University of Zambia

About: University of Zambia is a education organization based out in Lusaka, Lusaka, Zambia. It is known for research contribution in the topics: Population & Health care. The organization has 2593 authors who have published 4402 publications receiving 122411 citations. The organization is also known as: UNZA.

Strategies for Nevirapine Initiation in HIV-Infected Children Taking Pediatric Fixed-Dose Combination “ Baby Pills” in Zambia: A Randomized Controlled Trial

Abstract: BACKGROUND: Fixed-dose combination scored dispersible stavudine, lamivudine, and nevirapine minitablets (Triomune Baby and Junior; Cipla Ltd) are simpler and cheaper than liquid formulations and have correct dose ratios for human immunodeficiency virus-infected children. However, they cannot be used for dose escalation (DE) of nevirapine. METHODS: Children were randomized to initiate antiretroviral therapy with full-dose (FD) nevirapine (Triomune Baby or Junior in the morning and evening) versus DE (half-dose nevirapine for 14 days [Triomune in the morning and stavudine-lamivudine {Lamivir-S} in the evening], then FD), in accordance with World Health Organization weight-band dosing tables. The primary end point was nevirapine-related clinical or laboratory grade 3 or 4 adverse events (AEs). RESULTS: In total, 211 children (median [interquartile range {IQR}] age, 5 [ 2-9 ] years; median [IQR] CD4 cell percentage, 13% [8%-18%]) were enrolled and followed up for a median (IQR) of 92 (68-116) weeks. There were 31 grade 3 or 4 AEs that were definitely/probably or uncertainly related to nevirapine in the FD group (18.0 per 100 child-years), compared with 29 in the DE group (16.5 per 100 child-years) (incidence rate ratio, 1.09; 95% confidence interval, 0.63–1.87; P = .74). All were asymptomatic; 11 versus 3 were single grade 3 or 4 elevations in alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels, all of which resolved without a change in nevirapine dose or interruption. Thirteen (12%) FD versus 2 (2%) DE children had grade 1 (2 in FD) or grade 2 (11 in FD and 2 in DE) rashes. Three (2 in FD and 1 in DE) substituted efavirenz, 3 (FD) continued FD nevirapine, and 9 (8 in FD and 1 in DE) temporarily interrupted nevirapine, followed by successful DE. Predictors of nevirapine rash were older age (P = .003) and higher CD4 cell count for age (P = .03). Twenty-two children died (12 in FD and 10 in DE), 1 FD and 5 DE children at <4 weeks; none were considered to be drug related by independent review. CONCLUSIONS: Rash was more frequent with FD nevirapine, but 88% had no clinical toxicity; elevated AST or ALT levels were transient and resolved spontaneously, suggesting that routine laboratory monitoring has limited value. Dual pediatric stavudine-lamivudine minitablets are preferred for safe and simple DE; if unavailable, initiating FD Triomune requires timely review for rash, which could be managed by temporary reduction to half-dose Triomune or efavirenz substitution. TRIAL REGISTRATION: Current Controlled Trials identifier: ISRCTN31084535 .

Prevalence of amphistomiasis and its association with Fasciola gigantica infections in Zambian cattle from communal grazing areas.

Abstract: To estimate prevalence of amphistomiasis and its association with bovine Fasciola gigantica infections in Zambia, 709 faeces of cattle presented for slaughter from three major cattle rearing areas of Central, Southern and Western provinces were analysed. The prevalence rate of amphistomes was 51.6%. Egg counts per gram (EPG) of faeces ranged from 0 to 385 with a mean (+/- SEM) of 11.96 +/- 1.07. The origin of the cattle had a significant influence (P < 0.001) on the prevalence rate. Fasciola gigantica infections accounted for 46.7% of the cattle examined. The mean EPG count (+/- SEM) was 6.3 +/- 0.66 with a range of 0 to 223. A total of 34.6% were mixed infections while single Fasciola and amphistome infections represented 12.1% and 17.1%, respectively. Significantly more cattle (63.8%) were infected with either single or both trematode infections (P < 0.0001) than not. Mixed trematode infections were highest in the Southern province (80.0%) while the lowest were recorded in Central province (16.3%). A positive correlation (r(2) = 0.0428) was present in mixed infections. In order to minimize losses, epidemiology and cross-resistance of amphistomiasis and fascioliasis should be studied in different ecological regions of Zambia to formulate efficient control programmes.

Implications of climate warming on seedling emergence and mortality of African savanna woody plants

Abstract: Seedling emergence from scarified seeds and mortality of different seedling cohorts of five African savanna woody species (Acacia polyacantha, A. sieberana, Bauhinia thonningii, Dichrostachys cinerea and Ziziphus abyssinica) were studied under field conditions at a site in central Zambia. The study was conducted over a 4-year period, from 2003 to 2007. The objectives of the study were to determine climate factors that significantly influence seedling emergence rate and mortality in order to assess likely responses of the studied species to a warmer climate. Mean seedling emergence rate was 12% in D. cinerea and Z. abyssinica, 17% in B. thonningii, 47% in A. poyacantha and 62% in A. sieberana. Climate factors did not significantly affect seedling emergence in A. sieberana while temperature significantly influenced seedling emergence rate in the other species. Under a 1° warmer climate, seedling emergence rate was predicted to decline in A. polyacantha, B. thonningii and Z. abysssinica but is likely to increase slightly in D. cinerea. Time of seedling emergence during the wet season did not appear to affect seedling survival. Temperature also significantly influenced seedling mortality in all the studied species such that under a warmer climate, mortality was predicted to increase in A. sieberana and D. cinerea but decrease in A. polyacantha, B. thonningii and Z. abyssinica. As the studied species exhibited differential optimum temperature conditions for seedling emergence and seedling survival, they are likely to respond to climate warming in different but predictable ways. The results of the study are useful to forest management and development of climate change adaptation strategies in southern Africa.

The burden of primary headache disorders in Zambia: national estimates from a population-based door-to-door survey

Abstract: Three headache disorders – migraine, tension-type headache (TTH) and medication-overuse headache (MOH) – are major contributors to population ill-health. Policy-makers need local knowledge of these to guide priority-setting. Earlier we reported the prevalence of these disorders in Zambia; here we describe the burdens attributable to them. This was a cross-sectional population-based survey of adults aged 18-65 years, selected by cluster-randomized sampling in the mostly urban Lusaka Province and mostly rural Southern Province. Interviewers visiting households used a structured questionnaire. Diagnoses made algorithmically applied ICHD-II criteria. Burden enquiry focused on the previous 3 months and the day before interview. Disability was estimated by applying disability weights (DWs) from the Global Burden of Disease Survey 2010. From 1,134 households, 1,085 unrelated adults (450 male, 635 female) were interviewed (refusal rate 4.3%). The gender- and habitation-adjusted 1-year prevalence of migraine was 22.9%, of TTH 22.8%, of headache on ≥15 days/month 11.5%, of probable MOH (pMOH) 7.1%. Reported mean intensity of migraine attacks was 2.7, representing severe pain. People with migraine spent 10.0% of their time in the ictal state (DW: 0.433); they were therefore 4.3% disabled overall. Disability from TTH was much lower. People with pMOH (time with headache: 37.5%; DW: 0.220) were 8.3% disabled overall. Average lost productive time in the preceding 3 months for migraine was 4.1 days from work (6.3% loss) and 4.2 days (4.7% loss) from household work. Losses for pMOH were 4.8 days (7.4% loss) from work and 4.5 days (5.0% loss) from household work. In the population aged 18-65 years (effectively the working population), estimated disability from migraine was 0.98%, with 1.4% of workdays lost, and from pMOH was 0.59%, with 0.53% of workdays lost. Headache yesterday was reported by 28.3% of participants, whose average productivity yesterday was 55.9% of expectation. Zambia loses 1.93% of GDP to headache, and action is required to mitigate this loss and the associated suffering. Structured headache services with their basis in primary care are the most efficient, effective, affordable and equitable solution. They could be implemented within the existing health-care infrastructure of Zambia. These matters require urgent political attention.