Single-test syphilis serology: A case of not seeing the forest for the trees.

INTRODUCTION: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. METHODS: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. RESULTS: Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. CONCLUSION: Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.

Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia.

INTRODUCTION: Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs. METHODS: We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period. RESULTS: Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period. CONCLUSION: The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A.

Undernutrition in older children and adolescents in peri-urban Zambia.

Background: Adolescents make up roughly a quarter of the population in Zambia; however, most nutrition-related programming is targeted at the under-five population. Understanding the scale of undernutrition in older children and adolescents is fundamental to alleviating food insecurity and addressing undernutrition across all age groups. Methods: A cross-sectional survey was performed in four low-income, peri-urban compounds in Chilanga District which included anthropometric measurements of children between ages 6 months-19 years and a household-level diet diversity and food security questionnaire. Wasting was used for children under 5 and thinness for children 5-19 years. Descriptive analysis and multivariate logistic regression were conducted to quantify the prevalence and distribution of malnutrition and understand the impact of food security. Results: We surveyed 393 households and 1,004 children between the ages of 6 months and 19 years. Children aged 6-9 years had the highest prevalence of severe thinness (5.2%) and adolescents (10-19 years) had the highest rates of moderate thinness (6.5%). Across all age groups, more than 75% of children were in households that worried about running out of food in the previous month. 24.9% of adolescents and 28.4% of older children were in households were more likely to go a whole day without eating compared to 16.9% of children under 5. Conclusion: Our survey indicated that malnutrition in adolescents and older children living in Chilanga district was comparable to those under 5. Interventions to address undernutrition must be targeted at older children and adolescents in order to ameliorate this burden.

Impact of mHealth on contraceptive use among women and men of reproductive age in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: Around the world, the use of modern contraceptives has risen significantly, but the quality and reach of sexual and reproductive health services remains weak in the poorest countries. To address the high unmet need, an opportunity arises for mobile health technology (mHealth) to empower both clients and providers. However, evidence that mHealth is effective in increasing modern contraceptive use is limited and mixed, and we set out to assess its impact. METHODS: A systematic literature search from seven electronic databases was conducted using key search terms. Individually randomised controlled trials that compared modern contraceptive use in women and men using phone message interventions and those without the intervention were included. Stata was used to calculate pooled estimates of effect under the random-effects model, as well as produce the risk of bias using the Egger's regression method. GRADEpro GDT was used to assess the quality of individual studies. RESULTS: A pooled estimate of all of the studies showed a positive association between phone messages and contraception use, but no clear evidence of benefit (OR 1.12; 95% CI 0.97-1.29). Notably, pooled results of studies that reported modern contraceptive use as the primary outcome showed that mobile phone messaging was associated with an increase in the use of modern contraception (OR 1.22; 95% CI 1.01-1.47). CONCLUSIONS: The finding of this systematic review suggests that mobile phone message interventions utilising a behavioural change technique are an effective method of increasing modern contraceptive use among men and women of reproductive age in low- and middle-income countries though the effect is small.

OBJECTIF: Partout dans le monde, l'utilisation de contraceptifs modernes a considérablement augmenté, mais la qualité et la portée des services de santé sexuelle et reproductive restent faibles dans les pays les plus pauvres. Pour répondre à cet important besoin non satisfait, une opportunité se présente avec la technologie de la santé mobile (mHealth) permettant d'autonomiser à la fois les patients et les prestataires. Cependant, les preuves que mHealth est efficace pour augmenter l'utilisation de la contraception moderne sont limitées et mitigées, et nous avons entrepris d'évaluer son impact. MÉTHODES: Une recherche systématique de la littérature dans 7 bases de données électroniques a été menée à l'aide de termes de recherche clés. Des essais contrôlés randomisés individuels comparant l'utilisation de la contraception moderne chez les femmes et les hommes utilisant des interventions via des messages téléphoniques et ceux sans intervention ont été inclus. Stata a été utilisé pour calculer des estimations d'effet poolées selon le modèle à effets aléatoires, ainsi que pour produire le risque de biais à l'aide de la méthode de régression d'Egger. GRADEpro GDT a été utilisé pour évaluer la qualité des études individuelles. RÉSULTATS: Une estimation poolée de toutes les études a montré une association positive entre les messages téléphoniques et l'utilisation de la contraception, mais aucune preuve claire de bénéfice (OR 1,12; IC95%: 0,97­1,29). Notamment, les résultats poolés des études qui rapportaient sur l'utilisation de la contraception moderne comme critère principal ont montré que la messagerie par téléphone mobile était associée à une augmentation de l'utilisation de la contraception moderne (OR 1,22; IC95%: 1,01­1,47). CONCLUSIONS: Les résultats de cette revue systématique suggèrent que les interventions de messagerie par téléphone mobile utilisant une technique de changement de comportement sont une méthode efficace pour augmenter l'utilisation de la contraception moderne chez les hommes et les femmes en âge de procréer dans les pays à revenu faible ou intermédiaire, bien que l'effet soit faible.