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Deress T, Worede A, Birhanu A, Girma M. HIV-1 prevalence, drug resistance, and associated factors in the urban Ethiopian population. Sci Rep 2025; 15:17216. [PMID: 40382412 PMCID: PMC12085596 DOI: 10.1038/s41598-025-02122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Accepted: 05/12/2025] [Indexed: 05/20/2025] Open
Abstract
Despite progress in HIV control, gaps persist in understanding the prevalence, drug resistance, and associated factors in urban Ethiopia. This cross-sectional study analyzed data from 19,136 consenting participants (aged 15-64 years) for interview and blood testing in the 2017-2018 Population-based HIV Impact Assessment (PHIA) survey to assess HIV-1 prevalence, drug resistance mutations, and associated factors. Participants confirmed to be living with HIV (PLHIV) provided additional samples for CD4 + T-cell counts, viral load testing, and drug resistance analysis. Forty-three samples were analyzed for viral subtyping and drug resistance profiling, of which 42 samples successfully amplified. Data were analyzed using descriptive statistics and logistic regression. The overall HIV-1 prevalence was 3%. Among genotyped samples, 79.1% harbored drug resistance mutations, with high rates of resistance to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (78.8%) and Nucleoside Reverse Transcriptase Inhibitors (NRTIs) (66.7%). Regarding associated factors, females had 1.7 times higher odds of HIV infection than males (AOR = 1.7). Participants aged 35-44 and 45-54 had significantly higher odds of infection (AOR = 6.7 for both) compared to those aged 15-24. Lower educational attainment (primary school: AOR = 2.5; secondary school: AOR = 2.2) was associated with increased HIV prevalence compared to post-secondary education. Previously married individuals had higher infection odds than never-married participants (AOR = 2.7). Geographically, residents of Gambella showed significantly higher odds (AOR = 2.8) compared to those in Tigray. This study identified a high HIV-1 prevalence in Ethiopia, along with elevated virological failure rates, a significant proportion of PLHIV unaware of their status, and widespread drug resistance. Sex, age, education level, marital status, and region were the identified factors associated with HIV-1 prevalence. To improve treatment outcomes and curb transmission, Ethiopia should strengthen HIV prevention strategies focused on vulnerable populations, enhance testing and linkage to care, and implement routine drug resistance monitoring.
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Affiliation(s)
- Teshiwal Deress
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box:196, Gondar, Ethiopia.
| | - Abebaw Worede
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Birhanu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Girma
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box:196, Gondar, Ethiopia
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Tan M, Thuma PE, Hoffman S. Perceptions of COVID-19 and HIV Risk and Related Preventive Health Behaviors in Rural Zambia. JOURNAL OF PREVENTION (2022) 2025; 46:283-297. [PMID: 39661260 PMCID: PMC11981845 DOI: 10.1007/s10935-024-00817-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2024] [Indexed: 12/12/2024]
Abstract
Risk perception, its relationship to preventive health behaviors and other factors (e.g., direct experience of a disease) are important for determining effective targets for disease prevention. Whether these relationships are the same for various diseases has not been well-researched. Drawing on a holistic model of risk perception, this study compares levels of perceived risk for COVID-19 and HIV in a rural Zambian community, examines hypothesized correlates of perceived risk, and evaluates whether higher perceived risk and/or its correlates are associated with practicing preventive behaviors for each disease. The sample included 118 adults participating in a larger study of families affected by HIV. Via surveys, information about risk perception, preventive behaviors, knowledge about, trust in information sources, direct experience and hearing about each disease, and prosociality, were collected. For each disease, perceived risk was not related to its preventive behaviors. Levels of perceived risk for COVID-19 and HIV differed significantly, as did their correlates. Having trusted sources of information about HIV was related to higher perceived risk of HIV. Direct experience of COVID-19 was related to higher perceived risk of COVID-19, but only at a level of interest. Although practicing preventive behaviors for each condition was related to higher levels of knowledge about each disease at a level of interest, willingness to engage in behavior beneficial to others (prosociality) was significantly related only to COVID-19 preventive behaviors. Different diseases provoke different levels of perceived risk and engagement with preventive behaviors and may be correlated with distinct factors. These differences may be due to history of experience with a disease, as well as cultural factors.
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Affiliation(s)
- Mei Tan
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, USA.
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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Mmbando GS, Missanga J. The current status of genetic biofortification in alleviating malnutrition in Africa. J Genet Eng Biotechnol 2024; 22:100445. [PMID: 39674627 DOI: 10.1016/j.jgeb.2024.100445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 10/18/2024] [Accepted: 11/14/2024] [Indexed: 12/16/2024]
Abstract
Africa is a continent where undernutrition and micronutrient deficiencies are common and malnutrition is a major problem. Genetic biofortification (GB) offers a promising way to combat malnutrition. But little is still known about how widely used GB is in Africa today. This review explores the status, achievements, and challenges of GB on the continent today. It draws attention to the potential for enhanced nutritional results from biofortified crops that are enhanced with vital elements like zinc, iron, and vitamin A. Biofortification has a demonstrable positive effect on health and wellness, as evidenced by success stories from several African nations. However, obstacles like a lack of farmer awareness, difficulty obtaining biofortified seeds, and complicated regulations make adoption difficult. Research and collaboration advances hold the potential for increasing GB's effectiveness. This study offers guidance for the future and calls for coordinated efforts to implement GB programs to achieve a well-nourished Africa.
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Affiliation(s)
- Gideon Sadikiel Mmbando
- Department of Biology, College of Natural and Mathematical Sciences, University of Dodoma, P. O. BOX 259, Dodoma, Tanzania.
| | - Julius Missanga
- Department of Biology, College of Natural and Mathematical Sciences, University of Dodoma, P. O. BOX 259, Dodoma, Tanzania
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Yamba K, Chizimu JY, Mudenda S, Lukwesa C, Chanda R, Nakazwe R, Simunyola B, Shawa M, Kalungia AC, Chanda D, Mateele T, Thapa J, Kapolowe K, Mazaba ML, Mpundu M, Masaninga F, Azam K, Nakajima C, Suzuki Y, Bakyaita NN, Wesangula E, Matu M, Chilengi R. Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening. J Hosp Infect 2024; 148:129-137. [PMID: 38621513 PMCID: PMC11171463 DOI: 10.1016/j.jhin.2024.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.
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Affiliation(s)
- K Yamba
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
| | - J Y Chizimu
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia.
| | - S Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - C Lukwesa
- Department of Health, Lusaka District Health Office, Lusaka, Zambia
| | - R Chanda
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka, Zambia
| | - R Nakazwe
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka, Zambia
| | - B Simunyola
- Department of Pharmacy, Ministry of Health, Lusaka, Zambia
| | - M Shawa
- Hokudai Center for Zoonosis Control in Zambia, Hokkaido University International Institute for Zoonosis Control, Lusaka, Zambia
| | - A C Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - D Chanda
- Department of Internal Medicine, University Teaching Hospitals, Lusaka, Zambia
| | - T Mateele
- Department of Internal Medicine, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - J Thapa
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan
| | - K Kapolowe
- Department of Internal Medicine, University Teaching Hospitals, Lusaka, Zambia
| | - M L Mazaba
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
| | - M Mpundu
- Action on Antibiotic Resistance (ReAct) Africa, Lusaka, Zambia
| | - F Masaninga
- Department of Health, World Health Organization, Lusaka, Zambia
| | - K Azam
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - C Nakajima
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo, Hokkaido, Japan
| | - Y Suzuki
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo, Hokkaido, Japan
| | - N N Bakyaita
- Department of Health, World Health Organization, Lusaka, Zambia
| | - E Wesangula
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - M Matu
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - R Chilengi
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
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Ngoma MT, Sitali D, Mudenda S, Mukuma M, Bumbangi FN, Bunuma E, Skjerve E, Muma JB. Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship. JAC Antimicrob Resist 2024; 6:dlae034. [PMID: 38449513 PMCID: PMC10914457 DOI: 10.1093/jacamr/dlae034] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. Methods This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Results Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. Conclusions This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.
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Affiliation(s)
- Maty Tsumbu Ngoma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Doreen Sitali
- Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science, School of Agricultural Sciences and Nutrition, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Emmanuel Bunuma
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Yilema SA, Shiferaw YA, Belay AT, Belay DB. Mapping the spatial disparities of HIV prevalence in Ethiopian zones using the generalized additive model. Sci Rep 2024; 14:6215. [PMID: 38485726 PMCID: PMC10940621 DOI: 10.1038/s41598-024-55850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/28/2024] [Indexed: 03/18/2024] Open
Abstract
HIV is a worldwide social and health pandemic that poses a significant problem. This study contributes to the 2030 global agenda of reducing HIV prevalence. The study analyzed HIV prevalence using the 2016 Ethiopian Demographic and Health Survey data. The study included men aged 15-54 years and women aged 15-49 years who responded to questions about HIV tests. A generalized geo-additive model (GAM) was fitted to HIV data using nonparametric smooth terms for geolocations. Two smoothing techniques were used in GAMs to evaluate spatial disparities and the probable effects of variables on HIV risk. There were certain areas in Ethiopia that were identified as hot spot zones for HIV, including Nuer and Agnuak in Gambella, West Wollega and Illubabor in Oromia, Benchi Maji and Shaka in SNNPR, Awsi, Fantana, Kilbet, and Gabi in the Afar region, Shinilie of the Somalia region, North and South Wollo, Oromia special zones of the Amhara region, Central Ethiopia, and Addis Ababa city. On the other hand, the eastern parts of Ethiopia, particularly most zones in the Somalia region, were identified as cold spot zones with the lowest HIV odds ratio. The odds of HIV+ were higher for those who reside in rural areas than in urban areas. Furthermore, people who have STIs, who used contraceptive methods, and who learned at the secondary level of education were more likely to be infected with HIV. After adjusting for confounding variables, the results indicated that there are substantially significant spatial variations in HIV prevalence across Ethiopian zones. These results provide essential information to strategically target geographic areas to allocate resources and policy interventions at zonal level administrations.
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Affiliation(s)
- Seyifemickael Amare Yilema
- Department of Statistics, College of Natural and Computational Science, Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia.
| | - Yegnanew A Shiferaw
- Department of Statistics, University of Johannesburg, Auckland Park Kingsway Campus, P.O. Box 524, Johannesburg, 2006, South Africa
| | - Alebachew Taye Belay
- Department of Statistics, College of Natural and Computational Science, Debre Tabor University, P.O. Box 272, Debre Tabor, Ethiopia
| | - Denekew Bitew Belay
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Cuadros DF, Chowdhury T, Milali M, Citron DT, Nyimbili S, Vlahakis N, Savory T, Mulenga L, Sivile S, Zyambo KD, Bershteyn A. Geospatial patterns of progress towards UNAIDS '95-95-95' targets and community vulnerability in Zambia: insights from population-based HIV impact assessments. BMJ Glob Health 2023; 8:e012629. [PMID: 37899088 PMCID: PMC10619088 DOI: 10.1136/bmjgh-2023-012629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the '95-95-95' targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the '95-95-95' indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. METHODS This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimised hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access and social determinants of healthcare utilisation. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioural covariates and the three main outcomes of study. RESULTS Varied progress towards the '95-95-95' targets were observed in different regions of Zambia. Each '95' displayed a unique geographical pattern, independent of HIV prevalence, resulting in four distinct geographical clusters. Factors associated with gaps in the '95s' include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on antiretroviral therapy and having detectable viral loads. CONCLUSIONS Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographical patterns and levels of performance in the '95-95-95' targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors and developing innovative strategies to improve local HIV care continuum outcomes.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Tuhin Chowdhury
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Masabho Milali
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Daniel T Citron
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Sulani Nyimbili
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Natalie Vlahakis
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Theodora Savory
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lloyd Mulenga
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | | | | | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Abubakar EO, Cunningham N. Small-area estimation and analysis of HIV/AIDS indicators for precise geographical targeting of health interventions in Nigeria. a spatial microsimulation approach. Int J Health Geogr 2023; 22:23. [PMID: 37730574 PMCID: PMC10510115 DOI: 10.1186/s12942-023-00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 07/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Precise geographical targeting is well recognised as an indispensable intervention strategy for achieving many Sustainable Development Goals (SDGs). This is more cogent for health-related goals such as the reduction of the HIV/AIDS pandemic, which exhibits substantial spatial heterogeneity at various spatial scales (including at microscale levels). Despite the dire data limitations in Low and Middle Income Countries (LMICs), it is essential to produce fine-scale estimates of health-related indicators such as HIV/AIDS. Existing small-area estimates (SAEs) incorporate limited synthesis of the spatial and socio-behavioural aspects of the HIV/AIDS pandemic and/or are not adequately grounded in international indicator frameworks for sustainable development initiatives. They are, therefore, of limited policy-relevance, not least because of their inability to provide necessary fine-scale socio-spatial disaggregation of relevant indicators. METHODS The current study attempts to overcome these challenges through innovative utilisation of gridded demographic datasets for SAEs as well as the mapping of standard HIV/AIDS indicators in LMICs using spatial microsimulation (SMS). RESULTS The result is a spatially enriched synthetic individual-level population of the study area as well as microscale estimates of four standard HIV/AIDS and sexual behaviour indicators. The analysis of these indicators follows similar studies with the added advantage of mapping fine-grained spatial patterns to facilitate precise geographical targeting of relevant interventions. In doing so, the need to explicate socio-spatial variations through proper socioeconomic disaggregation of data is reiterated. CONCLUSIONS In addition to creating SAEs of standard health-related indicators from disparate multivariate data, the outputs make it possible to establish more robust links (even at individual levels) with other mesoscale models, thereby enabling spatial analytics to be more responsive to evidence-based policymaking in LMICs. It is hoped that international organisations concerned with producing SDG-related indicators for LMICs move towards SAEs of such metrics using methods like SMS.
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Affiliation(s)
| | - Niall Cunningham
- School of Geography, Politics and Sociology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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Mudenda S, Chizimu J, Chabalenge B, Kasanga M, Matafwali SK, Daka V, Yamba K, Mulomba M, Mufwambi W, Katowa-Mukwato P, Godman B. Knowledge, attitude, and practices toward infection prevention and control among undergraduate pharmacy students in Zambia: findings and implications. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e154. [PMID: 37771733 PMCID: PMC10523556 DOI: 10.1017/ash.2023.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 09/30/2023]
Abstract
Background Infection prevention and control (IPC) measures are critical in preventing the risk of acquiring and transmitting nosocomial infections. In Zambia, there is little information concerning IPC practices among pharmacy students who are exposed to potentially infectious areas both in public and private healthcare settings. Therefore, this study assessed the knowledge, attitude, and practices of undergraduate pharmacy students toward infection prevention and control at the University of Zambia. Materials and methods This cross-sectional study was conducted among 290 undergraduate pharmacy students at the University of Zambia using a structured questionnaire from August 2022 to October 2022. Data analysis was performed using SPSS version 25.0, and statistical significance was set at a 95% confidence level. Results Of the 290 participants, 166(57.2%) were female and the majority were aged between 18 and 23 years. Overall, 252(86.9%) had good knowledge, 167(57.6%) had positive attitudes, and 248(85.5%) had good practices toward IPC measures. These results indicate lower attitude scores compared to knowledge and practices. Having good knowledge of IPC was associated with being a Christian by religion compared to other religions (OR = 5.314, 95% CI: 1.141-24.745). There was no association between sociodemographics and attitude and practice concerning IPC. Conclusion This study found that pharmacy students had good knowledge, positive attitudes, and good practices toward IPC measures. Consequently, more emphasis is needed to improve the student's knowledge, attitudes, and practices toward IPC, especially in areas where gaps were identified. Additionally, there is a need to improve curricula on IPC measures in the training of pharmacy programs.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Maisa Kasanga
- Zhengzhou University, College of Public Health, Zhengzhou, Henan, China
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Margret Mulomba
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Patricia Katowa-Mukwato
- Department of Basic and Clinical Nursing, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
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Mweemba C, Mutale W, Masiye F, Hangoma P. Why is there a gap in self-rated health among people with hypertension? A decomposition of determinants and rural-urban differences. RESEARCH SQUARE 2023:rs.3.rs-3111338. [PMID: 37461663 PMCID: PMC10350196 DOI: 10.21203/rs.3.rs-3111338/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background Hypertension affects over one billion people globally and is one of the leading causes of premature death. The low- and middle-income countries, especially the sub-Saharan Africa region, bear a disproportionately higher share of hypertension globally. Recent evidence shows a steady shift in the burden of hypertension from the more affluent and urban population towards the poorer and rural communities. Our study examined inequalities in self-rated health among people with hypertension and whether there is a rural-urban gap in the health of these patients. We then quantified factors driving the health gap. We also examined how much HIV accounts for differences in self-rated health among hypertension patients due to the relationship between HIV, hypertension and health in sub-Saharan Africa. Methods We utilized the Zambia Household Health Expenditure and Utilization Survey for the data on SRH and other demographic and socioeconomic controls. District HIV prevalence information was from a previous study. The linear probability model provided a preliminary assessment of the association between self-rated health and independent variables. We then used the Blinder-Oaxaca decomposition to identify self-rated health inequality between urban and rural patients and determine determinants of the health gap between the two groups. Results Advanced age, lower education and low district HIV prevalence were significantly associated with poor health rating among hypertension patients. The decomposition analysis indicated that 45.5% of urban patients and 36.9% of rural patients reported good self-rated health, representing a statistically significant health gap of 8.6%. Most of the identified health gap can be attributed to endowment effects, with education (62%), district HIV prevalence (26%) and household expenditure (12%) being the most important determinants that explain the health gap. Conclusions Urban hypertension patients have better SRH than rural patients in Zambia. Educational interventions, financial protection schemes and strengthening hypertension health services in rural areas can significantly reduce the health gap between the two regions.
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Affiliation(s)
- Chris Mweemba
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Felix Masiye
- Department of Economics, School of Humanities and Social Science, P.O Box 32379, Great East Road Campus, University of Zambia, Lusaka, Zambia
| | - Peter Hangoma
- Department of Health Policy and Management, School of Public Health, P.O. Box 50110, Ridgeway Campus, University of Zambia, Lusaka, Zambia
- Chr. Michelson Institute (CMI), Bergen, Norway
- Bergen Center for Ethics and Priority Setting in Health, University of Bergen, Bergen, Norway
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Cuadros DF, Chowdhury T, Milali M, Citron D, Nyimbili S, Vlahakis N, Savory T, Mulenga L, Sivile S, Zyambo K, Bershteyn A. Geospatial Patterns of Progress towards UNAIDS "95-95-95" Targets and Community Vulnerability in Zambia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.24.23289044. [PMID: 37163012 PMCID: PMC10168516 DOI: 10.1101/2023.04.24.23289044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the "95-95-95" targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the "95-95-95" indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps. This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimized hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access, and social determinants of healthcare utilization. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioral covariates and the three main outcomes of study. Varied progress towards the "95-95-95" targets were observed in different regions of Zambia. Each "95" displayed a unique geographic pattern, independent of HIV prevalence, resulting in four distinct geographic clusters. Factors associated with gaps in the "95s" include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on ART and having detectable viral loads. Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographic patterns and levels of performance in the "95-95-95" targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors, and developing innovative strategies to improve local HIV care continuum outcomes.
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Affiliation(s)
- Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Tuhin Chowdhury
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, USA
| | - Masabho Milali
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Citron
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Sulani Nyimbili
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Natalie Vlahakis
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Theodora Savory
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lloyd Mulenga
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | | | - Khozya Zyambo
- National HIV Program, Ministry of Health, Lusaka, Zambia
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Bumbangi FN, Llarena AK, Skjerve E, Hang’ombe BM, Mpundu P, Mudenda S, Mutombo PB, Muma JB. Evidence of Community-Wide Spread of Multi-Drug Resistant Escherichia coli in Young Children in Lusaka and Ndola Districts, Zambia. Microorganisms 2022; 10:1684. [PMID: 36014101 PMCID: PMC9416312 DOI: 10.3390/microorganisms10081684] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 12/23/2022] Open
Abstract
Increased antimicrobial resistance (AMR) has been reported for pathogenic and commensal Escherichia coli (E. coli), hampering the treatment, and increasing the burden of infectious diarrhoeal diseases in children in developing countries. This study focused on exploring the occurrence, patterns, and possible drivers of AMR E. coli isolated from children under-five years in Zambia. A hospital-based cross-sectional study was conducted in the Lusaka and Ndola districts. Rectal swabs were collected from 565 and 455 diarrhoeic and healthy children, respectively, from which 1020 E. coli were cultured and subjected to antibiotic susceptibility testing. Nearly all E. coli (96.9%) were resistant to at least one antimicrobial agent tested. Further, 700 isolates were Multi-Drug Resistant, 136 were possibly Extensively-Drug Resistant and nine were Pan-Drug-Resistant. Forty percent of the isolates were imipenem-resistant, mostly from healthy children. A questionnaire survey documented a complex pattern of associations between and within the subgroups of the levels of MDR and socio-demographic characteristics, antibiotic stewardship, and guardians' knowledge of AMR. This study has revealed the severity of AMR in children and the need for a community-specific-risk-based approach to implementing measures to curb the problem.
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Affiliation(s)
- Flavien Nsoni Bumbangi
- School of Medicine, Eden University, Lusaka P.O. Box 37727, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Ann-Katrin Llarena
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - Bernard Mudenda Hang’ombe
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia
| | - Steward Mudenda
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Paulin Beya Mutombo
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
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Clarke-Deelder E, Afriyie DO, Nseluke M, Masiye F, Fink G. Health care seeking in modern urban LMIC settings: evidence from Lusaka, Zambia. BMC Public Health 2022; 22:1205. [PMID: 35710372 PMCID: PMC9202228 DOI: 10.1186/s12889-022-13549-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background In an effort to improve population health, many low- and middle-income countries (LMICs) have expanded access to public primary care facilities and removed user fees for services in these facilities. However, a growing literature suggests that many patients bypass nearby primary care facilities to seek care at more distant or higher-level facilities. Patients in urban areas, a growing segment of the population in LMICs, generally have more options for where to seek care than patients in rural areas. However, evidence on care-seeking trajectories and bypassing patterns in urban areas remains relatively scarce. Methods We obtained a complete list of public health facilities and interviewed randomly selected informal sector households across 31 urban areas in Lusaka District, Zambia. All households and facilities listed were geocoded, and care-seeking trajectories mapped across the entire urban area. We analyzed three types of bypassing: i) not using health centers or health posts for primary care; ii) seeking care outside of the residential neighborhood; iii) directly seeking care at teaching hospitals. Results A total of 620 households were interviewed, linked to 88 health facilities. Among 571 adults who had recently sought non-emergency care, 65% sought care at a hospital. Among 141 children who recently sought care for diarrhea, cough, fever, or fast breathing, 34% sought care at a hospital. 71% of adults bypassed primary care facilities, 26% bypassed health centers and hospitals close to them for more distant facilities, and 8% directly sought care at a teaching hospital. Bypassing was also observed for 59% of children, who were more likely to seek care outside of the formal care sector, with 21% of children treated at drug shops or pharmacies. Conclusions The results presented here strongly highlight the complexity of urban health systems. Most adult patients in Lusaka do not use public primary health facilities for non-emergency care, and heavily rely on pharmacies and drug shops for treatment of children. Major efforts will likely be needed if the government wants to instate health centers as the principal primary care access point in this setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13549-3.
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Affiliation(s)
- Emma Clarke-Deelder
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Doris Osei Afriyie
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Mweene Nseluke
- Directorate of Clinical Care and Diagnostic Services, Ministry of Health, Lusaka, Zambia
| | - Felix Masiye
- Department of Economics, University of Zambia, Lusaka, Zambia
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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