF) practices on crop net revenue of smallholder farm households using nationally representative household and plot survey data in Zambia were determined. And they found that CF practices significantly increase crop net income per hectare when practised either singly or jointly.
Abstract: We determine the impacts of conservation farming (CF) practices on crop net revenue of smallholder farm households using nationally representative household and plot survey data in Zambia. We estimate a multinomial endogenous switching regression model of farm household’s choice of combinations of CF practices and their impacts on crop net revenue. Four primary results are found. First, several factors affect adoption of CF practices depending on the combinations in which they are adopted. Second, all CF practices significantly increase crop net revenue per hectare when practised either singly or jointly. Third, a joint adoption of crop residue retention and minimum soil disturbance yields the highest crop net revenue per hectare among all the possible combinations of CF practices. Thus a more comprehensive approach that focuses on joint adoption of all CF practices is not the best income yielding portfolio. Fourth, adoption of CF practices in combination generally results in more crop net revenue...

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TL;DR: The existing data clearly establishes the presence of a severe environmental health crisis in Kabwe which warrants immediate attention, and three existing studies were re-analyzed.

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TL;DR: Data calls for urgent revision of the current empiric treatment of diarrhoea in children using ampicillin and co-trimoxazole, and emphasizes the need for continuous antimicrobial surveillance as well as the implementation of prevention programmes for childhood diarrhoeA.
Abstract: Bacterial diarrhoeal disease is among the most common causes of mortality and morbidity in children 0–59 months at the University Teaching Hospital in Lusaka, Zambia. However, most cases are treated empirically without the knowledge of aetiological agents or antimicrobial susceptibility patterns. The aim of this study was, therefore, to identify bacterial causes of diarrhoea and determine their antimicrobial susceptibility patterns in stool specimens obtained from the children at the hospital. This hospital-based cross-sectional study involved children aged 0–59 months presenting with diarrhoea at paediatrics wards at the University Teaching Hospital in Lusaka, Zambia, from January to May 2016. Stool samples were cultured on standard media for enteropathogenic bacteria, and identified further by biochemical tests. Multiplex polymerase chain reaction was used for characterization of diarrhoeagenic Escherichia coli strains. Antimicrobial susceptibility testing was performed on antibiotics that are commonly prescribed at the hospital using the Kirby-Bauer disc diffusion method, which was performed using the Clinical Laboratory Standards International guidelines. Of the 271 stool samples analysed Vibrio cholerae 01 subtype and Ogawa serotype was the most commonly detected pathogen (40.8%), followed by Salmonella species (25.5%), diarrhoeagenic Escherichia coli (18%), Shigella species (14.4%) and Campylobacter species (3.5%). The majority of the bacterial pathogens were resistant to two or more drugs tested, with ampicillin and co-trimoxazole being the most ineffective drugs. All diarrhoeagenic Escherichia coli isolates were extended spectrum β-lactamase producers. Five different groups of bacterial pathogens were isolated from the stool specimens, and the majority of these organisms were multidrug resistant. These data calls for urgent revision of the current empiric treatment of diarrhoea in children using ampicillin and co-trimoxazole, and emphasizes the need for continuous antimicrobial surveillance as well as the implementation of prevention programmes for childhood diarrhoea.

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TL;DR: This review discusses M2 protein synthesis and assembly into an ion channel, its roles in IAV replication, and the pathophysiological impact on the host cell.
Abstract: Influenza A virus (IAV) matrix protein 2 (M2) is among the smallest bona fide, hence extensively studied, ion channel proteins. The M2 ion channel activity is not only essential for virus replication, but also involved in modulation of cellular homeostasis in a variety of ways. It is also the target for ion channel inhibitors, i.e., anti-influenza drugs. Thus far, several studies have been conducted to elucidate its biophysical characteristics, structure-function relationships of the ion channel, and the M2-host interactome. In this review, we discuss M2 protein synthesis and assembly into an ion channel, its roles in IAV replication, and the pathophysiological impact on the host cell.

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TL;DR: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
Abstract: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4–6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.


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TL;DR: The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, and creation of morbidity management programmes.
Abstract: Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.