Southern Province Of Zambia Research Articles

Student Column Public Health Education Using Supercourse: A Computer-Based Learning Resource for Healthcare Professionals in the Southern Province of Zambia

<i>Student Column</i> Public Health Education Using Supercourse: A Computer-Based Learning Resource for Healthcare Professionals in the Southern Province of Zambia

Isolation of Mycobacterium Bovis from Human Sputum in Zambia: Public Health and Diagnostic Significance

The WHO reported in 1998 that 3.1% of tuberculosis cases in humans worldwide are attributable to M. bovis and that in 0.4-10% of sputum isolates from patients in African countries, M. bovis is isolated. Sputum samples were collected from a total of 917 smear-positive TB patients enrolled in a national drug resistance survey in the nine provinces of Zambia and another 100 patients enrolled in a separate TB survey conducted in the pastoral area of Namwala district of Southern province of Zambia between 2008 and 2011. Based on Spoligotyping, eight of the isolates from both surveys were confirmed as M. bovis belonging to the SB 0120 Spoligotype. The two surveys provided an opportunity to document isolation of M. bovis from sputum samples from patients diagnosed with TB from both urban and pastoral areas of Zambia. This study therefore, highlights the public health significance of M. bovis in Zambia and the importance of screening for M. bovis as part of routine diagnosis procedures. Hence, a targeted treatment for those human patients suffering from zoonotic tuberculosis is recommended to address important differences in pathology and treatment response between different mycobateria.

Identification of gaps in pearl millet germplasm from East and Southern Africa conserved at the ICRISAT genebank

The International Crops Research Institute for the semi-Arid Tropics Genebank at Patancheru, India holds the world's largest collection of 22,211 pearl millet germplasm accessions from 50 countries including 4488 landraces from 16 East and Southern African (ESA) countries. Gap analysis using FloraMap software and 3750 georeferenced pearl millet germplasm accessions from ESA countries revealed 34 districts located in 18 provinces of four East African countries and 76 districts located in 34 provinces of seven Southern African countries as geographical gaps. Analysis of characterization data using DIVA-GIS software showed 11 districts of seven provinces in Sudan and Uganda and 58 districts of 20 provinces of seven countries in Southern Africa as gaps in diversity for important morphoagronomic traits. The following districts were identified as gaps common to geographic area and diversity for some or the other traits: Amuria district in Soroti province of Uganda; Mpwapwa in Dodoma province of Tanzania; Mahalapye in Centre province and Kgatleng in Kgatleng province of Botswana; Lalomo in Southern province of Zambia; and Motoko, Mudzi and Wedza in the province of Mashonaland East; Makoni in Manikaland; Gutu and Chivi in Masvingo; Gwanda and Bulalimamangwe in Metabeland south; Hwange and Nkayi in Metabeland north; and Kwe Kwe in Midlands of Zimbabwe. For a successful germplasm collection mission to fill the gaps identified, planning should be made in advance of collaboration and consultation with National Agricultural Systems, local government officials and extension officers. It is suggested to collect the complete passport data including georeference information while collecting the germplasm.

Conservation agriculture in eastern and southern provinces of Zambia: Long-term effects on soil quality and maize productivity

Sustainable and resilient cropping systems are required in southern Africa to arrest declining soil fertility and offset the future negative effects of climate change. Conservation agriculture (CA) has been proposed as a potential system for improving soil quality and providing stable yields through minimum soil disturbance, surface crop residue retention (mulching) and crop rotations or associations. However, concerns have been raised about the lack of evidence of the benefits of CA for small-scale farmers in southern Africa. This research was carried out in two communities and one on-station site in Zambia to provide more scientific evidence about the effects of CA on soil quality, infiltration, soil moisture and crop performance. Results from Kayowozi showed that maize yields in a direct seeded CA treatment, using cowpea seeded with a dibble stick in full rotation, increased by up to 78% after four cropping seasons in comparison to a conventional control using a ridge and furrow system. At Malende, maize yields for animal traction rip-line seeded and direct seeded plots were, on average, 75% and 91% higher than a conventionally tilled control plot after six cropping seasons. Detailed studies undertaken at the Monze Farmer Training Centre revealed that CA treatments, especially that using cotton in rotation, increased water infiltration and soil moisture. In some years, infiltration was five times higher on CA fields than on those using conventional tillage. Carbon increases were only found at the on-station long-term trial, where, over time, CA plots outperformed conventional practice leading to an overall increase of 12% carbon in the first 30cm, compared with decreases of 15% in the conventional control. Comparative analyses between the on-farm and on-station trials point to a lack of adequate mulching, which might be the reason for lower carbon at the on-farm sites. We conclude that the effects of CA can build up on different soil types in most systems, but that scaling up and out requires the whole community to be targeted, rather than relying on individual farmers to overcome constraints related to the set-up in rural communities.

Effects of the Gama Cuulu Radio Serial Drama on HIV-Related Behavior Change in Zambia

The Gama Cuulu radio serial drama is written and produced in Zambia's Southern Province. It promotes behavior change and service use to prevent HIV transmission. The authors evaluated the effects of Gama Cuulu on intermediate outcomes (e.g., perceived norms), as well as number of sexual partners, condom use, and HIV testing in the past year among adults between 18 and 49 years of age. The authors used a pretest/posttest assessment with a comparison group design, with Southern Province as the intervention area and Western Province as the comparison area. Approximately 1,500 in-person interviews were conducted in both provinces in 2006 (pretest), 2007, and 2008. Regression models included terms for province, time, and the interaction of the two. Outcomes improved in both provinces (e.g., by 2008, 37.6% of participants in Southern Province and 28.3% participants in Western Province tested for HIV in the past year). Pretest-to-posttest changes in condom use (from 20.2% to 29.4% in Southern Province) and 5 intermediate outcomes were significantly different in the 2 provinces. However, changes in condom use were not associated with listening to Gama Cuulu and changes in other outcomes were similar in both provinces. Weak intervention effects might be attributable to implementation challenges or the saturation of HIV programs in Zambia.

Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results

To see if, in the diagnosis of infant infection with human immunodeficiency virus (HIV) in Zambia, turnaround times could be reduced by using an automated notification system based on mobile phone texting. In Zambia's Southern province, dried samples of blood from infants are sent to regional laboratories to be tested for HIV with polymerase chain reaction (PCR). Turnaround times for the postal notification of the results of such tests to 10 health facilities over 19 months were evaluated by retrospective data collection. These baseline data were used to determine how turnaround times were affected by customized software built to deliver the test results automatically and directly from the processing laboratory to the health facility of sample origin via short message service (SMS) texts. SMS system data were collected over a 7.5-month period for all infant dried blood samples used for HIV testing in the 10 study facilities. Mean turnaround time for result notification to a health facility fell from 44.2 days pre-implementation to 26.7 days post-implementation. The reduction in turnaround time was statistically significant in nine (90%) facilities. The mean time to notification of a caregiver also fell significantly, from 66.8 days pre-implementation to 35.0 days post-implementation. Only 0.5% of the texted reports investigated differed from the corresponding paper reports. The texting of the results of infant HIV tests significantly shortened the times between sample collection and results notification to the relevant health facilities and caregivers.

Institutionalizing Provider-Initiated HIV Testing and Counselling for Children: An Observational Case Study from Zambia

BackgroundProvider-initiated testing and counselling (PITC) is a priority strategy for increasing access for HIV-exposed children to prevention measures, and infected children to treatment and care interventions. This article examines efforts to scale-up paediatric PITC at a second-level hospital located in Zambia’s Southern Province, and serving a catchment area of 1.2 million people.Methods and Principal FindingsOur retrospective case study examined best practices and enabling factors for rapid institutionalization of PITC in Livingstone General Hospital. Methods included clinical observations, key informant interviews with programme management, and a desk review of hospital management information systems (HMIS) uptake data following the introduction of PITC. After PITC roll-out, the hospital experienced considerably higher testing uptake. In a 36-month period following PITC institutionalization, of total inpatient children eligible for PITC (n = 5074), 98.5% of children were counselled, and 98.2% were tested. Of children tested (n = 4983), 15.5% were determined HIV-infected; 77.6% of these results were determined by DNA polymerase chain reaction (PCR) testing in children under the age of 18 months. Of children identified as HIV-infected in the hospital’s inpatient and outpatient departments (n = 1342), 99.3% were enrolled in HIV care, including initiation on co-trimoxazole prophylaxis. A number of good operational practices and enabling factors in the Livingstone General Hospital experience can inform rapid PITC institutionalization for inpatient and outpatient children. These include the placement of full-time nurse counsellors at key areas of paediatric intake, who interface with patients immediately and conduct testing and counselling. They are reinforced through task-shifting to peer counsellors in the wards. Nurse counsellor capacity to draw specimen for DNA PCR for children under 18 months has significantly enhanced early infant diagnosis. The hospital’s bolstered antiretroviral supply chain, package of on-site HIV services, and follow-up care for children and families improved the continuum of service uptake.Conclusions and SignificanceThe clinical impact and operational experience emphasizes that institutional PITC is a feasible strategy for increasing access to paediatric HIV care, particularly in generalized epidemic settings.

Factors Affecting the Efficiency of Smallholder Cotton Producers in Zambia

Agriculture in Sub-Sahara Africa is considered as an engine of economic growth and has the potential to reduce rural poverty of smallholder farmers through increased food security and household income. However, most of Sub-Sahara Africa countries are faced with low agricultural productivity and this has undermined the potential to reduce rural poverty. The study focused on smallholder cotton producers in Zambia. Cotton is grown in Central, Eastern and Southern Provinces of Zambia and is an important cash crop which contributes over $60 million to the economy. It also supports over 150,000 households. However, the productivity of smallholder cotton farmers in Zambia is low, around 800 kg per hectare or less. While in West Africa productivity is over 1000 kg per hectare. Agricultural productivity is defined as a measure of the value of output for a given level of inputs. Efficiency is defined as the actual productivity of a farm relative to maximal potential productivity. This shows that efficiency is related to productivity though it is productivity at maximum or minimum values. The study used the 2008 supplemental survey data collected by the Ministry of Agriculture and Cooperatives, Central Statistics and Food Security Research Project. Using Data Envelopment Analysis (DEA) this study determines the technical, allocative and economic efficiency indices of a sample of 812 (population estimates 150,801) cotton producers in Zambia. Using the Ordinary Least Squares (OLS) regression, the study determines the factors influencing technical, allocative and economic efficiency variations. Results show that the mean technical, allocative and economic efficiency indices in cotton production are 46%, 37% and 20% respectively. This means that Zambian cotton farmers could reduce input use and production cost without altering the output by improving technical and allocative efficiency by 54% and 63% respectively. Female-headed households, number of years spent in school by the household head, leaving crop residues, the value of productive assets and off-farm income are some of the factors found to positively influence the technical, allocative and economic efficiency. The study found that cotton farmers are relatively inefficient and there is room to improve efficiency among smallholder cotton farmers in Zambia. Some socio-economic and farm-specific factors have a positive influence on efficiency. The study recommends that cotton stakeholders should devise strategies of involving more women in cotton production, improve access to productive assets, and encourage adoption of conservation farming crop residue retention as the means to improve cotton production efficiency.

Early detection of malaria foci for targeted interventions in endemic southern Zambia

BackgroundZambia has achieved significant reductions in the burden of malaria through a strategy of "scaling-up" effective interventions. Progress toward ultimate malaria elimination will require sustained prevention coverage and further interruption of transmission through active strategies to identify and treat asymptomatic malaria reservoirs. A surveillance system in Zambia's Southern Province has begun to implement such an approach. An early detection system could be an additional tool to identify foci of elevated incidence for targeted intervention.MethodsBased on surveillance data collected weekly from 13 rural health centres (RHCs) divided into three transmission zones, early warning thresholds were created following a technique successfully implemented in Thailand. Alert levels were graphed for all 52 weeks of a year using the mean and 95% confidence interval upper limit of a Poisson distribution of the weekly diagnosed malaria cases for every available week of historic data (beginning in Aug, 2008) at each of the sites within a zone. Annually adjusted population estimates for the RHC catchment areas served as person-time of weekly exposure. The zonal threshold levels were validated against the incidence data from each of the 13 respective RHCs.ResultsGraphed threshold levels for the three zones generally conformed to observed seasonal incidence patterns. Comparing thresholds with historic weekly incidence values, the overall percentage of aberrant weeks ranged from 1.7% in Mbabala to 36.1% in Kamwanu. For most RHCs, the percentage of weeks above threshold was greater during the high transmission season and during the 2009 year compared to 2010. 39% of weeks breaching alert levels were part of a series of three or more consecutive aberrant weeks.ConclusionsThe inconsistent sensitivity of the zonal threshold levels impugns the reliability of the alert system. With more years of surveillance data available, individual thresholds for each RHC could be calculated and compared to the technique outlined here. Until then, "aberrant" weeks during low transmission seasons, and during high transmission seasons at sites where the threshold level is less sensitive, could feasibly be followed up for household screening. Communities with disproportionate numbers of aberrant weeks could be reviewed for defaults in the scaling-up intervention coverage.

Ecology to Technocracy: Scientists, Surveys and Power in the Agricultural Development of Late-Colonial Zambia

This article provides an account of the transformation in agricultural development expertise that took place in late-colonial Zambia. Frustration with the slow pace of agricultural ‘improvement’ in the Native Reserves forced the socially and ecologically aware approach to rural development fostered during the 1930s–1940s, to give way to the technocratic model now associated with the green revolution agriculture and the ‘developmental state’. Through an exploration of these changes, the article seeks to advance ongoing debates concerning the interrelationship between knowledge, intervention, expertise and power in rural development. It focuses on research undertaken by Department of Agriculture (DOA) staff on the Tonga Plateau in Zambia's Southern Province during the 1940s and 1950s. Being both a major maize producing area and home to political organisations that challenged colonial and postcolonial rulers, the Tonga Plateau has long been the subject of concentrated scholarly enquiry. In late colonial Zambia, its political and economic importance made it a living laboratory1 for various scientists and technical experts. The article contributes to the rich historiography of agriculture on the Tonga Plateau by examining the knowledge claims behind various forms of state intervention that took place there.

Indices of Health; Clinical Haematology and Body Weights of Free-range Guinea Fowl (Numida meleagris) from the Southern Province of Zambia

Very little is known about the indices of health in free-range helmeted guinea fowl (Numida meleagris); particularly body mass and haematological values. The objective of the study was to determine baseline haematological and body mass values of free-range guinea fowls in Zambia. Body weights were measured and blood samples were collected from 90 clinically healthy adult guinea fowl. The blood was tested for total erythrocyte count, Packed Cell Volume (PCV), total plasma proteins, haemoglobin content, total leukocyte count, differential leukocyte counts. Erythrocyte indices were also calculated. The study revealed the following results in male guinea fowl 2.65±0.09 x 10 /l erythrocytes, haemoglobin content 12

Cattle's effect on land and labour productivity: Evidence from Zambia

AbstractCattle may have become under‐appreciated as a means of boosting staple crop production in areas of recurrent food insecurity. This study tests number of cattle owned as a determinant (alongside agronomic and socio‐economic control variables) of land and labour productivity for hybrid and local maize, and for all crops aggregated by value, from a cross‐sectional sample of 266 small and medium‐sized farms in Zambia's Southern Province. For all tested derivations of productivity, cattle ownership scores strongly as a determinant—more so than, for example, fertiliser application. The strong effect on land productivity (as robust as the expected effect on labour productivity) is ascribed to cattle owners' ability to optimally time ploughing and planting vis‐à‐vis the onset of rains. Cattle re‐stocking thus appears to be an under‐utilised tool of agricultural development. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Live immunisation against Theileria parva: spreading the disease?

In a recent Research Focus article in this journal [1], Declan McKeever raised some important concerns regarding the method of live immunisation against Theileria parva. Although persistence of vaccine strains in ticks and their presence in co-grazing non-vaccinated cattle is well documented, there could be some questions raised regarding the results reported by Geysen [2] of the presence of one or more components of the Muguga cocktail in the Southern province of Zambia after its limited deployment 10 years earlier.

Spatial and Temporal Genetic Structure of Anopheles arabiensis in Southern Zambia over Consecutive Wet and Drought Years

No studies have addressed the spatial complexity of Anopheles arabiensis populations in Zambia or the effects of drought on the genetic structure of this species. We genotyped approximately 420 An. arabiensis at 12 microsatellite loci representing 18 collections from the Southern Province of Zambia. Collections spanned three transmission seasons and covered a wet year-drought year-wet year cycle. Anopheles arabiensis within the 2,000 km(2) of the Macha study region were panmictic, with high gene flow between Macha and Namwala, Zambia, which are 80 km apart. There was little evidence for genetic structuring among years, with no significant shifts in allele frequency distributions or observed heterozygosity, and no evidence for a genetic bottleneck despite a drastic reduction in mosquito numbers during the drought year. Anopheles arabiensis in southern Zambia has a large deme size, and the regional genetic structure of this species was little affected by an extended drought period.

Further evidence for geographic differentiation in R. appendiculatus (Acari: Ixodidae) from Eastern and Southern provinces of Zambia

Studies in the biology, ecology and behaviour of R. appendiculatus in Zambia have shown considerable variation within and between populations often associated with their geographical origin. We studied variation in the mitochondrial COI (mtCOI) gene of adult R. appendiculatus ticks originating from the Eastern and Southern provinces of Zambia. Rhipicephalus appendiculatus ticks from the two provinces were placed into two groups on the mtCOI sequence data tree. One group comprised all haplotypes of specimens from the Eastern province plateau districts of Chipata and Petauke. The second group consisted of a single haplotype of specimens from the Southern province districts and Nyimba, an Eastern province district on the fringes of the valley. This variation provides additional evidence to the earlier observations in the 12S rDNA and ITS2 data for the geographic subdivision of R. appendiculatus from Southern province and Eastern province plateau. The geographic subdivision further corresponds with differences in body size and diapause between R. appendiculatus from these geographic areas. The possible implications of these findings on the epidemiology of East Coast fever (ECF) the disease for which R. appendiculatus is one of the vectors are discussed.

Seasonal pattern of bovine amphistomosis in traditionally reared cattle in the Kafue and Zambezi catchment areas of Zambia

Seasonality of bovine amphistomosis in the Southern province of Zambia was established after examining 268 faecal samples from cattle presented for slaughter at Turnpike slaughter slab, Mazabuka. Amphistomosis was found present throughout the year but the highest abundance rate was found during the post-rainy season (47.8%) and the lowest during the cold dry season (24.8%). In the rainy and post-rainy seasons, higher mean egg counts and cattle found positive were recorded than in any other season. The distribution of amphistome eggs was significantly different (p < 0.001) among the four seasons, with the rainy season having higher median egg counts than others. There were no significant differences in abundance rates between sexes or between ages of cattle. A similar seasonality to that of fasciolosis exists and may help in strategic management of Fasciola and amphistomes.

Altered Immune Response in Severe Malaria Anemia in Children.

We prospectively assessed immune markers in children <6 years with severe malarial anemia (hemoglobin <5.0 g/dL; n = 72) and uncomplicated malaria (n = 69) who presented to Macha Mission Hospital in Zambia's Southern Province. We also studied 70 children <6 years who presented to well child clinics in Harare, Zimbabwe as controls. Compared to controls, children with uncomplicated malaria had significantly higher temperatures and parasite counts, lower hemoglobin and platelet concentrations, higher plasma levels of interferon-gamma, tumor necrosis factor alpha, and interleukin 10 and lower levels of monocyte inhibitory factor (MIF). Compared to uncomplicated malaria, severe malaria anemia was associated with younger age, longer duration of fever and lower temperature on admission. Reticulocyte index and serum concentrations of bilirubin and LDH did not differ between the malaria groups, suggesting that unusually severe extra- or intra-medullary hemolysis did not explain the severe anemia. Higher white blood cell and platelet counts in the severe malaria group suggested that pan-suppression of the marrow was also not the primary cause. Of originally selected measures of inflammation, plasma levels of TNF-alpha and MIF did not differ between the malaria groups, but concentrations of both interferon-gamma and interleukin-10 were significantly lower in the severe anemia group (P <0.006). Additional testing revealed levels of interleukin-1alpha, interleukin-6, and IP-10 to be lower and levels of sFAS to be higher in the children with severe anemia versus uncomplicated malaria (P <0.0005). In a logistic regression model, severe malarial anemia was associated with younger age (P = 0.010), prior treatment with sulfadoxine/pyrimethamine or traditional medicine (P <0.32), lower levels of Interleukin-10 (P = 0.025) and higher levels of sFAS (P = 0.003) and TNFa (P = 0.013). Our results are consistent with a multifactorial cause of severe malarial anemia, possibly including infection with resistant plasmodia, over-expression of TNF-alpha in conjunction with under-expression of IL-10, and increased apoptosis.

Risk factors associated with porcine cysticercosis in selected districts of Eastern and Southern provinces of Zambia

To determine the risk factors associated with Taenia solium transmission in humans and pigs in the rural areas of Eastern and Southern provinces of Zambia, a questionnaire was administered in 788 households from 155 villages. Pigs were examined from 800 households. Tongue examination and enzyme-linked immunosorbent assay (Ag-ELISA) for the detection of circulating antigens of T. solium cysticerci were used to measure infection in pigs. A snowballing technique was utilised to select households with pigs. Prevalence of households with pigs infected with T. solium on tongue examination by district ranged from 12.7% to 32.1% with Ag-ELISA having a range of 30.0–51.7%. Of the total number of households visited, 18.8% and 37.6% had at least one pig positive for porcine cysticercosis on tongue examination and Ag-ELISA, respectively. Risk factors associated with T. solium infection were lack of pork inspection at slaughter (96.7%), consumption of pork with cysts (20.1%), selling of pork infected with T. solium cysticerci (18.3%), free-range husbandry system (83.2%) and absence of latrines (58.0). Free-range husbandry system (OR = 1.68; 95% CI = 1.36–2.07) was a significant risk factor for porcine cysticercosis in the surveyed areas. The result that pigs were mostly kept on free-range and semi-intensive husbandry systems may have permitted them to have access to eating human faeces that could be contaminated with tapeworm eggs. This study has shown that T. solium infection poses a high public health risk in the study areas and urban areas as well. We recommend that a human survey be conducted to verify the human exposure to taeniasis and/or cysticercosis in Zambia.

The association of Blastocystis hominis and Endolimax nana with diarrheal stools in Zambian school-age children

To determine the prevalence of endoparasites and their association with diarrhea, a survey was conducted in the Southern Province of Zambia that used conventional and molecular techniques applied to stool and urine samples from school-age children (n = 93). Almost half of the stools (49.5%) were diarrhetic. The overall prevalence of Endolimax nana, Schistosoma haematobium, Blastocystis hominis, Giardia lamblia, Cryptosporidium parvum, Encephalitozoon intestinalis, and Strongyloides stercoralis was 64.3, 59.1, 53.8, 19.4, 8.6, 8.6, and 1.1%, respectively. Only the associations between infection with B. hominis and E. nana with diarrhea were statistically significant. Although B. hominis and E. nana are considered to be nonpathogenic organisms, this study demonstrated that they can be associated with diarrhea in children when they occur at high prevalence and intensity. This survey supports the recent evidence that B. hominis and E. nana infections are associated with deficient sanitation and low hygiene standards and can contribute to diarrhea in children in developing countries.

Seasonal pattern of bovine fasciolosis in the Kafue and Zambezi catchment areas of Zambia

In order to establish seasonality of bovine fasciolosis in the Southern province of Zambia, 288 cattle were examined at slaughter at Turnpike slaughter slab for 1 year. The examination involved liver inspection and coprological examination. Liver condemnation rates were relatively high at the beginning of both the cold dry season and the rainy season (May/June and December, respectively). All cattle, regardless of age, had higher fluke abundances in the post-rainy season (39.1% young and 42.1% adult) while the lowest rates were in the hot dry season (13.3% young and 14.3% adult). On coprological examination, the highest abundance was in the post-rainy season (45.0%) and the lowest in the cold dry season (24.9%). From November (end of dry season) to February/March (end of rains), more fluke eggs were found than in any other period. The distribution of fluke eggs was significantly different ( p < 0.001) among the four seasons. Identified associations were: egg counts were highest in post-rainy (mean abundance = 146) and lowest in cold dry season (mean abundance = 118) at 95% confidence (CI 0.64–1.25). Differences in abundance observed according to origin, sex and age of cattle were not significant on both methods. Based on these results, it may be concluded that Fasciola gigantica was present throughout the year in cattle in Zambia but the abundance was highest in the post-rainy season and lowest in the cold dry season.