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  1. Article ; Online: Young Zambian infants with symptomatic RSV and pertussis infections are frequently prescribed inappropriate antibiotics

    Christian E. Gunning / Pejman Rohani / Lawrence Mwananyanda / Geoffrey Kwenda / Zacharia Mupila / Christopher J. Gill

    PeerJ, Vol 11, p e

    a retrospective analysis

    2023  Volume 15175

    Abstract: Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO’s Integrated Management of Childhood ... ...

    Abstract Pediatric community-acquired pneumonia (CAP) remains a pressing global health concern, particularly in low-resource settings where diagnosis and treatment rely on empiric, symptoms-based guidelines such as the WHO’s Integrated Management of Childhood Illness (IMCI). This study details the delivery of IMCI-based health care to 1,320 young infants and their mothers in a low-resource urban community in Lusaka, Zambia during 2015. Our Southern Africa Mother Infant Pertussis Study (SAMIPS) prospectively monitored a cohort of mother/infant pairs across infants’ first four months of life, recording symptoms of respiratory infection and antibiotics prescriptions (predominantly penicillins), and tested nasopharyngeal (NP) samples for respiratory syncytial virus (RSV) and Bordetella pertussis. Our retrospective analysis of the SAMIPS cohort found that symptoms and antibiotics use were more common in infants (43% and 15.7%) than in mothers (16.6% and 8%), while RSV and B. pertussis were observed at similar rates in infants (2.7% and 32.5%) and mothers (2% and 35.5%), albeit frequently at very low levels. In infants, we observed strong associations between symptoms, pathogen detection, and antibiotics use. Critically, we demonstrate that non-macrolide antibiotics were commonly prescribed for pertussis infections, some of which persisted across many weeks. We speculate that improved diagnostic specificity and/or clinician education paired with timely, appropriate treatment of pertussis could substantially reduce the burden of this disease while reducing the off-target use of penicillins.
    Keywords Pertussis ; RSV ; Community-acquired pneumonia ; Cohort study ; Africa ; Antibiotics ; Medicine ; R ; Biology (General) ; QH301-705.5
    Subject code 610
    Language English
    Publishing date 2023-05-01T00:00:00Z
    Publisher PeerJ Inc.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Healthcare worker perceptions of the implementation context surrounding an infection prevention intervention in a Zambian neonatal intensive care unit

    Carter Cowden / Lawrence Mwananyanda / Davidson H. Hamer / Susan E. Coffin / Monica L. Kapasa / Sylvia Machona / Julia E. Szymczak

    BMC Pediatrics, Vol 20, Iss 1, Pp 1-

    2020  Volume 9

    Abstract: Abstract Background Infants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. There is a need to ... ...

    Abstract Abstract Background Infants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. There is a need to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries. Aim The aim of this study was to identify NICU healthcare worker perceptions of an intervention to reduce bloodstream infections in a large Zambian NICU. Methods Semi-structured interviews were conducted with NICU staff during a prospective cohort study examining the impact of an infection prevention bundle on bloodstream infections. Interviews were analyzed using an integrated approach, combining inductive theme generation with an application of the Consolidated Framework for Implementation Research (CFIR). Results Interviews were conducted with 17 NICU staff (5 physicians and 12 nurses). Respondents believed the bundle elements were easy to use, well-designed and facilitated improved performance. Four organizational characteristics that facilitated HAI transmission were identified – (1) lack of NICU admission protocols; (2) physical crowding; (3) understaffing; and (4) equipment shortages. Respondents suggested that NICU resource constraints reflected a societal ethos that devalued the medical care of infants. Despite the challenges, respondents were highly motivated to prevent HAIs and believed this was an achievable goal. They enthusiastically welcomed the bundle but expressed serious concern about sustainability following the study. Conclusions By eliciting healthcare worker perceptions about the context surrounding an infection prevention intervention, our study identified key organizational and societal factors to inform implementation strategies to achieve sustained improvement.
    Keywords Infection prevention ; Pediatrics ; Implementation science ; Qualitative methodology ; Zambia ; Intensive care ; RJ1-570
    Subject code 360
    Language English
    Publishing date 2020-09-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Project SEARCH (Scanning EARs for Child Health)

    Lauren Etter / Alinani Simukanga / Wenda Qin / Rachel Pieciak / Lawrence Mwananyanda / Margrit Betke / Jackson Phiri / Caroline Carbo / Arnold Hamapa / Chris Gill

    Gates Open Research, Vol

    validating an ear biometric tool for patient identification in Zambia [version 1; peer review: 2 approved]

    2020  Volume 4

    Abstract: Patient identification in low- to middle-income countries is one of the most pressing public health challenges of our day. Given the ubiquity of mobile phones, their use for health-care coupled with a biometric identification method, present a unique ... ...

    Abstract Patient identification in low- to middle-income countries is one of the most pressing public health challenges of our day. Given the ubiquity of mobile phones, their use for health-care coupled with a biometric identification method, present a unique opportunity to address this challenge. Our research proposes an Android-based solution of an ear biometric tool for reliable identification. Unlike many popular biometric approaches (e.g., fingerprints, irises, facial recognition), ears are noninvasive and easily accessible on individuals across a lifespan. Our ear biometric tool uses a combination of hardware and software to identify a person using an image of their ear. The hardware supports an image capturing process that reduces undesired variability. The software uses a pattern recognition algorithm to transform an image of the ear into a unique identifier. We created three cross-sectional datasets of ear images, each increasing in complexity, with the final dataset representing our target use-case population of Zambian infants (N=224, aged 6days-6months). Using these datasets, we conducted a series of validation experiments, which informed iterative improvements to the system. Results of the improved system, which yielded high recognition rates across the three datasets, demonstrate the feasibility of an Android ear biometric tool as a solution to the persisting patient identification challenge.
    Keywords Medicine ; R
    Subject code 006
    Language English
    Publishing date 2020-11-01T00:00:00Z
    Publisher F1000 Research Ltd
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Asymptomatic Bordetella pertussis infections in a longitudinal cohort of young African infants and their mothers

    Christopher J Gill / Christian E Gunning / William B MacLeod / Lawrence Mwananyanda / Donald M Thea / Rachel C Pieciak / Geoffrey Kwenda / Zacharia Mupila / Pejman Rohani

    eLife, Vol

    2021  Volume 10

    Abstract: Recent pertussis resurgence in numerous countries may be driven by asymptomatic infections. Most pertussis surveillance studies are cross-sectional and cannot distinguish asymptomatic from pre-symptomatic infections. Longitudinal surveillance could ... ...

    Abstract Recent pertussis resurgence in numerous countries may be driven by asymptomatic infections. Most pertussis surveillance studies are cross-sectional and cannot distinguish asymptomatic from pre-symptomatic infections. Longitudinal surveillance could overcome this barrier, providing more information about the true burden of pertussis at the population level. Here we analyze 17,442 nasopharyngeal samples from a longitudinal cohort of 1320 Zambian mother/infant pairs. Our analysis has two elements. First, we demonstrate that the full range of IS481 qPCR CT values provides insight into pertussis epidemiology, showing concordance of low and high CT results over time, within mother/infant pairs, and in relation to symptomatology. Second, we exploit these full-range qPCR data to demonstrate a high incidence of asymptomatic pertussis, including among infants. Our results demonstrate a wider burden of pertussis infection than we anticipated in this population, and expose key limitations of threshold-based interpretation of qPCR results in infectious disease surveillance.
    Keywords Bordetella pertussis ; whooping cough ; cohort study ; asymptomatic infection ; qPCR ; Africa ; Medicine ; R ; Science ; Q ; Biology (General) ; QH301-705.5
    Language English
    Publishing date 2021-06-01T00:00:00Z
    Publisher eLife Sciences Publications Ltd
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Implementation and adherence of routine pertussis vaccination (DTP) in a low-resource urban birth cohort

    Christian E Gunning / Lawrence Mwananyanda / William B MacLeod / Magdalene Mwale / Donald M Thea / Rachel C Pieciak / Pejman Rohani / Christopher J Gill

    BMJ Open, Vol 10, Iss

    2020  Volume 12

    Abstract: Introduction Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within ... ...

    Abstract Introduction Reliable information on rates of up-to-date coverage and timely administration of routine childhood immunisations are critical for guiding public health efforts worldwide, yet prospective observation of vaccination programmes within individual communities is rare. Here, we provide a longitudinal analysis of the directly observed administration of a three-dose primary vaccination series to infants in a low-resource community in Lusaka, Zambia.Methods Throughout 2015, we recruited a longitudinal birth cohort of mother/infant pairs (initial enrolment, 1981 pairs; attending, 1497 pairs) from the periurban informal settlement of Chawama compound, located in Lusaka, Zambia. We prospectively monitored the administration of scheduled diphtheria–tetanus–pertussis (DTP) vaccinations across the first 14–18 weeks of life. We analysed study attendance and vaccine coverage, both overall and stratified by age group. We employed Kaplan-Meier analyses to estimate delays in age-appropriate administration of vaccine doses. We also assessed schedule timing violations, including early and compressed dose administration.Results At study completion, first dose (DTP1) rates were high (92.9% of attending), whereas third dose completion (DTP3) rates were far lower (61.9%). Missed vaccinations and study dropout both contributed to the low DTP3 completion rates. DTP1 was administered very late (at or after 10 weeks) to 61 infants (4.1%). DTP1 was administered too early to 64 infants (4.3%), and 77 (5.1%) received consecutive doses below the minimum recommended spacing of 28 days.Conclusions We observe substantial individual variation in the timing of early childhood DTP doses, though following this birth cohort proved challenging. Our results indicate that timely administration of both DTP1 and DTP3 remains a challenge in this community. These directly-observed, individual-based results provide an important counterpoint to more course-grained, survey-based national and province estimates of up-to-date vaccine coverage. This ...
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2020-12-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Using mortuary and burial data to place COVID-19 in Lusaka, Zambia within a global context

    Richard J. Sheppard / Oliver J. Watson / Rachel Pieciak / James Lungu / Geoffrey Kwenda / Crispin Moyo / Stephen Longa Chanda / Gregory Barnsley / Nicholas F. Brazeau / Ines C. G. Gerard-Ursin / Daniela Olivera Mesa / Charles Whittaker / Simon Gregson / Lucy C. Okell / Azra C. Ghani / William B. MacLeod / Emanuele Del Fava / Alessia Melegaro / Jonas Z. Hines /
    Lloyd B. Mulenga / Patrick G. T. Walker / Lawrence Mwananyanda / Christopher J. Gill

    Nature Communications, Vol 14, Iss 1, Pp 1-

    2023  Volume 15

    Abstract: Abstract Reported COVID-19 cases and associated mortality remain low in many sub-Saharan countries relative to global averages, but true impact is difficult to estimate given limitations around surveillance and mortality registration. In Lusaka, Zambia, ... ...

    Abstract Abstract Reported COVID-19 cases and associated mortality remain low in many sub-Saharan countries relative to global averages, but true impact is difficult to estimate given limitations around surveillance and mortality registration. In Lusaka, Zambia, burial registration and SARS-CoV-2 prevalence data during 2020 allow estimation of excess mortality and transmission. Relative to pre-pandemic patterns, we estimate age-dependent mortality increases, totalling 3212 excess deaths (95% CrI: 2104–4591), representing an 18.5% (95% CrI: 13.0–25.2%) increase relative to pre-pandemic levels. Using a dynamical model-based inferential framework, we find that these mortality patterns and SARS-CoV-2 prevalence data are in agreement with established COVID-19 severity estimates. Our results support hypotheses that COVID-19 impact in Lusaka during 2020 was consistent with COVID-19 epidemics elsewhere, without requiring exceptional explanations for low reported figures. For more equitable decision-making during future pandemics, barriers to ascertaining attributable mortality in low-income settings must be addressed and factored into discourse around reported impact differences.
    Keywords Science ; Q
    Subject code 310
    Language English
    Publishing date 2023-06-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study

    Lawrence Mwananyanda / William B MacLeod / Donald M Thea / Rachel C Pieciak / Christopher J Gill / Geoffrey Kwenda / Zachariah Mupila / Rotem Lapidot / Leah Forman / Lauren Etter / Ruth Nakazwe / Daniel Bridges / Chilufya Chikoti / Sarah Chirwa / Charles Chimoga / Ben Katowa / James Lungu / Japhet Matoba / Gift Mwinga /
    Benjamin Mubemba / Walter Muleya / Mulenga Mwenda / Benard Ngoma / Diana Nzara / Natalie Pawlak / Lillian Pemba / Ngonda Saasa / Edgar Simulundu / Baron Yankonde

    BMJ Open, Vol 12, Iss

    2022  Volume 12

    Abstract: Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We sampled a random subset of all decedents who transited ... ...

    Abstract Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We sampled the posterior nasopharynx of decedents using quantitative PCR. Prevalence was weighted to account for age-specific enrolment strategies.Interventions Not applicable—this was an observational study.Primary outcomes Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Secondary outcomes Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.Results From 1118 decedents enrolled between January and June 2021, COVID-19 was detected among 32.0% (358/1116). Roughly four COVID-19+ community deaths occurred for every facility death. Antemortem testing occurred for 52.6% (302/574) of facility deaths but only 1.8% (10/544) of community deaths and overall, only ~10% of COVID-19+ deaths were identified in life. During peak transmission periods, COVID-19 was detected in ~90% of all deaths. We observed three waves of transmission that peaked in July 2020, January 2021 and ~June 2021: the AE.1 lineage and the Beta and Delta variants, respectively. PCR signals were strongest among those whose deaths were deemed ‘probably due to COVID-19’, and weakest among children, with an age-dependent increase in PCR signal intensity.Conclusions COVID-19 was common among deceased individuals in Lusaka. Antemortem testing was rarely done, and almost never for community deaths. Suspicion that COVID-19 was the cause of deaths was highest for those with a respiratory syndrome and lowest for individuals <19 years.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2022-12-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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