16 research outputs found
Mental distress in the general population in Zambia: Impact of HIV and social factors
No full textAbstract Background Population level data on mental health from Africa are limited, but available data indicate mental problems to represent a substantial public health problem. The negative impact of HIV on mental health suggests that this could particularly be the case in high prevalence populations. We examined the prevalence of mental distress, distribution patterns and the ways HIV might influence mental health among men and women in a general population. Methods The relationship between HIV infection and mental distress was explored using a sample of 4466 participants in a population-based HIV survey conducted in selected rural and urban communities in Zambia in 2003. The Self-reporting questionnaire-10 (SRQ-10) was used to assess global mental distress. Weights were assigned to the SRQ-10 responses based on DSM IV criteria for depression and a cut off point set at 7/20 for probable cases of mental distress. A structural equation modeling (SEM) was established to assess the structural relationship between HIV infection and mental distress in the model, with maximum likelihood ratio as the method of estimation. Results The HIV prevalence was 13.6% vs. 18% in the rural and urban populations, respectively. The prevalence of mental distress was substantially higher among women than men and among groups with low educational attainment vs. high. The results of the SEM showed a close fit with the data. The final model revealed that self-rated health and self perceived HIV risk and worry of being HIV infected were important mediators between underlying factors, HIV infection and mental distress. The effect of HIV infection on mental distress was both direct and indirect, but was particularly strong through the indirect effects of health ratings and self perceived risk and worry of HIV infection. Conclusion These findings suggest a strong effect of HIV infection on mental distress. In this population where few knew their HIV status, this effect was mediated through self-perceptions of health status, found to capture changes in health perceptions related to HIV, and self-perceived risk and worry of actually being HIV infected.</p
Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia
No full textAbstract Background Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual's perspective on the illness. Although individual variations are important in determining help-seeking and treatment behaviour patterns, the ability to cope with an illness and quality of life, the role of explanatory models in shaping treatment preferences is undervalued. The aim was to identify explanatory models employed by HIV-infected and uninfected individuals and to compare them with those employed by local health care providers. Furthermore, we aimed to build a theoretical model linking the perception of mental distress to treatment preferences and coping mechanisms. Methods Qualitative investigation nested in a cross-sectional validation study of 28 (male and female) attendees at four primary care clinics in Lusaka, Zambia, between December 2008 and May 2009. Consecutive clinic attendees were sampled on random days and conceptual models of mental distress were examined, using semi-structured interviews, in order to develop a taxonomic model in which each category was associated with a unique pattern of symptoms, treatment preferences and coping strategies. Results Mental distress was expressed primarily as somatic complaints including headaches, perturbed sleep and autonomic symptoms. Economic difficulties and interpersonal relationship problems were the most common causal models among uninfected individuals. Newly diagnosed HIV patients presented with a high degree of hopelessness and did not value seeking help for their symptoms. Patients not receiving anti-retroviral drugs (ARV) questioned their effectiveness and were equivocal about seeking help. Individuals receiving ARV were best adjusted to their status, expressed hope and valued counseling and support groups. Health care providers reported that 40% of mental distress cases were due to HIV infection. Conclusions Patient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. Mental health interventions should be further researched and prioritized for HIV-infected individuals.</p
Strong effects of home-based voluntary HIV counselling and testing on acceptance and equity: A cluster randomised trial in Zambia
No full textHome-based voluntary HIV counselling and testing (HB-VCT) has been reported to have a high uptake, but it has not been rigorously evaluated. We designed a model for HB-VCT appropriate for wider scale-up, and investigated the acceptance of home-based counselling and testing, equity in uptake and negative life events with a cluster-randomized trial. Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and randomly assigned to the intervention or the control arm. Both arms had access to standard HIV testing services. Adults in the intervention clusters were offered HB-VCT by local lay counsellors. Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis. The study was registered with www.controlled-trials.com, number ISRCTN53353725. A total of 836 and 858 adults were assigned to the intervention and control clusters, respectively. In the intervention arm, counselling was accepted by 85% and 66% were tested (n = 686). Among counselled respondents who were cohabiting with the partner, 62% were counselled together with the partner. At follow-up eight months later, the proportion of adults reporting to have been tested the year prior to follow-up was 82% in the intervention arm and 52% in the control arm (Relative Risk (RR) 1.6, 95% CI 1.4–1.8), whereas the RR was 1.7 (1.4–2.0) according to the intention-to-treat analysis. At baseline the likelihood of being tested was higher for women vs. men and for more educated people. At follow-up these differences were found only in the control communities. Measured negative life events following HIV testing were similar in both groups. In conclusion, this HB-VCT model was found to be feasible, with a very high acceptance and to have important equity effects. The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential
MMWR. Morbidity and Mortality Weekly Report, Vol. 69, No. 42, October 23, 2020
No full textVaccination Coverage by Age 24 Months Among Children Born in 2016 and 2017 \u2014 National Immunization Survey-Child, United States, 2017\u20132019 / Holly A. Hill; David Yankey; Laurie D. Elam-Evans; James A. Singleton; \u2013 Valley Fever (Coccidioidomycosis) Awareness \u2014 California, 2016\u20132017 / Glorietta Hurd-Kundeti; Gail L. Sondermeyer Cooksey; Seema Jain; Duc J. Vugia et al.Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 \u2014 United States, May\u2013August 2020 / Jeremy A.W. Gold; Lauren M. Rossen; Farida B. Ahmad; Paul Sutton et al.Excess Deaths Associated with COVID-19, by Age and Race and Ethnicity \u2014 United States, January 26\u2013October 3, 2020 / Lauren M. Rossen; Amy M. Branum; Farida B. Ahmad; Paul Sutton et al.Risk for In-Hospital Complications Associated with COVID-19 and Influenza \u2014 Veterans Health Administration, United States, October 1, 2018\u2013May 31, 2020 /Jordan Cates; Cynthia Lucero-Obusan; Rebecca M. Dahl; Patricia Schirmer et al.Association Between Social Vulnerability and a County\u2019s Risk for Becoming a COVID-19 Hotspot \u2014 United States, June 1\u2013July 25, 2020 / Sharoda Dasgupta; Virginia B. Bowen; Andrew Leidner; Kelly Fletcher et al.Mitigating a COVID-19 Outbreak Among Major League Baseball Players \u2014 United States,2020 / Meghan T. Murray; Margaret A. Riggs; David M. Engelthaler; Caroline Johnson et al.First 100 Persons with COVID-19 \u2014 Zambia, March 18\u2013April 28, 2020 / Peter J. Chipimo; Danielle T. Barradas; Nkomba Kayeyi; Paul M. Zulu et al.Rapid Adaptation of HIV Treatment Programs in Response to COVID-19 \u2014 Namibia, 2020 / Steven Y. Hong; Laimi S.N. Ashipala; Leonard Bikinesi; Ndapewa Hamunime et al.Notes from the Field: Characteristics of E-cigarette, or Vaping, Products Confiscated in Public High Schools in California and North Carolina \u2014March and May 2019 / Mays Shamout; Lauren Tanz; Carolyn Herzig; Lisa P. Oakley et al.QuickStats: Percentage of Adults Aged 6520 Years Who Used Antidepressant Medications in the Past 30 Days, by Sex and Marital Status \u2014 National Health and Nutrition Examination Survey (U.S.), United States, 2015\u20132018
Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol.
No full textBACKGROUND: A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise current provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. METHODS/DESIGN: This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1) To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2) To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1) To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1) in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2) To conduct patient focus group discussions at each of these (Phase 1) to determine care received. 3) To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2). 4) To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2). 5) To undertake document analysis to appraise the clinical care procedures at each facility (Phase 2). 6) To determine principle cost drivers including staff, overhead and laboratory costs (Phase 2). DISCUSSION: This novel mixed methods protocol will permit transparent presentation of subsequent dataset results publication, and offers a substantive model of protocol design to measure and integrate key activities and outcomes that underpin a public health approach to disease management in a low-income setting
Morbidity and Mortality Weekly Report (MMWR)
No full textThe first laboratory-confirmed cases of coronaVirus disease 2019 (COVID-19), the illness caused by SARS-CoV-2, in Zambia were detected in March 2020 (1). Beginning in July, the number of confirmed cases began to increase rapidly, first peaking during July-August, and then declining in September and October (Figure). After 3 months of relatively low case counts, COVID-19 cases began rapidly rising throughout the country in mid-December. On December 18, 2020, South Africa published the genome of a SARS-CoV-2 Variants strain with several mutations that affect the spike protein (2). The Variants included a mutation (N501Y) associated with increased transmissibility.| SARS-CoV-2 lineages with this mutation have rapidly expanded geographically.|** The Variants strain (PANGO [Phylogenetic Assignment of Named Global Outbreak] lineage B.1.351|) was first detected in the Eastern Cape Province of South Africa from specimens collected in early August, spread within South Africa, and appears to have displaced the majority of other SARS-CoV-2 lineages circulating in that country (2). As of January 10, 2021, eight countries had reported cases with the B.1.351 Variants. In Zambia, the average number of daily confirmed COVID-19 cases increased 16-fold, from 44 cases during December 1-10 to 700 during January 1-10, after detection of the B.1.351 Variants in specimens collected during December 16-23. Zambia is a southern African country that shares substantial commerce and tourism linkages with South Africa, which might have contributed to the Transmission of the B.1.351 Variants between the two countries
Morbidity and Mortality Weekly Report (MMWR)
No full textZambia is a landlocked, lower-middle income country in southern Africa, with a population of 17 million (1). The first known cases of coronaVirus disease 2019 (COVID-19) in Zambia occurred in a married couple who had traveled to France and were subject to port-of-entry Surveillance and subsequent remote monitoring of travelers with a History of international travel for 14 days after arrival. They were identified as having suspected cases on March 18, 2020, and tested for COVID-19 after developing respiratory symptoms during the 14-day monitoring period. In March 2020, the Zambia National Public Health Institute (ZNPHI) defined a suspected case of COVID-19 as 1) an acute respiratory illness in a person with a History of international travel during the 14 days preceding symptom onset; or 2) acute respiratory illness in a person with a History of contact with a person with laboratory-confirmed COVID-19 in the 14 days preceding symptom onset; or 3) severe acute respiratory illness requiring hospitalization; or 4) being a household or close contact of a patient with laboratory-confirmed COVID-19. This definition was adapted from World Health Organization (WHO) interim guidance issued March 20, 2020, on global Surveillance for COVID-19 (2) to also include asymptomatic contacts of persons with confirmed COVID-19. Persons with suspected COVID-19 were identified through various mechanisms, including port-of-entry Surveillance, contact tracing, health care worker (HCW) tTesting, facility-based inpatient screening, community-based screening, and calls from the public into a national hotline administered by the Disaster Management and Mitigation Unit and ZNPHI. Port-of-entry Surveillance included an arrival screen consisting of a temperature scan, report of symptoms during the preceding 14 days, and collection of a History of travel and contact with persons with confirmed COVID-19 in the 14 days before arrival in Zambia, followed by daily remote telephone monitoring for 14 days. Travelers were tested for SARS-CoV-2, the Virus that causes COVID-19, if they were symptomatic upon arrival or developed symptoms during the 14-day monitoring period. Persons with suspected COVID-19 were tested as soon as possible after evaluation for respiratory symptoms or within 7 days of last known exposure (i.e., travel or contact with a confirmed case). All COVID-19 diagnoses were confirmed using real-time reverse transcription-polymerase chain reaction (RT-PCR) tTesting (SARS-CoV-2 Nucleic Acid Detection Kit, Maccura) of nasopharyngeal specimens; all patients with confirmed COVID-19 were admitted into institutional isolation at the time of laboratory confirmation, which was generally within 36 hours. COVID-19 patients were deemed recovered and released from isolation after two consecutive PCR-negative test results 6524 hours apart. A Ministry of Health memorandum was released on April 13, 2020, mandating tTesting in public facilities of 1) all persons admitted to medical and pediatric wards regardless of symptoms; 2) all patients being admitted to surgical and obstetric wards, regardless of symptoms; 3) any outpatient with fever, cough, or shortness of breath; and 4) any facility or community death in a person with respiratory symptoms, and 5) biweekly screening of all HCWs in isolation centers and health facilities where persons with COVID-19 had been evaluated. This report describes the first 100 COVID-19 cases reported in Zambia, during March 18-April 28, 2020
Morbidity and Mortality Weekly Report (MMWR)
No full textViolence is a major public health and human rights concern, claiming over 1.3 million lives globally each year (1). Despite the scope of this problem, population-based data on physical and sexual violence perpetration are scarce, particularly in low-income and middle-income countries (2,3). To better understand factors driving both children becoming victims of physical or sexual violence and subsequently (as adults) becoming perpetrators, CDC collaborated with four countries in sub-Saharan Africa (Malawi, Nigeria, Uganda, and Zambia) to conduct national household surveys of persons aged 13-24 years to measure experiences of violence victimization in childhood and subsequent perpetration of physical or sexual violence. Perpetration of physical or sexual violence was prevalent among both males and females, ranging among males from 29.5% in Nigeria to 51.5% in Malawi and among females from 15.3% in Zambia to 28.4% in Uganda. Experiencing physical, sexual, or emotional violence in childhood was the strongest predictor for perpetrating violence; a graded dose-response relationship emerged between the number of types of childhood violence experienced (i.e., physical, sexual, and emotional) and perpetration of violence. Efforts to prevent violence victimization need to begin early, requiring investment in the Prevention of childhood violence and interventions to mitigate the negative effects of violence experienced by children
Detection of B.1.351 SARS-CoV-2 Variants Strain \u2014 Zambia, December 2020
No full textThe first laboratory-confirmed cases of coronaVirus disease 2019 (COVID-19), the illness caused by SARS-CoV-2, in Zambia were detected in March 2020 (1). Beginning in July, the number of confirmed cases began to increase rapidly, first peaking during July\u2013August, and then declining in September and October (Figure). After 3 months of relatively low case counts, COVID-19 cases began rapidly rising throughout the country in mid-December. On December 18, 2020, South Africa published the genome of a SARS-CoV-2 Variants strain with several mutations that affect the spike protein (2). The Variants included a mutation (N501Y) associated with increased transmissibility.\u2020,\ua7 SARS-CoV-2 lineages with this mutation have rapidly expanded geographically.\ub6,** The Variants strain (PANGO [Phylogenetic Assignment of Named Global Outbreak] lineage B.1.351\u2020\u2020) was first detected in the Eastern Cape Province of South Africa from specimens collected in early August, spread within South Africa, and appears to have displaced the majority of other SARS-CoV-2 lineages circulating in that country (2). As of January 10, 2021, eight countries had reported cases with the B.1.351 Variants. In Zambia, the average number of daily confirmed COVID-19 cases increased 16-fold, from 44 cases during December 1\u201310 to 700 during January 1\u201310, after detection of the B.1.351 Variants in specimens collected during December 16\u201323. Zambia is a southern African country that shares substantial commerce and tourism linkages with South Africa, which might have contributed to the Transmission of the B.1.351 Variants between the two countries.Since September 2020, University of Zambia and PATH (https://www.path.orgexternal icon) have routinely been conducting genetic epidemiologic studies using whole genome sequencing (WGS) on SARS-CoV-2\u2013positive specimens. A subset of specimens collected during March 18\u2013December 23, 2020, were sequenced, from which 268 high-quality genomes were generated. Specimens were selected for WGS based on availability and real-time reverse transcription\u2013polymerase chain reaction (RT-PCR) diagnostic test cycle threshold (Ct) values of <30; lower Ct values are correlated with larger amounts of Virus in the sample. Sequences were linked to case investigation information including patient age, sex, and geographic location from routine public health data maintained by the Zambia National Public Health Institute. For WGS, complementary DNA was prepared using random primers from viral RNA extracted from SARS-CoV-2 real-time RT-PCR\u2013positive specimens. Multiplex PCR was then performed using custom primers (3) to generate overlapping amplicons for nanopore sequencing on a MinION (Oxford Nanopore Technology, United Kingdom).\ua7\ua7 Consensus sequence reads were generated using the standard ARTIC Network bioinformatic pipeline,\ub6\ub6 a system for processing samples from viral disease outbreaks to generate real-time, actionable epidemiologic information.Suggested citation for this article: Mwenda M, Saasa N, Sinyange N, et al. Detection of B.1.351 SARS-CoV-2 Variant Strain \u2014 Zambia, December 2020. MMWR Morb Mortal Wkly Rep. ePub: 17 February 2021.mm7008e2.htm?s_cid=mm7008e2_wmm7008e2-H.pd
Verification of dried blood spot as a sample type for HIV viral load and early infant diagnosis on Hologic Panther in Zambia
No full textAbstract Objective Zambia has embarked on improving the diagnostic capacity by setting up high throughput and accurate machines in the testing process and introduction of dried blood spot (DBS) as a sample type. This was a cross sectional study to verify dried blood spot as a sample type for HIV viral load and early infant diagnosis (EID) on Hologic Panther platform and Evaluate the analytical performance (precision, linearity and measurement of uncertainty) of the Hologic Panther. Results The specificity and sensitivity of EID performance of Aptima Quant Dx assay on Hologic panther machine against the gold standard machine COBAS Taqman (CAP/CTM) was 100% with an overall agreement of 100%. The quantitative HIV Viral Load (VL) accuracy had a positive correlation of (0.96) obtained against the gold standard (plasma samples) run on COBAS4800 platform. Analytical performance of the Hologic panther machine was evaluated; Precision low positive repeatability 3.50154 and within lab 2.268915 at mean 2.88 concentration and precision high positive repeatability 1.116955 and within lab 2.010677 at mean 5.09 concentration were obtained confirming manufacturers claims. Uncertainty of measurement for this study was found to be ± 71 copies/ml. Linearity studies were determined and all points were within acceptable limits. We therefore recommend DBS as a sample type alternative to plasma for the estimation of HIV-1 viral load and EID diagnosis on the Hologic panther machine
