Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening.

BACKGROUND: A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS: This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS: Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION: The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

Significant decline in lymphatic filariasis associated with nationwide scale-up of insecticide-treated nets in Zambia.

Lymphatic filariasis (LF) is a mosquito-borne disease, broadly endemic in Zambia, and is targeted for elimination by mass drug administration (MDA) of albendazole and diethylcarbamazine citrate (DEC) to at-risk populations. Anopheline mosquitoes are primary vectors of LF in Africa, and it is possible that the significant scale-up of malaria vector control over the past decade may have also impacted LF transmission, and contributed to a decrease in prevalence in Zambia. We therefore aimed to examine the putative association between decreasing LF prevalence and increasing coverage of insecticide-treated mosquito nets (ITNs) for malaria vector control, by comparing LF mapping data collected between 2003-2005 and 2009-2011 to LF sentinel site prevalence data collected between 2012 and 2014, before any anti-LF MDA was started. The coverage of ITNs for malaria was quantified and compared for each site in relation to the dynamics of LF. We found a significant decrease in LF prevalence from the years 2003-2005 (11.5% CI95 6.6; 16.4) to 2012-2014 (0.6% CI95 0.03; 1.1); at the same time, there was a significant scale-up of ITNs across the country from 0.2% (CI95 0.0; 0.3) to 76.1% (CI95 71.4; 80.7) respectively. The creation and comparison of two linear models demonstrated that the geographical and temporal variation in ITN coverage was a better predictor of LF prevalence than year alone. Whilst a causal relationship between LF prevalence and ITN coverage cannot be proved, we propose that the scale-up of ITNs has helped to control Anopheles mosquito populations, which have in turn impacted on LF transmission significantly before the scale-up of MDA. This putative synergy with vector control has helped to put Zambia on track to meet national and global goals of LF elimination by 2020.

Isolation of Trypanosoma spp. from wild tsetse flies through procyclic expansion in Glossina morsitans centralis.

Procyclic trypanosomes from wild tsetse flies were membrane-fed to Glossina morsitans centralis in order to develop an optimal technique for propagating field isolates. A 70% success rate was achieved in isolating Trypanosoma simiae and a variety of genotypes of T. congolense originating from G. pallidipes, G. brevipalpis and G. swynnertoni. Parasites matured into forms infective for mammals, and could be maintained by passage of gut forms to new groups of flies. In experiments with laboratory stocks, we also passaged immature gut infections of T. congolense and T. brucei from various tsetse species to G. m. centralis. The optimal technique was investigated for procyclic T. congolense through addition of various compounds to goat blood using G. m. centralis and G. m. morsitans as recipients. From these experiments, many approaches to procyclic expansion appeared possible. However, a simple and practical method based on the use of fresh goat blood for rapid feeding of G. m. centralis is recommended. Application of this technique should aid in the resolution of questions relating to the cryptic diversity of Nannomonas trypanosomes in diverse host and vector communities.

Sleeping sickness and tsetse awareness: a sociological study among the Tambo and Lambya of the northern Luangwa Valley, Zambia.

Data on awareness of tsetse flies and knowledge of trypanosomiasis were collected in May, 1988, in the Luangwa Valley of Isoka District in the Northern Province of Zambia. One thousand and nine hundred adult males and females were interviewed. There was a high level of fly awareness among all the respondents, regardless of duration of residence and age groups. Malaria was considered as the most serious illness in the community, and hence overshadowed the impact of trypanosomiasis in the community. Disease awareness gravity cannot be attributed to individual's socio-economic levels.

PIP: In May 1988, tropical disease researchers interviewed 1940 Tambo and Lambya men and women living in 2 chiefs' areas (Katyetye and Mweniwisi) of the Luangwa Valley of Isoka District in the Northern Province of Zambia to determine their knowledge of trypanosomiasis (sleeping sickness) and tsetse flies. 98.4% of the respondents who had lived in the area for at least one month knew that tsetse fly bites transmitted trypanosomiasis. 94.2% of those who lived in the area for 1 month also knew this. Only people who lived in the area for 1 month believed that witchcraft and bad water transmitted sleeping sickness (0.9% and 0.1% respectively). Approximately 73% reported tsetse flies to be uncommon in their villages. Just 2% believed trypanosomiasis to be a leading disease because its treatment often requires a long hospitalization. Most people (74%) thought malaria to be the most serious disease, because it occurs frequently and kills many people. Tsetse flies become ubiquitous during the rainy season. Further the Tropical Disease Research Centre in Ndola, Zambia has found extremely high tsetse densities along access roads and paths connecting villages. The researchers planned to use these results in developing a parasite control project in the area. Community health workers trained under the Primary Health Care project could conduct health education sessions about sleeping sickness in the area to increase awareness of the seriousness of the disease.