Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Malama C[original query] |
---|
SARS-CoV-2 mortality surveillance among community deaths brought to university teaching hospital mortuary in Lusaka, Zambia, 2020 (preprint)
Hamukale A , Hines JZ , Sinyange N , Fwoloshi S , Malambo W , Sivile S , Chanda S , Mucheleng'anga LA , Kayeyi N , Himwaze CM , Shibemba A , Leigh T , Mazaba ML , Kapata N , Zulu P , Zyambo K , Mupeta F , Agolory S , Mulenga LB , Malama K , Kapina M . medRxiv 2021 15 Introduction: During March-December 2020, Zambia recorded 20,725 confirmed COVID-19 cases, with the first wave peaking between July and August. Of the 388 COVID-19-related deaths occurring nationwide, most occurred in the community. We report findings from COVID-19 mortality surveillance among community deaths brought to the University Teaching Hospital (UTH) mortuary in Lusaka. Method(s): In Zambia, when a person dies in the community, and is brought into a health facility mortuary, they are recorded as 'brought in dead' (BID). The UTH mortuary accepts persons BID for Lusaka District, the most populated district in Zambia. We analyzed data for persons BID at UTH during 2020. We analyzed two data sources: weekly SARS-CoV-2 test results for persons BID and monthly all-cause mortality numbers among persons BID. For all-cause mortality among persons BID, monthly deaths during 2020 that were above the upper bound of the 95% confidence interval for the historic mean (2017-2019) were considered significant. Spearman's rank test was used to correlate the overall percent positivity in Zambia with all-cause mortality and SARS-CoV-2 testing among persons BID at UTH mortuary. Result(s): During 2020, 7,756 persons were BID at UTH (monthly range 556-810). SARS-CoV-2 testing began in April 2020, and through December 3,131 (51.9%) of 6,022 persons BID were tested. Of these, 212 (6.8%) were SARS-CoV-2 positive with weekly percent test positivity ranging from 0-32%, with the highest positivity occurring during July 2020. There were 1,139 excess persons BID from all causes at UTH mortuary in 2020 compared to the 2017-2019 mean. The monthly number of persons BID from all causes was above the upper bound of the 95% confidence interval during June-September and December. Conclusion(s): Increases in all-cause mortality and SARS-CoV-2 test positivity among persons BID at UTH mortuary corresponded with the first peak of the COVID-19 epidemic in June and August 2020, indicating possible increased mortality related to the COVID-19 epidemic in Zambia. Combining all-cause mortality and SARS-CoV-2 testing for persons BID provides useful information about the severity of the epidemic in Lusaka and should be implemented throughout Zambia. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Measles immunity gap among reproductive-age women participating in a simulated HIV vaccine efficacy trial in Zambia
Malama K , Tichacek A , Kelly H , Parker R , Inambao M , Sharkey T , Wall KM , Kilembe W , Price MA , Fast P , Priddy F , Allen S . Hum Vaccin Immunother 2022 18 (5) 1-5 Measles is a vaccine-preventable viral disease whose vaccination coverage remains low in Zambia, where the target group for vaccination is children aged 9 to 18 months. In addition to inadequate measles vaccination coverage among children, few studies address potential resultant immunity gaps among adults. We analyzed data from a simulated HIV vaccine efficacy trial (SiVET) conducted from 2015-2017 among adult Zambian women of childbearing age to determine measles antibody seroprevalence before and after vaccination with the measles, mumps and rubella (MMR) vaccine. We used MMR vaccine as a substitute for an experimental HIV vaccine as part of a simulation exercise to prepare for an HIV vaccine efficacy trial. We found that 75% of women had measles antibodies prior to receiving MMR, which increased to 98% after vaccination. In contrast, mumps and rubella antibody prevalence was high before (93% and 97%, respectively) and after (99% and 100%, respectively) vaccination. The low baseline measles seropositivity suggests an immunity gap among women of childbearing age. We recommend that measles vaccination programs target women of childbearing age, who can pass antibodies on to neonates. Moreover, administering the MMR vaccine to clinical trial candidates could prevent measles, mumps or rubella-related adverse events during actual trials. |
SARS-CoV-2 Prevalence among Outpatients during Community Transmission, Zambia, July 2020.
Hines JZ , Fwoloshi S , Kampamba D , Barradas DT , Banda D , Zulu JE , Wolkon A , Yingst S , Boyd MA , Siwingwa M , Chirwa L , Kapina M , Sinyange N , Mukonka V , Malama K , Mulenga LB , Agolory S . Emerg Infect Dis 2021 27 (8) 2166-2168 During the July 2020 first wave of severe acute respiratory syndrome coronavirus 2 in Zambia, PCR-measured prevalence was 13.4% among outpatients at health facilities, an absolute difference of 5.7% compared with prevalence among community members. This finding suggests that facility testing might be an effective strategy during high community transmission. |
COVID-19 Severity and COVID-19-Associated Deaths Among Hospitalized Patients with HIV Infection - Zambia, March-December 2020.
Chanda D , Minchella PA , Kampamba D , Itoh M , Hines JZ , Fwoloshi S , Boyd MA , Hamusonde K , Chirwa L , Nikoi K , Chirwa R , Siwingwa M , Sivile S , Zyambo KD , Mweemba A , Mbewe N , Mutengo KH , Malama K , Agolory S , Mulenga LB . MMWR Morb Mortal Wkly Rep 2021 70 (22) 807-810 The effect of HIV infection on COVID-19 outcomes is unclear. Studies in South Africa (1) and the United Kingdom (2) found an independent association between HIV infection and COVID-19 mortality; however, other studies have not found an association between poor COVID-19 outcomes and either HIV status among hospitalized patients (3-5) or HIV-associated factors such as CD4 count, viral load, or type of antiretroviral therapy (ART) (6). The effect of HIV infection on COVID-19 outcomes remains an urgent question in sub-Saharan Africa, where many countries are experiencing dual HIV and COVID-19 epidemics, and capacity to treat severe COVID-19 is limited. Using data from patients with probable or confirmed COVID-19 admitted to specialized treatment centers during March-December 2020 in Zambia, the Zambian Ministry of Health and CDC assessed the relationship between HIV infection and severe COVID-19 and COVID-19-associated death. Among 443 patients included in the study, 122 (28%) were HIV-positive, and of these, 91 (89%) were receiving ART at the time of hospitalization. HIV status alone was not significantly associated with severe COVID-19 at admission or during hospitalization or with COVID-19-associated death. However, among HIV-positive persons, those with severe HIV disease were more likely to develop severe COVID-19 and were at increased risk for COVID-19-associated death. Ensuring that persons maintain HIV disease control, including maintaining ART continuity and adherence, achieving viral suppression, and addressing and managing underlying medical conditions, could help reduce COVID-19-associated morbidity and mortality in sub-Saharan Africa. |
Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) among Health Care Workers-Zambia, July 2020.
Fwoloshi S , Hines JZ , Barradas DT , Yingst S , Siwingwa M , Chirwa L , Zulu JE , Banda D , Wolkon A , Nikoi KI , Chirwa B , Kampamba D , Shibemba A , Sivile S , Zyambo KD , Chanda D , Mupeta F , Kapina M , Sinyange N , Kapata N , Zulu PM , Makupe A , Mweemba A , Mbewe N , Ziko L , Mukonka V , Mulenga LB , Malama K , Agolory S . Clin Infect Dis 2021 73 (6) e1321-e1328 INTRODUCTION: Healthcare workers (HCWs) in Zambia have become infected with SARS-CoV-2, the virus that causes coronavirus disease (COVID-19). However, SARS-CoV-2 prevalence among HCWs is not known in Zambia. METHODS: We conducted a cross-sectional SARS-CoV-2 prevalence survey among Zambian HCWs in twenty health facilities in six districts in July 2020. Participants were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) and for SARS-CoV-2 antibodies using enzyme-linked immunosorbent assay (ELISA). Prevalence estimates and 95% confidence intervals (CIs), adjusted for health facility clustering, were calculated for each test separately and a combined measure for those who had PCR and ELISA performed. RESULTS: In total, 660 HCWs participated in the study, with 450 (68.2%) providing nasopharyngeal swab for PCR and 575 (87.1%) providing a blood specimen for ELISA. Sixty-six percent of participants were females and the median age was 31.5 years (interquartile range 26.2-39.8 years). The overall prevalence of the combined measure was 9.3% (95% CI 3.8%-14.7%). PCR-positive prevalence of SARS-CoV-2 was 6.6% (95% CI 2.0%-11.1%) and ELISA-positive prevalence was 2.2% (95% CI 0.5%-3.9%). CONCLUSIONS: SARS-CoV-2 prevalence among HCWs was similar to a population-based estimate (10.6%) during a period of community transmission in Zambia. Public health measures such as establishing COVID-19 treatment centers before the first cases, screening for COVID-19 symptoms among patients accessing health facilities, infection prevention and control trainings, and targeted distribution of personal protective equipment based on exposure risk might have prevented increased SARS-CoV-2 transmission among Zambian HCWs. |
Prevalence of SARS-CoV-2 in six districts in Zambia in July, 2020: a cross-sectional cluster sample survey.
Mulenga LB , Hines JZ , Fwoloshi S , Chirwa L , Siwingwa M , Yingst S , Wolkon A , Barradas DT , Favaloro J , Zulu JE , Banda D , Nikoi KI , Kampamba D , Banda N , Chilopa B , Hanunka B , Stevens TL Jr , Shibemba A , Mwale C , Sivile S , Zyambo KD , Makupe A , Kapina M , Mweemba A , Sinyange N , Kapata N , Zulu PM , Chanda D , Mupeta F , Chilufya C , Mukonka V , Agolory S , Malama K . Lancet Glob Health 2021 9 (6) e773-e781 BACKGROUND: Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey. METHODS: Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections. FINDINGS: Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute. INTERPRETATION: The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission. FUNDING: US Centers for Disease Control and Prevention. |
A multisectoral emergency response approach to a cholera outbreak in Zambia: October 2017-February 2018
Kapata N , Sinyange N , Mazaba ML , Musonda K , Hamoonga R , Kapina M , Zyambo K , Malambo W , Yard E , Riggs M , Narra R , Murphy J , Brunkard J , Azman AS , Monze N , Malama K , Mulwanda J , Mukonka VM . J Infect Dis 2018 218 S181-S183 Zambia has experienced recurrent cholera outbreaks since the late 1970s, primarily during the rainy season. The 2017–2018 cholera outbreak started on October 6, 2017, initially localized to 2 peri-urban areas of Lusaka, the capital, and was linked to contaminated water consumption. From mid-December 2017 to early February 2018 cases spread city-wide, with 3938 cases and 82 deaths (case fatality rate, 2.1%) by February 17, 2018 (Figure 1). |
Cholera epidemic - Lusaka, Zambia, October 2017-May 2018
Sinyange N , Brunkard JM , Kapata N , Mazaba ML , Musonda KG , Hamoonga R , Kapina M , Kapaya F , Mutale L , Kateule E , Nanzaluka F , Zulu J , Musyani CL , Winstead AV , Davis WW , N'Cho H S , Mulambya NL , Sakubita P , Chewe O , Nyimbili S , Onwuekwe EVC , Adrien N , Blackstock AJ , Brown TW , Derado G , Garrett N , Kim S , Hubbard S , Kahler AM , Malambo W , Mintz E , Murphy J , Narra R , Rao GG , Riggs MA , Weber N , Yard E , Zyambo KD , Bakyaita N , Monze N , Malama K , Mulwanda J , Mukonka VM . MMWR Morb Mortal Wkly Rep 2018 67 (19) 556-559 On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018 (Figure). In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city's water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10-February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged >/=1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents. |
Role of food insecurity in outbreak of anthrax infections among humans and hippopotamuses living in a game reserve area, Rural Zambia
Lehman MW , Craig AS , Malama C , Kapina-Kany'anga M , Malenga P , Munsaka F , Muwowo S , Shadomy S , Marx MA . Emerg Infect Dis 2017 23 (9) 1471-1477 In September 2011, a total of 511 human cases of anthrax (Bacillus anthracis) infection and 5 deaths were reported in a game management area in the district of Chama, Zambia, near where 85 hippopotamuses (Hippopotamus amphibious) had recently died of suspected anthrax. The human infections generally responded to antibiotics. To clarify transmission, we conducted a cross-sectional, interviewer-administered household survey in villages where human anthrax cases and hippopotamuses deaths were reported. Among 284 respondents, 84% ate hippopotamus meat before the outbreak. Eating, carrying, and preparing meat were associated with anthrax infection. Despite the risk, 23% of respondents reported they would eat meat from hippopotamuses found dead again because of food shortage (73%), lack of meat (12%), hunger (7%), and protein shortage (5%). Chronic food insecurity can lead to consumption of unsafe foods, leaving communities susceptible to zoonotic infection. Interagency cooperation is necessary to prevent outbreaks by addressing the root cause of exposure, such as food insecurity. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 20, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure