Perspectives on factors influencing transmission of COVID-19 in Zambia: a qualitative study of health workers and community members.

OBJECTIVE: To explore the health professionals' and community members' perspectives on the factors influencing transmission of the novel COVID-19 in Zambia. DESIGN: An exploratory qualitative study using in-depth interviews as data collection technique. SETTING: Four primary healthcare facilities and local communities of Lusaka city and Chirundu international border town under Lusaka province, Zambia. PARTICIPANTS: Purposive sampling of 60 study participants comprising health professionals (n=15) and community members (n=45). Health staff were health inspectors and surveillance officers. Community members included public market traders, civic and religious leaders, immigration officers, bus and international truck drivers. RESULTS: Both health professionals and community members were aware of the COVID-19 pandemic, the preventive and control measures. Nevertheless, stark differences were observed on the two groups' perspectives on COVID-19 and the factors influencing its transmission. Most health staff expressed high personal risk and susceptibility to the disease and a positive attitude towards the prevention and control measures. Conversely, myths and misconceptions influenced most community members' perspectives on the disease and their attitude towards the COVID-19 guidelines. Participants were unanimous on the low levels of adherence to the COVID-19 preventive and control measures in the community. Reasons for non-adherence included limited information on COVID-19, negative attitude towards COVID-19 guidelines, social movement and travel patterns, networks and interactions, living and work conditions, water and sanitation facilities, and observation of behaviours of important role models such as politicians and other community leaders. These factors were perceived to increase the risk of COVID-19 transmission. CONCLUSION: These findings highlight important factors influencing transmission of COVID-19 in Zambia. Future interventions should focus on providing information to mitigate myths and misconceptions, increasing people's risk perception to the disease, and improving attitude towards the prevention and control interventions and mitigating structural and socioeconomic barriers.

Lay perceptions, beliefs and practices linked to the persistence of anthrax outbreaks in cattle in the Western Province of Zambia.

Anthrax, a neglected zoonotic disease that is transmitted by a spore-forming, rod-shaped bacterium, Bacillus anthracis, has reached endemic proportions in the Western Province of Zambia. Transmission of anthrax from the environment as well as between cattle has been observed to be partly because of entrenched beliefs, perceptions and traditional practices among cattle farmers in the known outbreak areas. This study was aimed at exploring lay perceptions, beliefs and practices that influence anthrax transmission in cattle of the Western Province. A mixed-methods study was conducted from August to December 2015. Quantitative data were collected using a cross-sectional survey. Qualitative data were generated by interviewing professional staff and community members. Five focus group discussions and five key informant interviews were conducted. Thematic analysis of interview data was performed using NVivo software. The findings suggested that cattle anthrax was biologically as well as culturally maintained. Cattle farmers were reluctant to have their livestock vaccinated against anthrax because of perceived low efficacy of the vaccine. Also, the cattle farmers did not trust professional staff and their technical interventions. Popular cultural practices that involved exchange of animals between herds contributed to uncontrolled cattle movements between herds and subsequent transmission of anthrax. These findings imply the need for professional staff to be culturally competent in handling socio-cultural issues that are known to be barriers for disease control in animals. There is a need to develop a policy framework that will foster integrated control of anthrax across disciplines.