Validation of HIV risk screening tool to identify infected adults and adolescents greater than 14 years at community level in Tanzania and Zambia

Introduction: There are several risk factors being used to identify undiagnosed HIV-infected adults. As the number of undiagnosed people gets less and less, it is important to know if existing risk factors and risk assessment tools are valid for use. Methods: Data from the Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys which were conducted during 2016 was used. We first included 12 risk factors (being divorced, separated or widowed; having an HIV+ spouse; having one of the following within 12-months of the survey: paid work, slept away from home for ≥1-month, having multiple sexual partners, clients of sex workers, sexually transmitted infection, being tuberculosis suspect, being very sick for ≥3-months; ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed. Receiver Operating Characteristic (ROC) curve comparison statistics was also used to determine which risk assessment tool was better. Results: HIV prevalence was 2.3% (2.0%-2.6%) (n=14,820). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were present (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9%(41.1%-42.7%), 3.2%(2.8%-3.6%), and 99.0%(98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC (0.65 vs 0.61) compared to the use of all risk factors (p value <0.001). Conclusions: The use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfill multiple risk factors should be explored further to improve HIV testing yield.

Malaria and Its Prevention: Socio-acceptability in the Application of Insecticides-treated Bed Nets Among Household Heads in the Rural Village Community of Mazabuka, Zambia

@#Introduction: Malaria poses immerse public health challenges in the world as it is still causing significant morbidity and mortality especially in endemic regions such as Zambia. One of the effective tools in preventing malaria is the application of insecticide-treated bed nets (ITNs). This study aims to explored the socio-acceptability of malaria and ITNs among rural village community of Mazabuka, Zambia. Methods: A semi-structured questionnaire was administered to 177 respondents via two different approached methods; focus group discussions and one-to-one interviews to assess the level of KAP of the respondents about malaria and ITNs. Results: Most of the respondents (98.7%) possessed ITNs that were provided free of charge by the Ministry of Health Zambia. Overall, the knowledge and attitude of respondents on malaria and ITNs were at moderate levels of 68.1% and 71.8%, respectively. In contrast, the level of practice was poor with only 36.2% of positive response. Although 92.1% of the respondents answered correctly on the association between malaria and mosquito bites, myths and misconceptions were still common as some of them still attributed malaria to drinking dirty waters (32.8%), bad weather (15.8%), witchcraft (3.4%), and bathing dirty water (19.8%). The practice was significantly associated with knowledge (p=0.003), but not attitude (p=0.230). Logistic regression analysis revealed that respondents with high knowledge level and tertiary education were more likely to use ITNs correctly (OR=2.957; OR=21.739, respectively). Conclusion: The present study showed that the knowledge gaps were remained among the villagers as misconceptions and their believe of myths were still exist.

Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managedata Teaching Hospital in Zambia: A Retrospective Cross-Sectional Study

BackgroundThe obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and, in most cases, treatable. Surgicalrepairis themainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia. Methods: Aretrospective review of medical records for all women who underwent obstetric fistula repair surgeryat Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer's exact test was used to measure association between surgical outcomes and variables in the model.: ResultsIn total,18 out of 29 records of patients who underwentfistularepairwereretrievedandanalyzed. Ages ranged from 15 to 47 years, mean age 29years.Overtwothirds(72.23%)weremultiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83%at 2 weeks post-operative.Study findings were inadequate to show a significant association between successful repair and factors in the model. Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by caesarean section and poor birth outcomes. Success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.:

Risk Factors for Occupational Transmission of Tuberculosis among Healthcare Workers in Zambia

Healthcare workers (HCWs) play a critical role in the management and control of nosocomial transmission of tuberculosis (TB). At the same time, working in TB healthcare facilities such as hospital wards, diagnostic and treatment facilities increases the risk of acquiring TB due to occupational exposure in HCWs. The risk is further heightened in high TB prevalence populations, such as Zambia, as HCWs are exposed both occupationally and in the community. This review aims to provide a better understanding of the risk factors associated with occupational transmission of TB in HCWs in Zambia, by synthesising available data on TB in HCWs in Zambia and the surrounding region. A search of peer reviewed original research on the transmission of TB among HCWs in Zambiawas conducted in PubMed and Google Scholar. Studies were eligible for inclusion in the analysis if they described TB amongst HCWs in Zambia, risk factors for TB in HCWs, and nosocomial transmission of TB in Zambia and the surrounding region. The prevalence of TB in HCWs has been demonstrated to be higher than that of the general population. Transmission of TB in healthcare facilities is driven by several factors centred on the lack of adherence to TB infection prevention and control (IPC) practices. Nosocomial transmission of TB in HCWs is further driven by the HIV epidemic and the rise in lifestyle diseases such as diabetes mellitus. However, there is very scarce data on the association of diabetes mellitus and TB among HCWs in Zambia. Prolonged contact with TB patients on wards has been demonstrated to play a vital role in occupational transmission of TB amongst nurses in Zambia. To curb the transmission of TB in HCWs several measures will require implementation such as; administrative support, IPC training and annual TB and HIV screening for all HCWs

Community Perspectives on Worm Infections in a Peri-Urban Area of Lusaka, Zambia

Soil transmitted helminths (STH) known as worm infections are more than a technical or biomedical problem. They can be linked directly to specific human behaviour in relation to sanitation and hygiene practices. Although these infections are prevalent in Zambia, There is paucity of data on community perceptions and beliefs with respect to STH infections. Therefore, this study sought to understand this aspect from a peri-urban point of view. Qualitative interviews were conducted on fifty-seven participants from Ngombe compound; a peri-urban area within Lusaka, Zambia. The study was carried out between August and December 2015 using semi-structured interviews and analysed by means of question analysis. Wide spread knowledge about the various types of worms was foundin the community, although most of it was generally folk knowledge. However, this did not mean that the study population recognized STH as serious health problem as some participants considered having worms as normal. While consumption of food was commonly cited as cause of STH, most participants failed to give empirical evidence linking soil or faecal contaminated food items as direct cause of STH. Although the findings cannot be generalized, the study provides informative reference in understanding beliefs and perceptions regarding STH in Zambian peri-urban communities. There is need for concentrated efforts that are bio-medically relevant as well as beneficial to the targeted population

Perceived Risk of Contracting HIV and AIDS among Sexually Active Unmarried Young People in Zambia

The paper explored gender differences in factors affecting perceived risk of contracting HIV and AIDS among sexually active unmarried young people in Zambia. The data used was from the Zambia Demographic Health Survey (2013-2014), logistic regression analysis was used to identify the gender differences in perceived risk of acquiring HIV and AIDS. The study revealed that 61% of females and 64.4% of males reported low perceived risk of contracting HIV and 16.5% of females and 16.6% of males reported having a high risk of getting HIV/AIDS. Logistic regression analysis also identified wealth index, exposure to media, having had STDs in the last 12 months, consistent use of condoms with all partners and drinking alcohol as strong predictors of respondent’s likelihood of low risk perception of contracting HIV and AIDS. The analysis further indicated that females who used condoms consistently with all partners were 1.2 times more likely to report being at low risk of contracting HIV and AIDS. This suggests that interventions that seek to reduce the rate of HIV infection may need to focus on increasing risk perception among young people as a protective factor.

Perceptions of Risk of Contracting HIV among Married Men and Women in Zambia

This study explored the perceived risk of contracting HIV among the currently married men and women in Zambia. The analysis was carried out on data from the latest Zambia Demographic Health Survey (2014).Results indicated that 48% of the currently married women, and 61% of the currently married men reported low perceived risk for contracting HIV. The results also indicate that age, place of residence, wealth status, having had sex with three or more partners for the last 12 months, drinking alcohol and condom use were associated with high risk perception of contracting HIV for men. Women who had three or more sexual partners during the last 12 months were 1.5 times more likely to perceive high risk for contracting HIV than those who had less than three partners. Among the males, those who had sex with three or more sexual partners were 1.7 times more likely to perceive being at high risk for contracting HIV than those who had sex with less than three partners. Respondents from the higher socio-economic group were 1.3 times more likely to report low risk of contracting HIV as compared to those from middle and lower socio-economic group. These findings suggest that behaviour change campaigns encouraging marriedmen and women to accurately assess their personal risk of contracting HIV should be complemented with targetedawareness messages emphasizing the positive attributes of usingcondom.

Assessment of knowledge, attitude and practices on antibiotic resistance among undergraduate medical students in the school of medicine at the University of Zambia

Background: The issue of antibiotic resistance has become a global public health concern, with an extensive clinical and economic burden. The study aimed to assess the knowledge, attitude, and practices of antibiotic resistance among undergraduate medical students at the University of Zambia.Methods: This cross-sectional study was conducted at the University of Zambia Ridgeway Campus. A structured questionnaire was administered to 260 randomly selected undergraduate medical students. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Associations between dependent and independent variables were done using a Chi-square test. The statistical significance was done at 95% confidence level (p<0.05). Ethical approval was done by the University of Zambia Health Sciences Research Ethics Committee.Results: The study found that 227 of 260 (87.3%) of the medical students had good knowledge on antibiotic use and resistance. The majority of the medical students 252 of 260 (96.9%) had positive attitudes and 195 of 260 (75%) had good practices towards antibiotic resistance. There was a significant difference between the year of study and the level of knowledge (?2=16.333, p=0.003). There was no significant difference between the year of study and the attitude of the participants (?2=4.061, p=0.398). A significant difference was found between the year of study and the practices of the respondents (?2=10.926, p=0.027).Conclusions: The medical students had good knowledge, a positive attitude, and good practices towards antibiotic resistance. Final year students had higher levels of knowledge and attitude but lower levels of practice compared to other years of study.

The African digital health library and digitization of health information in Zambia: process, challenges and achievements

The rapid growth of Internet and increasing interest in its usage has led to an acceleration of digitisation of printed documents and making available born digital documents online. Zambia's research output is primarily in print and not much is disseminated globally. It is against this background that innovations for digital libraries have been started in several African countries, including Zambia. The overall objective of the African Digital Health Library Zambia was to increase the health content that is held in the University of Zambia Institutional Repository by digitising publications produced by various institutions in Zambia, with a vision of capturing over 6,000 current and historical materials. Equipment was acquired and sensitisation meetings were held with various stake holders to ensure successful project initiation and sustainability. Scanning and uploading of documents was done after a technical expert had trained both Library and Information Technology staff on Dspace software. Marketing the digital library within the institutions and nationally was also conducted. In June 2018 there were 266,838 downloads of materials. Challenges of collecting required materials from relevant stake holders and convincing them to make available their content were encountered in the process. Enhanced collaboration and sensitisation of stakeholders were essential in ensuring the successful implementation of the project.

Health librarians making a difference in a health care setting: the Chitambo emergency care communications project

Health librarians in the role of a knowledge broker can encourage health care workers to use evidence based health information. The knowledge broker role is an intervention dedicated to translating knowledge into action originating from the evidence-based medicine campaign. The Chitambo Emergency Care Communications Project through its knowledge component work strand has visualisations of converting knowledge into action to improve emergency care response by health workers, through the implementation of the knowledge broker role for health care workers in Chitambo district, Central Zambia. Implementation of the knowledge broker activity for Chitambo adopted a framework purposefully designed to build capacity for health librarians by the National Health Service Education for Scotland. The knowledge to action model can be useful in providing the relevant information to improve patient outcomes for healthcare workers. These knowledge gaps can be alleviated by knowledge brokering as it straddles through any knowledge gaps between the health workers' knowledge and their service delivery practice.

Which community volunteers participate most frequently in support programs for TB patients? Case report from Lusaka, Zambia, 2015 / 国際保健医療

Objectives  The Japan International Cooperation Agency, Japan Anti-Tuberculosis Association and the Lusaka district health office conducted Community Mobilization for TB/HIV Care Project at three health centres in Lusaka, Zambia from 2012 to 2015. This study describes the assessment of the factors associated with high participation rates of tuberculosis (TB) treatment supporters (TSs) in patient support activities. Methods  A cross-sectional study was conducted for the evaluation. Information about individual participation to the weekly patient support activities at the health centres between September 2014 and February 2015 was drawn from the health centres’ administrative records. Data were collected between February and March 2015 via a structured questionnaire administered to TSs working at the health centres. Descriptive, univariate and multiple logistic regression analyses were done to identify factors associated with high participation of TSs. Results  For the 74 respondents, the average monthly participation rate between September 2014 and February 2015 was 83.2%. The rate was tended to be over 80% for the TSs who had temporary work or no work, or were housewives, and those who had experience as a group leader. The TSs who did not complete primary education were positively associated with participating over 80% of the time compared to those who had a secondary or higher education. Conclusion  The study provided information on the higher participation of TSs’ activities including their job, education status and leadership experiences. In recruiting TSs, priority should be given to those who have a temporary job or no work, or are housewives. Those who have lower education levels should not be excluded from the selection because they participated more often. Selecting an individual as a leader may facilitate the commitment of the person to the activities. These can be used in selection criteria of TSs in the similar setting.

Incidence, risk factors, treatment and outcomes of postpartum hemorrhage at a district hospital in Zambia / 国際保健医療

Background and Objectives  Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide; 99% of maternal deaths due to PPH occur in developing countries. The aim of this study was to analyze the current status and trend of PPH at a district hospital in Zambia. Methods  All women who delivered at Zimba Mission Hospital, a district hospital covering a population of 98,000, in 2017 were included in this retrospective survey. The incidence, risk factors, treatment, and outcomes of PPH were analyzed. PPH was defined as blood loss ≥ 500 ml within 24 h after vaginal delivery or ≥1,000 ml within 24 h after cesarean section. Data were extracted from admission, delivery, and operation registers. Risk factors were identified by multivariable logistic regression analysis.Results  Among the 1,704 women who delivered at the hospital, PPH developed in 107 (6.3%) women. Risk factors for PPH after vaginal delivery were assisted vaginal delivery (adjusted odds ratio [aOR], 14.40; 95% confidence interval [CI], 6.72-30.80), macrosomia (aOR, 5.19; 95% CI, 1.69-15.90), and multiple pregnancy (aOR, 4.04; 95% CI, 1.37-11.90). Risk factors for PPH after cesarean section were placenta previa (aOR, 13.20; 95% CI, 2.37-73.10) and parity ≥ 3 (aOR, 9.85; 95% CI, 3.50-27.70). Sufficient oxytocin was administered in all cases. Advanced treatment was required in 19 (17.8%) cases. Balloon tamponade was performed successfully in 7 (6.5%) cases. B-Lynch uterine compression suturing was performed successfully in 2 (1.9%) cases. Hysterectomy was performed in 10 (9.3%) cases, and 2 (1.9%) women died after the operation.Conclusions  The incidence of PPH was slightly higher than estimated global incidence. Different risk factors for PPH were identified between vaginal deliveries and cesarean sections. Most of the patients survived after advanced treatment.

Depressive Symptoms Are Negatively Associated with Glucose Testing and Eating Meals on Time among Individuals with Diabetes in Zambia

BACKGROUND: Depression is an established risk factor for cardiovascular diseases and mortality among individuals living with diabetes, and impaired self-care behaviors may play a mediating role. In Africa, this association is not very well known. In this study, we examined the associations between depressive symptoms and different aspects of diabetes self-care in Zambian individuals with diabetes mellitus. METHODS: A total of 157 individuals with diabetes mellitus participated. The sample was drawn from four city hospitals in Zambia. Diabetes self-care was assessed using the diabetes self-care inventory, and depression was assessed using the major depression inventory. RESULTS: Fifty-nine percent of the sample had type 1 diabetes mellitus. Variations in self-care activities and behaviors were reported as least adhered to by individuals with type 1 and type 2 diabetes mellitus, in adolescent and adult patients. Regression analysis indicated that there was no association between total diabetes self-care and the depression total score. However, depression was associated with poor glucose testing and not eating meals on time by patients with diabetes. CONCLUSION: Some variance on poor self-care was explained by demographic characteristics, specifically age, body mass index, and to some extent, socioeconomic status. Recognition and successful treatment of depression in patients with diabetes might help to optimize self-care behaviors, especially glucose testing and eating meals on time. However, this hypothesis needs further testing.

Ethnobotanical study of medicinal flora utilised by traditional healers in the management of sexually transmitted infections in Sesheke District, Western Province, Zambia

ABSTRACT Since many rural-poor Lozi people of Sesheke District (Western Province, Zambia) that suffer from sexually transmitted infections do not usually access public health facilities; they turn to traditional healers who administer remedies extracted from medicinal plants. However, the medicinal plants used for sexually transmitted infections and data on the usage of plants in Sesheke District in particular and Western Province in general have not been documented. In this study, an ethnobotanical survey was conducted to document the indigenous knowledge of medicinal plants that alleviate symptoms of sexually transmitted infections in Sesheke District, Western Province, Zambia. Using semi-structured interviews and questionnaires, ethnobotanical data were collected from twenty traditional healers that manage patients presenting with sexually transmitted infections. The results showed that 52 plant species in 25 families and 43 genera were used to treat gonorrhoea, syphilis, chancroid, chlamydia, genital herpes, and ano-genital warts. Sexually transmitted infections were frequently managed using the following plants: Terminalia sericea, Strychnos cocculoides, Ximenia caffra, Cassia abbreviata, Cassia occidentalis, Combretum hereroense, Combretum imberbe, Dichrostachys cinerea, Boscia albitrunca, Momordica balsamina and Peltophorum africanum. Many of these plants have putative antimicrobial activities which may justify their roles as natural remedies for sexually transmitted infections. Further studies are needed to determine the dosages, minimum inhibitory concentrations, biological activities and toxicities, and characterise the plants' chemical compounds.

Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006–2012): Potential determinants and highlight of lessons learnt

Objective To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment (IPTp), given to pregnant women as early as possible during the second trimester in Zambia. Methods Data from four national malaria surveys (2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics (ANCs) who received two or more doses of sulfadoxine–pyrimethamine (IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake. Results The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012 (P < 0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012, IPTp2 uptake among women with no formal education increased from 51% to 68% (P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2% to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index (P = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas (OR = 1.56, 95% CI: 1.39–1.74), having college (OR = 1.83, 95% CI: 1.25–2.75) or secondary education (OR = 1.68, 95% CI: 1.44–1.96) or of being of higher wealth status (OR = 1.86, 95% CI: 1.60–2.17). Conclusions Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities.

Tuberculosis in the mines of Zambia: A case for intervention

Zambia is among the sub-Saharan countries highly burdened with tuberculosis (TB) and has an estimated prevalence rate of 638 per 100 000 population in those aged 15 years and above. The mining industry is the main contributor to the country's gross national product, although it is associated with public health challenges, with TB in the mines being among the occupational health diseases having a negative economic impact and threatening to delay the control of TB in the country. We reviewed available evidence on the extent of the burden of TB in the mines so as to inform the development of targeted interventions for the post-2015 End TB Strategy. This was a review of published data from Medline/Pubmed, Cochrane Library and Embase, including unpublished “grey” literature on the burden of TB and the risk factors of TB in the mines of Zambia. There is limited research in Zambia to fully understand the burden of TB and risk factors associated with TB in the mines. However, the few studies and data available have shown that TB is a significant health problem requiring interventions to improve the quality of life of miners, ex-miners and surrounding communities. TB is a potential problem in the mines of Zambia and the actual burden needs to be determined. Exposure to silica as a risk factor needs further investigation.

Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006-2012):Potential determinants and highlight of lessons learnt

Objective: To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment (IPTp), given to pregnant women as early as possible during the second trimester in Zambia. Methods: Data from four national malaria surveys (2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics (ANCs) who received two or more doses of sulfadoxine–pyrimethamine (IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake. Results: The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9%in 2006;and to 72%by 2012 (P<0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012, IPTp2 uptake among women with no formal education increased from 51% to 68%(P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2%to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index (P = 0.05). Incidence of malaria cases, hospital admissions and mortality during preg-nancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas (OR=1.56, 95%CI:1.39–1.74), having college (OR=1.83, 95%CI:1.25–2.75) or secondary education (OR=1.68, 95%CI:1.44–1.96) or of being of higher wealth status (OR=1.86, 95%CI:1.60–2.17). Conclusions: Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities.

Tuberculosis in the mines of Zambia:A case for intervention

Zambia is among the sub-Saharan countries highly burdened with tuberculosis (TB) and has an estimated prevalence rate of 638 per 100 000 population in those aged 15 years and above. The mining industry is the main contributor to the country's gross national product, although it is associated with public health challenges, with TB in the mines being among the occupational health diseases having a negative economic impact and threatening to delay the control of TB in the country. We reviewed available evidence on the extent of the burden of TB in the mines so as to inform the development of targeted interventions for the post-2015 End TB Strategy. This was a review of published data from Medline/Pubmed, Cochrane Library and Embase, including unpublished “grey”literature on the burden of TB and the risk factors of TB in the mines of Zambia. There is limited research in Zambia to fully understand the burden of TB and risk factors asso-ciated with TB in the mines. However, the few studies and data available have shown that TB is a significant health problem requiring interventions to improve the quality of life of miners, ex-miners and surrounding communities. TB is a potential problem in the mines of Zambia and the actual burden needs to be determined. Exposure to silica as a risk factor needs further investigation.

Decliners of provider-initiated HIV testing and counselling: Characteristics of participants who refused HIV testing in a population survey in Zambia

Objective: To assess the prevalence of HIV infection, to highlight HIV-testing refusal rates among participants in a population-based tuberculosis survey and to assess the implication for programme implementation. Methods: This cross-sectional study on the characteristics of participants who refused HIV testing was conducted in a national survey in Zambia. All eligible participants were aged above 15 years and included in the analysis. Results: Out of the 44 791 tuberculosis survey participants, 14 164 (31.6%) refused to participate in HIV testing. The unemployed, rural dwellers, married, and those aged 15- 24 years were associated with higher refusal rates. Conclusions: Strategies to improve HIV testing acceptance are necessary. Qualitative research is recommended to understand the reasons for testing refusals so that remedial interventions can be implemented.

Prevalence and burden of gastrointestinal helminths in wild and domestic guineafowls (Numida meleagris) in the Southern Province of Zambia

Objective: To determine the gastrointestinal tract helminthic fauna in domestic and wild guineafowl in Zambia. Methods: Post-mortem and laboratory parasitological examinations for helminth identification and enumeration were conducted on 198 guineafowls (148 domestic and 50 wild) from November 2010 to October 2011. Results: All guineafowls were infested with one or more helminths. Eleven helminth species, namely, Raillietina echinobothrida, Raillietina tetragona, Raillietina cesticillus, Ascaridia galli, Allodapa suctoria, Gongylonema ingluvicola, Tetrameres spp., Heterakis spp., Acuaria spiralis, Syngamus trachea, and Streptocara pectinifera were identified with no trematodes recorded. Mean nematode burden between domestic and wild fowl showed no differences having 113.7 [confidence interval (CI) 98.9-128.6] and 108 (CI 76.6-139.5) nematodes respectively. In contrast, female guineafowls had a mean of 151.9 (CI 128.4-177.8) nematodes per host which was significantly more than the males that had a mean of 79.6 (CI 66.8-94.4). However, there were differences in helminth species richness between domestic and wild guineafowls with domestic guineafowls having more species present at a mean of 4.2 (CI 3.91-4.44) than the wild ones at a mean of 3.4 (CI 2.92-3.88) but there were no sex differences. Eight of the eleven helminth species cooccurred in domestic and wild fowl and five of the helminth species had higher prevalence in domestic guineafowls. Conclusions: Syngamus trachea, Streptocara pectinifera and Acuaria spiralis are reported for the first time in domestic poultry in Zambia. This study represents the first comparative study of helminths in domestic and wild guineafowls at an interface area and adds to the knowledge base in a discipline where a dearth currently exists.