World Health Organization - Zambia

Background Carbapenem and third-generation cephalosporin (3GC) resistance among Enterobacterales poses a serious threat to human and animal health. This study aimed to identify and characterize carbapenem- and 3GC-resistant Enterobacterales isolated from poultry in Lusaka Province, Zambia. Methods Ninety pooled cloacal samples were collected from market-ready broiler chickens in Chongwe and Chilanga districtsof Lusaka Province. The isolates were screened for 3GC and carbapenem resistance using disk diffusion and broth microdilution. PCR and Sanger sequencing were performed for species identification and detection of the β-lactamase-encoding (bla) genes, including blaCTX-M, blaTEM, blaOXA-1, and blaSHV. Hierarchical clustering was used to assess phenotypic and genotypic relationships. Results A total of 83 3GC-resistant Gram-negative isolates were recovered, of which 12% were also carbapenem-resistant. Escherichia coli was the most prevalent species, followed by Klebsiella pneumoniae and Enterobacter spp., then Pseudomonas aeruginosa, other Pseudomonas spp., Acinetobacter baumannii, Citrobacter freundii, and Aeromonas caviae. Multidrug resistance (MDR) occurred in 84.3% of the isolates, with the highest resistance to ampicillin, tetracycline, and co-trimoxazole. Overall, 80.7% of the isolates harbored at least one of the four tested bla genes, with blaCTX-M and blaTEM being the most common. Hierarchical clustering revealed that isolates from both districts shared similar phenotypic and genotypic resistance patterns. Conclusions The presence of multidrug- and carbapenem-resistant Enterobacterales from poultry highlights the emergence of carbapenem resistance in Zambia’s food production sector. Imipenem-resistant isolates indicate the potential for transmission of resistance genes between animals and humans. These findings underscore the need for prudent antimicrobial use, strengthened stewardship, and One Health surveillance to contain the spread of carbapenem resistance genes.

The Kochi Declaration 2024 (resulting from the International Leadership Summit of Medical Associations) marks a significant step in global TB elimination efforts. By emphasising private sector engagement, it addresses critical gaps in TB care delivery, particularly in high-burden countries where 60%–80% of patients initially seek care from private providers. This initiative aligns with the WHO’s public–private mix approach, enhancing case detection, treatment quality, and global health equity. It underscores the potential of collaborative strategies to accelerate progress towards a TB-free world by 2030, aligning with United Nations High-Level Meeting targets and broader global health goals.

Mercury-dependent gold mining operations expose workers to occupational health and safety hazards due to mercury's toxicity. This study assessed occupational health and safety (OHS) services provided in mercury-based gold mines in Mumbwa District, Zambia, aiming to evaluate compliance with OHS standards and identify prevalent health hazards faced by miners. A sequential mixed-methods approach was used. Data was collected through questionnaires from 108 conveniently sampled miners, while qualitative data was gathered through in-depth interviews with safety supervisors. Observational checklists were also used in the mines. Workers were exposed to dust and particulate matter (98%), and mercury exposure (62.7%), among other hazards. Compliance with OHS standards was lacking: only 23.8% of mines complied with training standards, and 33.3% with health checks. No mines had onsite medical services. Higher compliance rates were observed for reporting systems (66.7%), first aid services (62%), and fire safety measures (66.7%). Miners in gold amalgamation processes faced mercury exposure, respiratory risks from dust, and environmental contamination. Among workers in mercury-based gold mines, satisfaction was significantly higher among those who received training (OR = 4.82, p = 0.002), had access to First Aid services (OR = 5.88, p = 0.006), and possessed greater experience (OR = 2.75, p = 0.036), while education showed a non-significant trend (OR = 1.92, p = 0.097), and neither gender (OR = 2.25, p = 0.240) nor fire safety measures (OR = 0.96, p = 0.944) were statistically associated with satisfaction. Facilitators to compliance included a safe work environment, regulations and enforcement, and management support, while barriers included financial constraints, lack of training and awareness, and resistance to change. There is an urgent need for enhanced training programs, onsite medical services, and improved worker participation through OHS committees. Comprehensive strategies are needed to improve OHS compliance and protect miners' health in Mumbwa, District.

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR.

ABSTRACT The mid-Luangwa Basin has a continuous area of Permo–Triassic fossiliferous exposure, in contrast to the faulted outcrops of the northern basin where most fossils of the 20th century were collected. The richest deposits are in the upper Permian upper Madumabisa Mudstone Formation, which preserve a diverse therapsid assemblage with accompanying pareiasaurian reptiles, temnospondyl amphibians, actinopterygians, and elasmobranchs. In recent analyses of biogeography and ecosystem structure, the upper Madumabisa Mudstone fauna has been treated as a single operational unit, biostratigraphically correlated to the therapsid-dominated Cistecephalus and/or Daptocephalus assemblage zones of the South African Karoo Basin. However, increased sampling, a revised stratigraphic framework, and substantial geological observations in 2018–19 now allow us to delineate at least two distinct vertebrate assemblages from the upper member of the Madumabisa Mudstone Formation. We also identify four lithofacies including fluvial, floodplain, lacustrine, and alluvial plain facies in the lower and upper Madumabisa Mudstone. The assemblages mirror turnover events seen in the Karoo Basin between the upper subzone of the Endothiodon Assemblage Zone and the overlying lower subzone of the Daptocephalus Assemblage Zone (AZ), which bracket a shorter and relatively less well defined Cistecephalus AZ. The lower assemblage is dominated by cryptodonts such as Oudenodon and contains records of Endothiodon and Odontocyclops, whereas the upper assemblage preserves the dicynodontoids Daptocephalus, two species of Dicynodon, two novel lystrosaurid species, and the cynodont Procynosuchus. Successive assemblages in the Luangwa Basin offer a geographically distinct study system for ecosystem changes leading up to the end-Permian mass extinction.

Accurate population size estimates (PSE) of key populations-those disproportionately affected by HIV-are critical to forecast need and inform HIV prevention and treatment programs, though they can be difficult to ascertain due to low visibility of these groups. In Zambia, reliable estimates on the number of people who inject drugs are limited, inhibiting public health response. We sought to estimate the population size of people who inject drugs in 3 large cities in Zambia, assess how PSEs vary across different estimation methods, and explore the strengths and limitations of each approach. We applied 2-source capture-recapture (2S-CRC), 3-source capture-recapture (3S-CRC), and successive sampling population size estimation (SS-PSE) methods in Lusaka, Livingstone, and Ndola, Zambia. 3S-CRC methods included location-based 2S-CRC in combination with a respondent-driven sampling (RDS) survey. Data were collected from November 2021 to February 2022 and analyzed using a Bayesian nonparametric latent class model. SS-PSEs were produced using the RDS recruitment and network sizes. Kruskal tests and general linear models were used to examine sociodemographic and behavioral factors associated with being captured in 2S-CRC among RDS participants. Final city population estimates, incorporating 3S-CRC and SS-PSE with imputed visibility estimates, were generated using a Bayesian consensus estimator. Bayesian consensus PSEs ranged between 0.5% and 1.8% of the adult male population and were below 1% of the total adult population in each city. Consensus estimates were highest in Lusaka (3700, 95% credible interval [CRI] 1500-7500), followed by Ndola (2200, 95% CRI 1600-2900) and Livingstone (1200, 95% CRI 900-1,900). There was variability in estimates by method, with SS-PSE with imputed visibility generally providing the lowest estimates across cities, excluding Lusaka. Across methods, PSEs and uncertainty bounds (95% confidence interval [CI] or CRI depending on method) ranged from 1510 (95% CRI 1030-2070) to 4350 (95% CI 1410-18,890) in Lusaka, 360 (95% CI 290-530) to 2620 (95% CRI 1510-4680) in Livingstone, and 760 (95% CI 390-3060) to 4030 (95% CRI 960-5480) in Ndola. In all cities, fewer recaptures occurred in capture 3 (RDS) than with location sampling via 2S-CRC. Though results varied across cities, RDS participants captured through 2S-CRC differed from those captured solely through RDS in sociodemographic and behavioral risk factors, including housing, education, injection or needle sharing frequency, time since last injection, receipt of drug treatment, and experience with a peer educator in at least one city. This study used rigorous methods to produce PSEs in Zambia, and is the first to produce these for major geographies in the country. Through RDS, 3S-CRC reached people who inject drugs with distinct characteristics that were less accessible via location-based sampling (2S-CRC), yielding a PSE that may better reflect the population and informing the Bayesian consensus estimate. Findings from this study can guide program planning and future surveillance activities.

Introduction Zambia continues to experience measles outbreaks regardless of efforts made towards its control. On 4th October 2022, Kasempa district reported four cases of acute non-vesicular rash and conjunctivitis from three members of the same family and one child of a different family within the same area The investigation was done to confirm the existence of an outbreak, determine risk factors & establish control measures. Methods We conducted a descriptive retrospective study. Our sample size was calculated at 55 participants whom we randomly selected from the community. A case was defined as anyone who presented with acute non-vesicular rash and conjunctivitis in October 2022. Additionally, we collected 21 serum samples from suspected cases for lab analysis. We collected data on religious practices, knowledge, and immunization status using a structured questionnaire. Eight health Centers were assessed for vaccine stock availability. We calculated attack rates using the facility population as the denominator, and the cases as the numerator multiplied by 1000. The risk ratio was calculated using cases as the numerator and population at risk as the denominator. We implemented control and preventive measures. Results Of the fifty-five participants, only ten 10% (n=5) were fully vaccinated against measles. Three of the twenty-one samples tested positive for measles IgM (14.2% positivity rate). Overall Attack Rate and Risk Ratio were 1.8 and 0.5 of <5 to >5 respectively. Religious, and cultural beliefs, and being unvaccinated individuals were major causes for the measles infection. Availability of vaccine stocks was at 50%. People aged five years and above were 0.3 times more likely to get the disease as compared to those below five. Conclusion The study found high rates of measles due to low vaccination rates and limited vaccine availability. Religious and cultural beliefs were identified as barriers to vaccination. To address these issues, the study suggests conducting longitudinal studies to establish a stronger causal relationship between risk factors and measles infection. Evaluating the economic impact of measles and involving community leaders in vaccine promotion efforts is key.

Background Cholera, a highly contagious and potentially fatal infection, can be prevented through effective awareness and practices. However, gaps in the general population’s knowledge, attitudes, and practices often hinder the effectiveness of preventive measures. This study, conducted amidst a cholera outbreak, aimed to investigate these gaps through Knowledge, Attitudes, and Practices (KAP) to understand the factors contributing to the low uptake of preventive and control measures. Methods A mixed-method study was conducted in the first week of February 2024 amidst a cholera outbreak in the Lusaka District. Utilizing Two-stage sampling, 780 participants aged 18 and above were randomly selected from the 6 sub-districts of Lusaka. We collected data through trained enumerators via Kobo Collect, while qualitative insights were gathered through (FGDs) in 6 sub-districts. Quantitative data was analyzed using R for descriptive, univariate, and multivariable analyses., while qualitative data was examined using Nvivo. Results Of 780 respondents, 774 provided data with 78% female representation. The average age was 32 years (IQR: 24-43), and 50% had secondary education. Symptoms and transmission rates varied widely between subdistricts (78%-86%). On health practices, 71% always treated water, 64% washed hands with soap, and 8% sought early care. Significant associations were found for vaccination status (OR = 6.12, p = 0.015), higher knowledge percentages (OR = 31.7, p = 0.017), and transmission percentage (OR = 0.08, p = 0.022), while age (OR = 0.96, p = 0.040) showed a marginally significant effect. No significant differences were observed for education level and employment status. Conclusion This study revealed significant gaps in knowledge, attitudes, and practices across different subdistricts. The results emphasize the need for enhanced community awareness and improved access to safe water, sanitation, and hygiene facilities. To reduce cholera incidence, it is crucial to address these gaps through targeted public health interventions and policies. Public health stakeholders and government authorities should take proactive steps to promote better practices and control disease transmission.

Introduction: Despite progress over the last decade, uptake of family planning services remains a challenge in Zambia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly among hard-to-reach populations. The aim of this study was to investigate willingness of women of reproductive age to using a mobile based application to improve uptake to family planning services in selected communities of Zambia. Methods: A cross-sectional study was conducted in two selected communities of Mumbwa district between October-November 2021. Community Health Volunteers were responsible for mapping households within the catchment areas and administering survey questionnaires. Descriptive statistics were calculated for dichotomous and categorical variables. To assess associations between categorical variables, Chi-square tests were performed. All data analyses were carried out using STATA version 14.2. Results: A total of 449 participants were surveyed, from Bulungu Urban Health Centre (UHC) and Najanjoli Rural Health Centre (RHC). Most participants were between 15 and 24 years (42.54%). Only 2.46% of participants reported no formal education, with the majority having attained a secondary school level of education (52.13%). Half of households (51.70%) possessed phones, among which only 30% (126/440) were smartphones. Furthermore, 83.41% (367/450) were willing to receive family planning messages via phones. A much higher proportion of unemployed participants (73.02%; P<005), those who accessed services from Bulungu UHC (60.33%: p<005) and married women (83.65%: p<005) were willing to receive planning messages on phones. Conclusion: This study demonstrates strong willingness to use digital application to increase awareness and enhance uptake of family planning services amongst women of reproductive age in rural settings of Zambia. These findings support the feasibility of implementing digital/phone-based strategies in community health systems to increase access to health care. Further research is needed to design and evaluate scalable mobile health solutions tailored to the local context.