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We conducted a systematic review to assess the scope and effectiveness of interventions to improve human papilloma virus (HPV) vaccination in Africa from 2006 to 2021. Systematic review. Four databases (Medline, Embase, CINAHL and PsycINFO) were searched for articles published between 2006 and 2021. Articles were screened and included based on eligibility criteria using DistillerSR (Version 2.35). Data were extracted and reported using a narrative synthesis. A quality assessment was also conducted for each study using validated quality appraisal tools. Out of 7603 articles identified by a systematic search, 18 articles met the inclusion criteria. Included studies comprised impact evaluation and cross-sectional studies published between 2012 and 2021 and conducted in eight African countries namely: Nigeria, Cameroon, South Africa, Kenya, Tanzania, Zambia, Mali, and Malawi. Study quality ranged from high to low quality. Interventions comprised fifteen educational and three multicomponent interventions. Out of thirteen impact evaluation studies (all educational interventions), twelve studies were effective in increasing HPV vaccine uptake and/or improving participants' knowledge, attitudes, and perceptions about the vaccine. Across five cross-sectional studies (two educational and three multicomponent interventions), HPV vaccine uptake rates ranged from 34% to 93.3%, with a consensus on safety and effectiveness in 67.9%–90.3% of participants post-intervention. Educational and multicomponent interventions have been implemented to improve HPV vaccination in Africa. While educational interventions have proven effective at improving HPV vaccine uptake, a more diverse range of interventions with robust impact evaluation study designs are needed to strengthen the available evidence and improve vaccine uptake. [ABSTRACT FROM AUTHOR]

The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG where we adapted the international recommendations for the emergency management of seizures in children beyond the neonatal period to suit the health care in Egypt. The quality of evidence and the strength of recommendations are indicated. This study aimed to standardize the treatment of acute epileptic seizures and to provide an easy-to-apply acute treatment protocol that will allow immediate and appropriate seizure control. This is part of a larger program by the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) in collaboration with the staff of pediatric departments of 15 Egyptian universities and the National Research Centre. EPG was affiliated later to the Supreme Council of the Egyptian University Hospitals aiming to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan (http://epg.edu.eg). The committee is guided by a formal CPG adaptation methodology: the "Adapted ADAPTE." The Egyptian Childhood Seizure Group (ECSG) reviewed the results of the Appraisal of Guidelines for Research and Evaluation II assessment and decided to adapt the recommendations of three source CPGs: American Epilepsy Society, Italian League Against Epilepsy, Neurocritical Care Society, and Neurologic & Psychiatric Society of Zambia. Eight implementation tools were included. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings. Our experience with this adaptation methodology provides useful insight into its national utilization in Egypt. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Sexual minority men (SMM) in Zambia face significant challenges including stigma, discrimination, and mental health issues, which further impact their HIV-related risk behaviors. This study aimed to investigate the associations between enacted stigma, substance abuse, HIV-related behaviors, and mental health (i.e., depression, anxiety, and post-traumatic stress disorder [PTSD] symptoms) among SMM in Zambia. SMM aged 18–35 years who reported having multiple and/or concurrent sexual partners or low and/or inconsistent condom use in the past three months were recruited from four districts in Zambia between February and November 2021. Participants completed an anonymous interviewer-administered survey. Key variables of interest were compared between participants with higher vs. lower levels of enacted stigma. Independent samples t -tests were used for continuous variables, and chi-squared tests were used for categorical variables. A total of 197 eligible SMM participated in the study (mean age = 24.41 years). Participants with a higher level of enacted stigma showed a higher level of anxiety symptoms (χ2 = 12.91, p ≤.001), PTSD symptoms (χ2 = 7.13, p <.01), tobacco use (χ2 = 10.47, p <.01), cannabis use (χ2 = 5.90, p <.05), and a higher number of sexual partners (t = 1.99, p <.05) in the past three months. Stigma reduction interventions may help mitigate substance abuse, HIV-related behaviors, and adverse mental health outcomes among SMM in Zambia. Health care providers, especially psychiatric-mental health nurses, can incorporate strategies for recognizing and addressing stigma into their practice through training and integrate multiple resources to create an inclusive and non-judgmental environment for SMM to improve their well-being. • In Zambia, enacted stigma among SMM is associated with mental health issues. • Enacted stigma relates to tobacco use, cannabis use, and a higher number of sexual partners. • Stigma reduction interventions are needed to reduce substance abuse and HIV-related risk behaviors. [ABSTRACT FROM AUTHOR]

Enterotoxigenic Escherichia coli (ETEC) is an important cause of moderate to severe diarrhoea in children for which there is no licensed vaccine. We evaluated ETVAX®, an oral, inactivated ETEC vaccine containing four E. coli strains over-expressing the major colonization factors CFA/I, CS3, CS5, and CS6, a toxoid (LCTBA) and double mutant heat-labile enterotoxin (dmLT) adjuvant for safety, tolerability, and immunogenicity. A double-blind, placebo-controlled, age-descending, dose-finding trial was undertaken in 40 adults, 60 children aged 10–23 months, and 146 aged 6–9 months. Adults received one full dose of ETVAX® and children received 3 doses of either 1/4 or 1/8 dose. Safety was evaluated as solicited and unsolicited events for 7 days following vaccination. Immunogenicity was assessed by evaluation of plasma IgA antibody responses to CFA/I, CS3, CS5, CS6, and LTB, and IgG responses to LTB. Solicited adverse events were mostly mild or moderate with only 2 severe fever reports which were unrelated to the vaccine. The most common events were abdominal pain in adults (26.7 % in vaccinees vs 20 % in placebos), and fever in children aged 6–9 months (44 % vs 54 %). Dosage, number of vaccinations and decreasing age had no influence on severity or frequency of adverse events. The vaccine induced plasma IgA and IgG responses against LTB in 100 % of the adults and 80–90 % of the children. In the 6–23 months cohort, IgA responses to more than 3 vaccine antigens after 3 doses determined as ≥2-fold rise was significantly higher for 1/4 dose compared to placebo (56.7 % vs 27.2 %, p = 0.01). In the 6–9 months cohort, responses to the 1/4 dose were significantly higher than 1/8 dose after 3 rather than 2 doses. ETVAX® was safe, tolerable, and immunogenic in Zambian adults and children. The 1/4 dose induced significantly stronger IgA responses and is recommended for evaluation of protection in children. Clinical trials registration: The trial is registered with the Pan African Clinical Trials Registry (PACTR Ref. 201905764389804) and a description of this clinical trial is available on: https://pactr.samrc.ac.za/ Trial Design. [ABSTRACT FROM AUTHOR]

Cashew (Anacardium occidentale Linn.) is an important cash crop in Zambia. However, the cashew production is about 3–20 kgs/tree and the quality of the nuts is extremely poor due to the use of unimproved cashew genotypes. There are variations in cashew trees grown in farmers' fields because cashew is highly cross pollinated. As a short-term measure, farmers are currently planting cashew polyclonal seeds imported from Tanzania. Nevertheless, there are numerous cashew germplasm that were introduced to Zambia since 1940s. These cashew trees have adapted to the local environment and a small proportion of them are high yielding with good nut quality. Researchers need to identify these genotypes in farmers' fields and collect them as mother trees to initiate a cashew breeding programme. In Zambia, cashew research is still at its infancy hence the knowledge and skills are still low among the small-scale cashew farmers. Though cashew improvement programmes are being developed in several countries, there is enormous knowledge and technologies that have been generated from some cashew producing countries which could be adopted and later adapted in Zambia to revamp the whole cashew value chain. The approaches to accelerate cashew improvement in Zambia include; evaluation of germplasm for genetic diversity, conservation of germplasm, introduction of new alleles, selection of elite materials, vegetative propagation techniques, hybridization and marker assisted selection. This paper reviews the various knowledge, technologies and approaches that have been developed over time for cashew improvement and discusses their implication to the Zambia cashew industry. • Cashew is an important cash crop in Zambia. • Its yields are very low due to use of unimproved genotypes. • Since 1940s, many cashew germplasm varieties have been brought to Zambia. • However, cashew growers have limited knowledge and expertise in cashew genotypes. • Thus, germplasm diversity evaluation is vital to speed up cashew improvement. [ABSTRACT FROM AUTHOR]

Medical and rehabilitative advances increasingly transform management of rare genetic neuromuscular diseases (GNMDs) for children in the global north. Lack of information about GNMDs and related health care needs in sub-Saharan Africa threatens to widen pre-existing health disparities. This is a cross-sectional study of probands enrolling in a study of GNMDs at the University Teaching Hospital in Lusaka, Zambia, a member of the International Consortium for Genomic Medicine in Neuromuscular Disease. Probands/caregivers were interviewed about utilization of medical, rehabilitative, and other support services by a research assistant. A neuromuscular neurologist and/or physiotherapist examined each case and completed an independent questionnaire regarding health service utilization for each proband. Diagnoses were made on available clinical and electrophysiologic data. Molecular findings were unavailable at the time of this analysis. Among 50 probands, 52% were male with median age 12 (absolute range 2 months to 54 years). Motor neuron diseases (n = 16; 32%), muscle disorders (n = 20; 40%), and inherited polyneuropathies (n = 5; 10%) were most common. Six (15%) cases had insufficient clinical data to classify the GNMDs. Outside of primary care, patient/caregiver-reported access to recommended health services (n = 34; 69%) was challenging. Large disparities in current utilization of health care services versus clinician-recommended services are reported. Paradigms to improve access to diagnostics and therapeutic interventions are needed for GNMDs in Zambia. Multidisciplinary clinics may improve access and utilization of needed health services. Qualitative and other research focused on improving referrals, access, and quality of available health services are greatly needed. [ABSTRACT FROM AUTHOR]

Although research has demonstrated that the COVID-19 pandemic has increased the likelihood of children experiencing domestic abuse, few empirical studies have focused on the most vulnerable communities in developing countries. This study aimed to evaluate the impact of the COVID-19 pandemic on domestic violence towards children in Kenya and Zambia. In collaboration with an international non-governmental organisation (NGO), an original door-to-door survey of 842 children and their parents (or adult guardians) was conducted in Kenya and Zambia. The survey sites were carefully selected to target economically underprivileged communities with the presence of NGOs as well as those without. Using multivariate regression analysis of child and parent survey responses, we attempted to identify how parents' experiences of COVID-19 affected children's exposure to domestic violence. Our analysis of domestic violence included both emotional (psychological) and physical violence. Children from households whose guardians perceived a strongly negative effect of COVID-19 were more likely to experience domestic violence. The correlation was statistically significant for both emotional and physical violence. In Kenya, children in communities with NGO presence were less likely to experience domestic violence. The COVID-19 pandemic has exposed children to an increased risk of experiencing domestic violence. Children from underprivileged communities in developing countries are particularly vulnerable to such risk, as they tend to lack social support from communities and governments. International organisations must pay more attention to these children during the pandemic. [ABSTRACT FROM AUTHOR]

We identified a ca. 180 Ma diamondiferous lamproite event in Zambia, establishing a link between ultrapotassic volcanism and the early Jurassic Karoo flood basalt province of sub-Saharan Africa. The cratonic lamproites erupted through the Permo–Triassic Luangwa Rift structure, but MgO-rich ultrapotassic magma formation was unrelated to rifting and triggered by plume–lithosphere interactions during the Karoo LIP event. Elevated Li–Zn–Ti concentrations in magmatic olivine (up to 18.5 ppm Li at 86–90 mol.% forsterite) and strong Sr–Nd–Hf–Pb isotopic enrichment of the host lamproites (87Sr/86Sr = 0.70701–0.70855, εNd = −10.8 to −10, εHf = −20.3 to −19.1, 206Pb/204Pb = 16.8–17.5) suggest partial melting of phlogopite-metasomatized lithospheric mantle domains, at approximately 180–200 km depth. The mantle-like δ7Li values (+2.8 to +5.7‰) of the most pristine lamproite samples are compatible with source enrichment by asthenosphere-derived melts, without significant involvement of recycled sedimentary components. This geochemical fingerprint stands in sharp contrast to the negative δ7Li compositions of primitive K-rich volcanic rocks from collision zone settings, where the shallow mantle sources contain recycled sediment. Isotope modelling demonstrates that the sub-Saharan lamproites originate from a MARID-style metasomatized peridotitic mantle source that underwent incompatible element enrichment at ca. 1 Ga, during tectonic activity associated with Rodinia supercontinent formation. Plume-sourced basaltic and picritic magmas of the 180 Ma Karoo LIP interacted with such K-rich hydrous lithospheric mantle domains, thereby attaining enriched incompatible element and radiogenic isotope compositions. Nd–Hf isotope mass balance suggests that up to 25% of MARID-sourced lamproite melt component contributed to some of the high-Ti flood volcanic units. Although large quantities of volatiles can be transferred from Earth's mantle to the atmosphere via plume–lithosphere interactions, it is unlikely that outgassing of mantle-sourced sulphur can exceed the climatic impact caused by the release of much more abundant carbon from thick continental roots. Thus, the excess SO 2 required to account for transient atmospheric cooling during the early Jurassic, coincident with the Karoo LIP event, must have had a thermogenic origin near the surface of Earth. [ABSTRACT FROM AUTHOR]

There is increasing recognition of the role of Indigenous and local knowledge systems in sustainable land use and conservation practices. However, the evidence base remains fragmented, while local knowledge remains marginalised in many national biodiversity strategies and development plans. This applies to the Tonga people of Zambia and Zimbabwe. Here, we synthesise existing evidence of Tonga knowledge and practices to explore their potential contribution to the implementation of integrated landscape approaches that aim to incorporate multiple stakeholders' objectives in landscape-scale management. Based on a semi-systematic literature review, we identify how various dimensions of Tonga knowledge contribute to biodiversity, food security, soil conservation, and other well-being dimensions. Research gaps identified include significantly less documented evidence of Tonga knowledge and practices in Zimbabwe and limited attention to the biophysical impact of local practices on land and natural resources. Furthermore, there is limited attention to the historical processes that have led to the erosion of Tonga local knowledge and the political disempowerment of Tonga knowledge holders. The findings contribute to greater recognition and validation of Tonga local knowledge and practices in natural resource governance, particularly how such knowledge can contribute to integrated landscape governance. Finally, the review helps to define a future research agenda based on the knowledge gaps identified. • Indigenous local knowledge can enhance human-nature relationship. • Valuing different knowledges can reinforce participatory processes. • There is limited attention to the historical processes that have led to the erosion of local knowledge. • There is limited attention to the political empowerment of knowledge holders. [ABSTRACT FROM AUTHOR]

This study assesses the technical resource potential for floating solar photovoltaic systems on Zambia's existing hydro-based power plants. The research uses System Advisor Model (SAM) and has made some input changes to adapt the standard photovoltaic performance model to Floating Solar Photovoltaics. The input changes are the tilt angle and the losses. Tilt has been taken as 5o, while the soiling losses have been taken as zero (0). Zambia's theoretical maximum floating solar photovoltaic potential (100% coverage) was found to be 254.083 GWp. The floating solar photovoltaic potential in Zambia at 10% coverage is the best option. It was found to be 25.408 GWp, while the energy generated was 43,448.1212 GWh. Compared to the total installed electricity (3.011) GW, this power is 8 times more than the current installed capacity. Kariba dam shows the highest potential of 24.461 GWp, followed by Itezhi Tezhi (0.506 GWp), Kafue Gorge Upper (0.393 GWp), Mita Hills (0.0314) GWp, Mulungushi Dam (0.0131) GWp, and Kafue Gorge Lower (0.0043 GWp). The country has an average photovoltaics electricity daily output ranging from 4.54 to 4.85 kWh/kWp, which equates to 1658 to 1772 kWh/kWp totals. The findings of this study will increase public awareness of floating solar photovoltaic systems and It will allow the government and investors to consider investing in the technology. This shall ultimately increase power generation in Zambia, helping to alleviate the country's 0.81 GWp power deficit. The National Energy Policy facilitates the development and deployment of renewable and alternative energy sources like hydropower and solar photovoltaic power. Through this policy, an assessment of the resource potential for ground-mounted Solar photovoltaics has been conducted. The policy does not mention the new technology of floating solar photovoltaic systems, which benefits from an increased energy yield due to the cooling effect of water since it is located on the water's surface. Lower shading, decreased civil works, lower grid interconnection costs, reduced water evaporation, enhanced water quality, lowered algae blooming, and valuable land are released for other uses, such as agricultural land or residential developments, when existing water reservoirs are used. Some potential benefits come with the new technology, although it is still nascent. [ABSTRACT FROM AUTHOR]

The study explores the techno-economic feasibility and viability of a Photovoltaic-Diesel Hybrid system for rural electrification in sub-Sahara Africa with a case study of Chilubi island, a remote district without access to electricity in the Northern Province of Zambia. Using HOMER (Hybrid Optimization of Multiple Electric Renewables) Pro software, the best and most feasible technical solutions through different hybrid system configurations, combinations and the district's rate of access to electricity were considered based on the least Levelized Cost of Energy (LCoE) and life cycle costs of the project. The results show that operating diesel generators as stand-alone is not economically sustainable and has a high LCoE. Influencing factors include variability in diesel pump prices, high fuel transportation costs, high cost of operation and maintenance, among other factors of concern. 100% photovoltaic (PV) with a battery system gave the lowest LCoE. However, the initial capital cost of solar energy projects in Zambia is relatively high compared to the equivalent diesel-based plants, as shown herein. It explains why diesel power plants are favoured for off-grid settlements. On the hand, the low operational cost and LCoE of PV power plants favour rural districts as they offset the high initial capital costs. Additionally, the continued downward trend in the cost of PV installations per kWp has opened discussions among policymakers and energy planners in Zambia to favour rural electrification with renewable energy-based power generation. This study contributes to this discussion. • Grid extension is costly for rural electrification in Southern Africa. • Offgrid PV-Diesel generation microgrids are options for cheaper electricity. • Techno-economic analysis herein favours high penetration of PV and storage. • $ 1 increase in fuel increases LCoE by $ 0.283 and vice versa. • PV-hybrids are expensive and may require government interventions to implement. [ABSTRACT FROM AUTHOR]

• In Zambia, injuries are a major public health issue contributing to 1 in 5 premature deaths and 7% of all deaths annually. • A high burden of injury-related death and disability and a paucity of detailed information and actions addressing that high burden are two fundamental issues that frame the injury situation in Zambia. • A suggested action and research recommendations for evidence, policy, and interventions in include allocating resources towards systematically collecting data on injuries that can be used to inform national policy; using evidence-based targets to enforce and monitor the success of injury-prevention policies; expanding training programs at all levels to establish a robust program that can prevent and manage injuries. Injuries are predicted to become a greater cause of mortality than communicable diseases in sub-Saharan Africa by 2030, signaling a public health dilemma for governments and citizens in each country. This article uses epidemiological estimates of injuries in Zambia, considers the socio-economic impact of injuries, examines current policies for prevention, and provides a rapid situation analysis to help develop an action and research agenda for injury prevention in the country. It calls for better epidemiological data, capacity building for human resources, and adoption of evidence-based targets and interventions. For Zambia to reduce its burden of injuries, funding for research and training should be integral to the future of its national health agenda. [ABSTRACT FROM AUTHOR]

Like many other examples of the ongoing global land rush, a large Zambian land deal initiated by a European agribusiness in 2012 was met with cries of alarm from international critics about the amount of land purchased and the negative impact the investment could have on local residents. The agribusiness, however, responded relatively quickly. Not only did this initially contribute to protecting the position of (affected) residents, but it also enhanced the image of the agribusiness as a corporation willing to listen to concerns. As with land deals elsewhere, though, the situation looks much different ten years on, with the project not living up to its promises, either financially or regarding rural residents. To better understand these discrepancies, a closer look at various temporalities together is revealing – importantly, as others have discussed, because tensions between temporal dimensions of finance and agriculture frequently affect land deals. But simultaneously, as the Zambian case demonstrates, (international) critics, such as advocacy groups, NGOs, and media, operate according to particular temporal dynamics – with attention devoted to the investment fluctuating over time – while (local) stakeholders, including neighbouring rural residents and state institutions refraining from enforcing the agribusiness to honour agreements along the line, also affect developments. Through analysing these temporalities over an extended period of time, this article aims to contribute to an understanding of challenges involved in holding land deals to account. Accordingly, broader lessons can be drawn about the ambiguous potential for mitigating negative effects of large-scale land acquisitions – and corporate practices more generally. [ABSTRACT FROM AUTHOR]

Pediatric postoperative neurosurgical care is an essential component of a child's treatment pathway. It is important to better understand how neurosurgeons in lower middle-income countries (LMICs) have been able to address socioeconomic and systemic factors to improve their patients' access to quality pediatric postoperative neurosurgical care. We aim to characterize the pediatric neurosurgical postoperative system in place in Zambia and to discuss how these efforts have been implemented to improve outcomes and address socioeconomic barriers to accessing health care. We acquired a patient list of 90 tenants of House of Hope (HOH)—an out-of-hospital center caring for children awaiting surgery, as well as those recovering from surgery. Of the patient list, 44 patients qualified for our study. Survey responses and occurrence of demographic and clinical characteristics were calculated. Non-normally distributed variables (age) were reported by median and interquartile range (IQR). Dichotomous variables were presented as percentages. Fisher's Exact test was applied to compare categorical data and hospital re-admission. A P -value of <0.05 was considered significant. Our study demonstrates two key findings: (1) low 30-day hospital re-admission rate of 9% and (2) favorable postoperative experience by patient families. Of the 44 patients, a majority were 1-year-old children (n = 31, 70%) and female (n = 24, 55%) (IQR 1–2 years). Presenting conditions included: hydrocephalus only (n = 35, 80%), hydrocephalus and myelomeningocele (n = 5, 11%), myelomeningocele only (n = 2, 5%), cerebral palsy (n = 1, 2%), and encephalocele (n = 1, 2%). Half (n = 22, 50%) of the patients lived in east Zambia, 8 (18%) lived in central, 8 (18%) in north, 5 (11%) in south, and 1 (2%) in west Zambia. We report the first qualitative and quantitative analysis of postoperative care for LMIC pediatric neurosurgical patients in the academic literature. Quality, patient-centered postoperative pediatric neurosurgical care that is rooted in addressing socioeconomic determinants of health produces good outcomes in LMICs. [ABSTRACT FROM AUTHOR]

• From 2018 to 2020, Zambia recorded an increase in TB notifications in the patients ages 45 and above • An increase in drug resistant TB cases detected by GeneXpert MTB/RIF were seen • Bacteriologically confirmed TB cases were more than the clinically diagnosed. • Negative growth in case detection of childhood TB Zambia is one of the TB high-burden countries. It is important to track the progress being made towards enhancing case finding and reducing mortality. We reviewed routine TB notifications and mortality trends, over a decade from all facilities in Zambia. A 10-year retrospective study of TB notifications and mortality trends was performed using a Joint Point Analysis version 4.9.0.0, NCI. We extracted the annual national TB program data for the period under review. There was a decline in annual point average for notification between 2010 and 2020 in both males and females, but the females notification rates had a higher rate of decline (AAPC = -6.7, 95%CI:-8.3 to -5.0), p<0.001) compared to the decline in males notification rate (AAPC = -4.1, 95%CI:-4.1 to -5.1, P<0.001). We found a significant growth rate in the proportion of TB patients that were bacteriologically confirmed (AAPC = 6.1, 95% CI: 3.6 to 8.7, p< 0.001), while the proportion of clinically diagnosed patients declined (AAPC= -0.1, 95%CI: -2.3 to 2.1, p<0.001). Notification of drug-resistant TB increased exponentially (AAPC=27.3, 95% CI: 13 to 41), p< 0.001) while mortality rate declined from 21.3 in 2011 to 12.7 in 2019 per 100,000 population (AAP=-5.6, 95%CI: -9.6 to -1.5, p=0.008). This study has illustrated the importance of reviewing and analyzing routinely collected TB data by national programs. The study revealed areas of improvement in terms of TB control and underscores the need for increased and sustained investment in case detection and diagnostics. [ABSTRACT FROM AUTHOR]

• Forensic autopsies of community deaths show incidental, undiagnosed TB cases • Undiagnosed TB and related deaths reveal gaps in TB control programs • TB remains an important public health problem in Lusaka, Zambia • Low social-economic status and TB are intertwined in these cases Tuberculosis remains a global emergency. In Zambia only 55% of tuberculosis cases are diagnosed. We performed a study to determine incidental cases of tuberculosis seen at forensic autopsy of individuals who died suddenly and unexpectedly in the community in Lusaka, Zambia. Whole-body autopsies were performed according to Standard Operating Procedures. Representative samples obtained from relevant organs were subjected to pathological examination. Information on circumstances surrounding the death was obtained. Data on patient demographics, gross and microscopic pathological findings, and cause(s) of death were analysed. Incidental tuberculosis was found in 52 cases (45 male, 7 female, age range 14-66) out of 4286 whole-body autopsies. 41/52 (80%) were aged 21-50 years. One was a 14-year old boy who died during a football match. 39/52 (75%) deaths were attributable specifically to tuberculosis only. Other deaths were due to acute alcohol intoxication(4), violence(7), ruptured ectopic pregnancy(1), bacterial meningitis (1). All the cases were from poor socio-economic backgrounds and lived in high-density areas of Lusaka. Incidental cases of active tuberculosis undiagnosed antemortem seen at forensic autopsy reflects major gaps in the national TB control programs. More investments into proactive screening, testing, treatment activities, and accurate data collection are required. [ABSTRACT FROM AUTHOR]

Background: Injuries are a significant cause of mortality and morbidity, particular in low- and middle-income countries (LMICs). While there is a focus on increasing injury care capacity, less attention is given to assessing, improving, and understanding the quality of care provided, especially from a patient perspective. This study therefore aims to understand what patients from a Zambian orthopaedic ward believe good quality care to be, to identify its key components, and contribute to better understanding what patients believe local healthcare priorities could be.Methods: Patients admitted to the orthopaedic ward of a Zambian tertiary care hospital were invited to take part in-depth face-to-face interviews. Interviews were continued until thematic saturation was achieved. Interviews were recorded and transcribed. Analysis was done using an inductive grounded theory approach.Results: Of 13 patients approached, 12 consented to take part. Analysis of the themes from the transcripts led to the emergence of four core categories of quality care which are important to the patient: i) restoring the patient to normality (category: 'restoring normality'), ii) establishing trust between patients and providers ('trusting the provider'), iii) respecting the patient and allowing them to maintain autonomy ('autonomy and respect') iv) finding ways for patients to enjoy their time in the hospital ('enjoying life'). From these results, a patient perspective theory of quality care emerged. This theory posits the idea that high-quality care in this context needs to fulfil these four core categories. Additionally, these core categories were ranked on significance and priority.Conclusion: The hierarchy of core categories could help to identify areas to improve care quality in this setting. Not only has this study helped to determine local priorities for achieving high-quality care but can encourage others to test injured patient perceptions of care quality in comparable settings. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women ages 15–24 experience high rates of gender-based violence (GBV), underpinned by gender and social norms that shape their transitions to adulthood. For interventions that seek to leverage and build on existing infrastructure for health service provision, it is important to understand how gender norms operate in the background and how they shape service engagement or non-engagement. In formative work for our project, Screen & Support, outside of Lusaka, Zambia, we engaged in community conversations with adolescent girls and young women to understand common types and experiences of violence, perceptions of what causes violence, and pathways to post-violence service access. This manuscript explores emerging findings surrounding social and gender norms. We engaged n = 12 adolescent girls and young women ages 15–24, including survivors of GBV, young women living with HIV, and young married women in separate conversations conducted in a mix of Nyanja, Bemba, and English. Arts-based activities accompanied guided focus group discussions. Translated transcripts were coded and thematically analysed by two authors using Dedoose software. Key themes emerged around two major themes—understanding the norms underpinning violence, and observing how these norms were activated in the aftermath of violence. Sub-themes focused on power differentials supporting violence, social expectations and community-enacted sanctions, and understanding dominant norms and assumptions. Considering what unfolded in the aftermath of violence, young women participants considered key reference groups upholding norms, explored the contexts where norms may be contested or become more complicated, and described how accepting silence was a common means of closure. We discuss the implications of these findings for programme design, delivery, and evaluation, as well as the potential, and roadmap, for shifting norms that negative affect adolescent girls and young women. • Adolescent girls and young women noted dominant gender norms perpetuating violence. • There were critical reflections on spaces for dissonance, resistance, and change. • Future work should engage diverse stakeholders to shift to healthier norms. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study was based on two premises; the ultimate objective of hydrological modelling is a contribution to sustainable water resources management, and the inherent uncertainties in model results should be realistically quantified. The study uses methods of uncertainty analysis that have been previously applied in the southern Africa region which are based on constraining model outputs using the likely ranges of a set of hydrological indices. One objective was to offer suggestions for sound modelling practice and highlight potential problems. The approach is applied to two case studies where there are very limited streamflow observations. The uncertainty ensemble outputs from the hydrological model are input into a water supply allocation model to assess system performance under different abstraction scenarios. The results are compared with the limited available evidence of system performance and the conclusion is that the uncertainty bands are generally acceptable for future decision making. • A combined modelling approach is applied using a hydrological and water allocation model, both with uncertainty assessments. • The uncertainty approach uses the likely ranges of model-independent hydrological signatures to constrain model outputs. • The approach is applied to a municipal water supply scheme in South Africa and an irrigation scheme in Zambia. • The results highlight the risks associated with different management options in both examples. [ABSTRACT FROM AUTHOR]

Theileriosis caused by Theileria parva infections is responsible for high cattle mortalities in Zambia. Although infected buffalo are a risk to cattle, the characterization of T. parva parasites occurring in this host in Zambia has not been reported. Furthermore, considering the advances in the development of a p67 subunit vaccine, the knowledge of p67 genetic and antigenic diversity in both cattle and buffalo associated T. parva is crucial. Therefore, blood samples from buffalo (n=43) from Central, Eastern and Southern provinces, and cattle (n=834) from Central, Copperbelt, Eastern, Lusaka, and Southern provinces, were tested for T. parva infection and the parasites characterized by sequencing the gene encoding the p67 antigen. About 76.7 % of buffalo and 19.3 % of cattle samples were PCR positive for T. parva. Three of the four known p67 allele types (1, 2 and 3) were identified in parasites from buffalo, of which two (allele types 2 and 3) are associated with T. parva parasites responsible for Corridor disease. Only allele type 1, associated with East Coast fever, was identified from cattle samples, consistent with previous reports from Zambia. Phylogenetic analysis revealed segregation between allele type 1 sequences from cattle and buffalo samples as they grouped separately within the same sub-clade. The high occurrence of T. parva infection in buffalo samples investigated demonstrates the risk of Corridor disease infection, or even outbreaks, should naïve cattle co-graze with infected buffalo in the presence of the tick vector. In view of a subunit vaccine, the antigenic diversity in buffalo associated T. parva should be considered to ensure broad protection. The current disease control measures in Zambia may require re-evaluation to ensure that cattle are protected against buffalo-derived T. parva infections. Parasite stocks used in 'infection and treatment' immunization in Zambia, have not been evaluated for protection against buffalo-derived T. parva parasites currently circulating in the buffalo population. • Buffalo in Zambia harbour East Coast fever (ECF) and Corridor disease parasites. • p67 allele type 3 is common in buffalo-derived T. parva strains from Zambia. • p67 antigen epitope TpM12 is more prone to mutations, especially in allele type 3. • Cattle in Zambia are at risk of Corridor disease infection. • Zambian ITM vaccine stocks need evaluation for efficacy against Corridor disease. [ABSTRACT FROM AUTHOR]

Environmental degradation due to human economic activities is closely linked to poverty in developing countries and can have long-term effects on well-being and sustainable development. This study investigates the nexus between toxic pollution and poverty by examining the economic impacts of lead (Pb) exposure on household welfare in Kabwe, Zambia. Kabwe, once a lead and zinc mining center, is now one of the world's most polluted urban areas, with high soil and air lead levels posing substantial health risks. We conducted a household survey and collected blood samples, matching socioeconomic data with blood lead levels (BLLs). Our empirical strategy uses variations in soil lead concentration across Kabwe neighborhoods to assess the causal impact of lead exposure on household welfare dimensions, such as consumption, education, health, and labor supply. Results show that a 1% increase in adult BLLs reduces per capita household consumption by 0.1–0.2% and increases the probability of being below the poverty line. Additionally, BLLs negatively affect adult health and children's schooling, while healthcare costs and labor supply remain unaffected. These findings suggest that lead exposure exacerbates poverty, hinders human capital accumulation, and has long-lasting implications for sustainable development. • Investigates the nexus between toxic pollution and poverty in Kabwe, Zambia. • Uses soil lead concentration variations to assess the causal impact of lead exposure on household welfare. • A 1% increase in adult blood lead levels decreases per capita consumption by 0.1-0.2% and increases the poverty risk. • Lead exposure harms adult health and children's schooling, while healthcare costs and labor supply remain unaffected. • Highlights lead exposure's enduring effects on human capital and poverty. [ABSTRACT FROM AUTHOR]

• Displacing fossil fuels are imperative for climate change mitigation. • Uncritically unleashed, alternatives dispossess resource dependent peoples. • Solar "Parks" in Rajasthan are causing the premature death of agrarian lifeways. • Ambitions for "green" extractivism in Luapula undermine sustenance of villagers. • Our cases show how energy transitions can produce exposure to premature death. Sixty-five million years into the era of New Life (the Cenozoic), we find ourselves in what might be the Cenozoic's last epoch, the Necrocene. To mitigate the crises provoked by exhuming and burning dead matter (i.e. fossil fuels) from the depths of the earth, the industrialized world has reached a consensus to build massive infrastructures for lower-carbon energy and rapidly electrify all sectors. Through international agreements that take a techno-managerial approach to decarbonization, nation-states have committed to solutions that require an unprecedented demand for the extraction of transition materials (e.g. cobalt, copper, manganese), alongside the appropriation of land used for centuries by agropastoralists for subsistence and the more-than-human as a habitat, with the moral rectitude of taking climate action. Despite a deluge of scholarly work illustrating the futility of decoupling such transitions from environmental destruction, climate mitigation through technological substitution continues its march toward economic growth, fed by the logic of "green" extractivism. In this study, we interrogate the utopian discourses of energy transitions by drawing from fieldwork examining the implementation of industrial-scale solar plants in Rajasthan, India, and on a potential resource frontier in Luapula, Zambia for the high-grade manganese required in electric vehicle batteries. We ask whether lower-carbon energy transitions create conditions of precarity and death. The two case studies reveal a trajectory that exacerbates precarity and hastens social and premature death in deeply unequal ways, underpinned by ongoing climate coloniality: the essence of electrified Necropolitics in the Necrocene. [ABSTRACT FROM AUTHOR]

Rural livelihood diversification can improve food security at the household level. However, a large majority of the research has focused on male-headed households, thus overlooking experiences of female-headed households that constitute a significant portion of households in low-income and middle-income countries. This paper explores how on-farm livelihood diversification affects female-headed households' food security experiences. Using interviews and focus group discussions, the paper finds that on-farm diversification improves female-headed households' food security. The paper also finds that on-farm diversification was more effective in improving the food security experiences of female-headed households compared with off-farm diversification. Further, the additional income from diversification creates additional benefits, including empowering women and allowing them to further diversify their livelihoods. • Female-headed households are neglected in rural livelihood diversification research. • On-farm diversification can improve female-headed households' food security. • On-farm diversification can improve women's empowerment. • On-farm activities support off-farm diversification in female-headed households. [ABSTRACT FROM AUTHOR]

• vSTEP 2.0 is a fully-virtual leadership program for supply chain professionals in LMIC settings. • We achieved high levels of engagement and significant gains in leadership competencies. • Participants led "transformation projects" with impact on supply chain performance. • We demonstrate high levels of demand for the program and feasibility of a fully virtual model. Equipping supply chain professionals at all levels of the health care systems with essential leadership and management skills is essential to achieving global immunization targets. Numerous and diverse professional development initiatives have been established to support vaccine supply chain managers in Gavi-eligible countries. However, COVID-19 catalyzed rapid innovation in approaches to support leadership development in times of rapid change, and systematic evaluation of these approaches can inform future workforce development strategies to ensure resilient health systems. Therefore, we sought to evaluate outcomes and short-term impact of the fully virtual Strategic Training Executive Program 2.0 (vSTEP 2.0) program in Zambia on participant engagement, skill development, and application of new skills to improve supply chain performance. We used a multi-method design to describe the outcomes and short-term impact of vSTEP 2.0 at three levels: (1) delegate response to the training experience (including participation, completion, and satisfaction); (2) delegate change in leadership skill (including achievement of learning objectives and change in competencies); and (3) application of new skills to impact supply chain performance. The program achieved high levels of engagement and an 83% graduation rate despite the length and rigor of the program. High satisfaction was evidenced by positive feedback from delegates on the quality and relevance of the program, especially in the context of COVID response (100% would "definitely" recommend). Delegates demonstrated significant growth in all domains of leadership competencies and applied their learnings to address a complex challenge in supply chain performance in their home organization. These findings demonstrate a strong appetite for leadership development support among vaccine supply chain professionals, especially in times of rapid change such as during the COVID response. These results also demonstrate the feasibility and impact of a fully virtual model for leadership development, with implications well beyond the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

• D. chamaethamnus demonstrated antiplasmodial activity against the chloroquine-sensitive (D10) strain. • Both aqueous and organic extracts exhibited prominent antioxidant activity. • Biologically active compounds found in the extracts of D. chamaethamnus are known to have antimicrobial properties including antimalarial activity. Diospyros chamaethamnus, a low woody perennial, which is endemic to Namibia, Botswana, Angola, and Zambia, is used in the management of malaria. The current study aimed to assess the effectiveness of this plant against malaria parasites and to identify some of the compounds , which may be responsible for the therapeutic properties of this plant. Dried roots were macerated in dichloromethane-methanol (1:1 v/v) and water to isolate phytoconstituents, which were then screened for antimalarial activity using the P. falciparum chloroquine-sensitive strain, D10. Furthermore, the antioxidant activities of the plant extracts were determined using the DPPH method. Lastly, the plant extracts were analyzed by gas chromatography-mass spectrometry. Moderate in vitro antiplasmodial activity (IC 50 < 50 µg/ml) was observed for the D. chamaethamnus organic (19.51 µg/mL) and aqueous (18.30 µg/mL) extracts. Antioxidant activity based on DPPH scavenging potential showed that D. chamaethamnus aqueous and organic extracts exhibited significant antioxidant activities with IC 50 values of 7.63 and 10.74 µg/mL, respectively. Some of the biologically active compounds found in the extracts of D. chamaethamnus include lupeol, palmitic acid, stigmasterol, and pyrogallol. These findings support the use of D. chamaethamnus against malaria and/or malaria-associated symptoms and provide a foundation or guide for further studies of this plant as an alternative treatment option for malaria. [ABSTRACT FROM AUTHOR]

Medical imaging in healthcare plays a vital role in the assessment, confirmation, and documentation of the course of many diseases and injuries. However, literature reports that the urban population in Sub-Saharan Africa have more access to imaging services than the rural population. This imbalance can affect radiographers working in rural areas. The aim of this study was to explore factors affecting the ability of radiographers to deliver imaging services in rural parts of Zambia. This study employed a qualitative exploratory research design. Semi-structured interviews were used to collect data from a stratified and purposive sample of six rural radiographers and three stakeholders [Ministry of Health (MOH), Radiological Society of Zambia (RSZ), and Schools of Radiography] across the country. Data were audio-recorded, transcribed, and subjected to manual thematic analysis. Four themes emerged following thematic analysis: procurement processes and resources, imaging equipment, job satisfaction, and education and training. Factors, such as donated equipment, the introduction of new imaging services and continuous professional development (CPD) were positive elements that assisted rural radiographers in the delivery of imaging services. However, an unequal distribution of equipment between urban and rural areas, old and obsolete equipment, lack of maintenance and servicing, lack of postgraduate courses, bureaucratic procurement processes, lack of consumables, workload, and low salaries, negatively affected the ability of rural radiographers. Lack of maintenance and servicing of equipment, as well as bureaucratic procurement processes were the main challenges identified by radiographers to imaging services in rural Zambia. There is a need to decentralise the procurement processes and establish a culture of regular maintenance and servicing of equipment. This research highlights the importance of supporting rural radiographers in the delivery of imaging services. [ABSTRACT FROM AUTHOR]

The Lancet Commission outlines a vision of universal access to safe emergency and essential surgery. Global disparities in perioperative outcomes are recognized, with resource-poor environments and a workforce crisis particularly challenging low- and middle-income countries (LMICs) to provide safe surgical and anaesthesia care. The coronavirus disease (COVID-19) pandemic placed an even greater strain on under-resourced and over-stretched healthcare systems. Bridging the gap to achieve universal access is a substantial undertaking and requires collaboration with high-income countries. Global partnerships are abundant and mutually beneficial, aiming to alleviate the workforce crisis, provide education, training and expertize and raise standards of care in host LMICs. Clinical, leadership and management experience gained in low-resource settings is valued by healthcare systems in high-income countries, acknowledged by curriculum for 'developing world anaesthesia'. Further challenges to healthcare delivery, training and implementation of change are influence by government policy, cultural traditions, expectations and work ethic. During the COVID-19 pandemic many partnerships were required to move online. The necessity of providing remote support has created its own set of challenges, while also providing novel opportunities for education and collaboration with the global health community. This article describes challenges through reflection on personal experience in Zambia. [ABSTRACT FROM AUTHOR]

To conduct a diagnostic validation study of SARS-CoV-2 diagnostic kits. We compared SARS-CoV-2 diagnostic test results from 3 RT-PCR assays used by the Zambian government between November 2020 and February 2021 (Panther Fusion assay, Da An Gene's 2019-nCoV RNA kit and Maccura's PCR Kit) with the Altona RealStar RT-PCR kit which served as the gold standard. We also evaluated results from rapid antigen testing and whether comorbidities were linked with increased odds of infection. We recruited 244 participants, 61% (149/244) were positive by at least 1 PCR assay. Da An Gene, Maccura, and Panther Fusion assays had sensitivities of 0.0% (95% confidence interval [CI] 0%–41%), 27.1% (95% CI 15%–42%), and 76% (95% CI 65%–85%), respectively, but specificity was low (<85% for all 3 assays). HIV and TB were not associated with SARS-CoV-2, whereas female sex (OR 0.5 [0.3–0.9], p = 0.026) and chronic pulmonary disease (0.1 [0.0–0.8], p = 0.031) were associated with lower odds of SARS-CoV-2 infection. Of 44 samples, 84% sequenced were Beta variant. The RT-PCR assays evaluated did not meet WHO recommended minimum sensitivity of 80%. Local diagnostic validation studies should be embedded within preparedness plans for future outbreaks to improve the public health response. [ABSTRACT FROM AUTHOR]

• An optimal control of Hydrokinectic-Battery generator for a rural community. • The model shows huge potential for energy access to millions of rural communities. • This proposed model has energy production capability of 7.706MWh/year. • This model can be used for ICTs and drone charge station in rural communities. • Performance index has higher reliability for observatory and military sensors. The paper presents a rural community hydrokinetic power plant model under optimal energy management control. A storage system is proposed on the demand side to provide reliability and easier system expansion with other distributed energy sources. More than half of the population in Sub-Saharan African countries have no access to electricity despite having of plenty of running rivers. The model's performance index is to harness more of the river energy while prolonging the life of the battery storage. Unlike solar energy that is only available during the daytime, hydrokinetic energy is available throughout the day. This model's optimal control strategy is a mixed integer linear problem solved in Matlab SCIP. A case study was done and the results show huge potential for providing energy as enabler to rural communities. A total of 21.406 kWh / day energy generation was achieved, energy that would have been lost in river currents. This clean energy can be used for refrigeration of people's farm produce and increase access to information/communication, which would eventually improve market intelligence. This model can be applied in powering remote military sensors, a drone-charging station and observatory centers as well. [ABSTRACT FROM AUTHOR]

We nested a seroprevalence survey within the TREATS (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening) project. We aimed to measure the seroprevalence of SARS-CoV-2 infection and investigate associated risk factors in one community (population ∼27,000) with high prevalence of TB/HIV in Zambia. The study design was cross-sectional. A random sample of 3592 individuals aged ≥15 years enrolled in the TREATS TB-prevalence survey were selected for antibody testing. Randomly selected blocks of residence were visited between October 2020 and March 2021. Antibodies against SARS-CoV-2 were detected using Abbott- ARCHITECT SARS-CoV-2 IgG assay. A total of 3035/3526 (86.1%) individuals had a blood sample taken. Antibody testing results were available for 2917/3035 (96.1%) participants. Overall, 401/2977 (13.5%) individuals tested positive for IgG antibodies. Seroprevalence was similar by sex (12.7% men vs 14.0% women) and was lowest in the youngest age group 15–19 years (9.7%) and similar in ages 20 years and older (∼15%). We found no evidence of an association between seroprevalence and HIV-status or TB. There was strong evidence (p <0.001) of variation by time of enrollment, with prevalence varying from 2.8% (95% CI 0.8–4.9) among those recruited in December 2020 to 33.7% (95% CI 27.7–39.7) among those recruited in mid-February 2021. Seroprevalence was 13.5% but there was substantial variation over time, with a sharp increase to approximately 35% toward the end of the second epidemic wave. • SARS-CoV-2 seroprevalence survey conducted between October 2020 and March 2021. • Overall seroprevalence of approximately 13.5% in one community in Zambia. • Sharp increase in prevalence was seen (up to 35%) in mid-February 2021. • Strong time trend in levels of seropositivity in parallel with the epidemic. • Useful urgent seroepidemiological data needed for public health responses. [ABSTRACT FROM AUTHOR]

Zambia has experienced a rise in per capita fish supply in recent years due in part to growing domestic aquaculture production and expanding import markets that supply farmed Nile tilapia to mostly urban markets. While urban consumers enjoy a wide variety of local fish species, including wild-caught native tilapia, little is known regarding the consumer preferences for farmed tilapia traits. Understanding aquaculture consumer markets is needed, including more detailed evidence of differences in tilapia trait preferences between women and men of differing socioeconomic backgrounds. Such data may add value to current and future genetic improvement programs, inform the design of domestic production systems and aquaculture marketing campaigns, and improve the food and nutrition security potential of the sector. This study assessed consumer preference rankings of farmed tilapia traits in four major urban sites in Zambia in 2018. Women and men consumers of different socioeconomic status (SES) participated in the study (N = 313). Using a pairwise ranking method and multi-criteria survey tool, consumers made a choice between values of different morphometric traits: total body weight, length, width, and height, skin colour, and head and tail sizes. Men reported a stronger preference for traits that were ranked higher overall by the sample, including larger body weight (p < 0.001), darker skin colour (p < 0.05), and taller body height (p < 0.05). Women reported stronger preferences for traits that were ranked lower overall, including shorter body height (p < 0.01) and smaller body weight (p < 0.001). Controlling for several covariates believed to influence consumer trait preferences for farmed tilapia (e.g., SES, age, educational level, and household size), nonparametric regression analysis revealed strong consumer preferences by men for thicker body width (p < 0.05), larger body weight (p < 0.001), and taller body height (p < 0.05). Consumers of lower SES had a stronger preference for darker skin colour than consumers of middle SES (p < 0.05). These findings confirm existence of differences in consumer preferences for farmed tilapia traits in urban Zambia and should be considered in genetic improvement programs. Fish breeding thus should be more gender-responsive and pro-poor. Differences suggest limitations in genetic innovations to meet the needs of diverse consumer groups, requiring complementary production and marketing interventions within the aquaculture industry. • The study assessed gendered consumer preference rankings of farmed tilapia traits in four urban sites in Zambia. • The study found significant differences between preference rankings of women and men consumers for traits ranked higher and lower by the sample. • Regression analysis revealed strong consumer preference by men for thicker body width, larger body weight, and taller body height. • Consumers of lower socioeconomic status had a stronger preference for darker skin colour. • Gendered trait preferences for farmed tilapia should be considered when genetic improvement programs set their objectives and strategies. • Production and marketing interventions are also required to respond to the needs of diverse consumer groups. [ABSTRACT FROM AUTHOR]

This research focuses on the implementation of micro-hybrid renewable energy systems (MHRES) in rural Zambia, where a large part of the population lacks adequate electrical infrastructure. Using a multi-criterion decision-making approach (MCDM), specifically the Technique for Preference Order by Similarity to an Ideal Solution (TOPSIS) with an entropy-weighted method, this research aims to identify an optimal MHRES solution to replace dependence on wood and fossil fuels. Analysis is carried out in 14 scenarios, taking into account technical, economic, social, and environmental criteria. The results show that a biogas-solar photovoltaic integrated with Energy System Power Safe Storage Battery Systems 190 (SBS 190) is the most visible option, demonstrating a relative proximity of 0.98556. In contrast, a diesel generator-solar PV system is the least favorable, with a relative proximity of 0.02576. Validation of the results through a convergent distance assessment (CODAS), an evaluation based on the distance from the average solution (EDAS), and the weighted aggregate sum of the product assessment (WASPAS) confirm its robustness. The proposed MHRES solution is designed to meet the energy needs of rural communities using local biomass and solar resources, free of obstacles by high buildings and structures. This research highlights the potential of MHRES to meet energy needs and promote sustainable development in developing countries, providing valuable insights for policymakers and energy stakeholders. [ABSTRACT FROM AUTHOR]

Realizing the double-edged goals of food security and crop diversification require knowledge of crop yield response to different agricultural practices and the extent to which such response is context dependent. This is particularly important in Southern Africa where cropping systems are dominated by maize and smallholders use few external inputs. The objectives of this study were (1) to evaluate the performance of cropping systems with different levels of legume diversification and intensification on maize productivity across the main agroecological zones and farming systems of Zambia, and (2) to establish the minimum land required to reach maize self-sufficiency at household level with the different cropping systems tested. Six maize-based cropping systems, comprising maize monocropping, maize-legume rotations and intercrops under 'conventional' tillage and conservation agriculture, were evaluated across 40 farms in contrasting agro-ecological zones and farming systems of Zambia. A household survey was conducted in the same communities hosting the on-farm trials to quantify the share of households with enough maize cultivated area to benefit from the tested cropping systems. Maize yield measured in the on-farm trials ranged, on average, between 3.6 and 5.4 t ha−1, which was greater than mean maize yields reported by farmers not hosting on-farm trials during the same growing seasons and in the same sites. Our results showed a clear positive effect of legume rotation on maize yield in Eastern province only, where cropping systems including groundnut as rotation crop yielded between 1.0 and 2.0 t ha−1 more maize than other cropping systems. Pigeon pea intercrops and Gliricidia hedgerows, crop residue management, and tillage practice had no significant effect on maize yield in any of the provinces. Finally, nearly 35, 50, and 70% of surveyed farms in Northern, Eastern, and Southern province would have enough land to achieve the same level of maize production obtained on their farm with the yields, and associated area requirements, of the maize-legume rotations tested in the on-farm trials. Legume rotations can increase maize productivity on land abundant farms in high potential maize production areas of Southern Africa, whereas legume intercrops have benefits at cropping systems level and should be targeted to land constrained farms. The study contributes to better understand the niche for diversified maize-based cropping systems with legume rotations and intercrops in Southern Africa, along with their impacts on maize productivity at the field level and their land requirements at the farm level. • Prospects for food security in Southern Africa need to be reconciled with diversified crop demands. • Six maize-based cropping systems, diversified and intensified with legumes, were tested on-farm. • Maize-legume rotations can increase maize yield by 1.0–2.0 t ha−1 in the Eastern province of Zambia. • Legume intercrops, crop residue management, and tillage practice had no significant effect on maize yield. • Land availability needs to be considered when targeting legume rotations and intercrops to smallholder farms. [ABSTRACT FROM AUTHOR]

[Display omitted] • Bulk sorting of copper ore at 2800tph achieved. • Measurement on conveyor with a 3-sigma minimum detectable grade of 0.045 wt% copper as chalcopyrite in 4 s. • Sorted ore found by re-circulation to be less than 0.2 wt% copper. • High ore grade variability observed within the plant. Sensor-based bulk ore sorting (BOS) is a technique that may lead to uplift of processing grades by excluding waste as well as an increase in usable resource by sorting material designated as mineralised waste. A magnetic resonance analyser (MRA) was installed on the primary crushed ore feed to the sulphide plant at the Kansanshi copper mine in northwestern Zambia to trial BOS. The conveyor belt operated at 2800tph and carried ore of which greater than 85% by weight of the copper-bearing minerals are chalcopyrite. The MRA was therefore tuned for chalcopyrite's zero static field magnetic resonance. The analyser achieved a 3σ detection limit of 0.045 wt% copper as chalcopyrite over a 4 s measurement time and standard belt loading, with lower detection thresholds possible if the measurement time increased. A trial of ore diversion was then carried out at the site. Pods of ore measured as less than 0.2 wt% copper as chalcopyrite by the MRA were diverted by a dead box diverter system to form a low-grade stockpile of approximately 10,000 tonnes. A cavity in the mill feed stockpile was arranged and the rejected material fed back through the crusher, past the MRA and directly through the milling circuit to the flotation feed where a Vezin sampler was used to take a sample every 5 min. This sample was then tested for copper grade by the site metallurgical laboratory. The MRA measured a grade of 0.16 wt% copper as chalcopyrite over the test time period and the Vezin samples for the last hour of the trial reported approximately 0.2–0.3 wt% copper despite some mixing with unsorted ore being inevitable. This is as clear a demonstration of bulk ore sorting (BOS) as practically achieveable in the production environment at Kansanshi and, to the author's knowledge, the first demonstration of BOS on a copper ore stream of at least this throughput. [ABSTRACT FROM AUTHOR]

The evolution of complex floral morphology in orchids can be attributed largely to mechanisms that ensure precise placement of pollinaria on the bodies of animal flower visitors. Floral advertisements and rewards also play a key role in selective attraction of animals that are suitable as pollen vectors. Previous studies of the large African orchid genus Disa have demonstrated high levels of pollination system specialization and have identified functions of floral morphology for transfer of pollen, but studies of pollination in members of the tropical clade of Disa sect. Micranthae have been lacking. This clade is characterized by highly unusual floral morphology, including vertical anthers and pronounced spatial separation between a nectar-producing spur located in the centre of the dorsal sepal and the rostellum lobes that serve to attach pollinaria to flower visitors. In a study conducted in central Zambia, I found that the flowers of Disa engleriana are pollinated by large wasps (Eumeninae and Scoliidae) and carpenter bees. These insect groups carry pollinaria near the tip of their abdomen, which contacts the rostellum when the abdomen is tucked under the flower for balance during nectar-feeding. The pollinaria are rigid and project at 90˚ from the underside of the abdomen such that they contact the deeply recessed stigma during subsequent flower visits. This study reveals a new mechanism of pollen transfer in Disa and sheds light on the evolution of the highly complex floral morphology of this large orchid clade [ABSTRACT FROM AUTHOR]

In this paper, we report the insecticidal effects of the cashew nut shell liquid extract on Spodeptera frugiperda larva and eggs as well as antifeeding properties. S. frugiperda is a serious invasive insect pest of maize and other economically important cultivated crops in Zambia and around the world. Literature sources revealed that in the absence of proper control methods, it has potential to cause 21 to 50 percent of crop yield losses. At the moment, synthetic insecticides are the preferred method for controlling S. frugiperda. However they are linked to several undesired environmental and human health issues. Cashew nutshell liquid (CNSL) is a natural product derived from cashew nut shells (CNSs). It has been reported to have interesting insecticidal properties, and less impact on the environment and human health. Hence, this work aimed at studying its potential application in the management of S. frugiperda , as an alternatives to synthetic pesticides. CNSL was prepared by solvent extraction and characterized by High performance Thin Layer Chromatography (HPTLC), and Gas chromatograph-Mass Spectroscopy (GC-MS). Fourier transform infrared (FT-IR) results were consistent with presence of alkyphenols. Both TLC and GC-MS analysis results showed the presence of cardol (5-pentadecyl resorcinol) and cardanol(3-pentadecyl phenol); two distinctive alkyl phenolic lipids characteristic to CNSL. The toxicity of CNSL against S.frugiperda was dose-dependent. The lethal concentrations (LC 50, CL 95%) against larvae after 2 h was 1.92 (1.71–2.15), while for eggs it was 2.50 (0.22–4.05) %. Furthermore, the effective concentrations (EC 50) for antifeedant effects were 0.34 % for CNSL and 1.46 % for Neemcide, a commercial insecticide. Our results showed that CNSL has ovicidal, larvicidal and antifeedant effects against S.frugiperda, suggesting that it can be exploited as a cheap, safe and eco-friendly alternative insecticide for managing S. frugiperda outbreaks in Zambia and across the world. • Cashew nut shell liquid. • Larvicidal. • Fall army worm. • Biopesticide. [ABSTRACT FROM AUTHOR]

We completed a cross-sectional survey study to determine headache prevalence and its association with HIV characteristics among people living with HIV (PLHIV) in Lusaka, Zambia. Headaches are common but their association with HIV status is unknown. The HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed during a 3-month period to 3666 consecutive adult PLHIV attending routine clinic appointments at the Adult Infectious Diseases Centre at the University Teaching Hospital in Lusaka, Zambia. HIV disease characteristics were abstracted from their charts. 1015 (27.7%) participants responded to the survey. Adjusted for age, 64% reported having a headache within the last year unrelated to another illness. Among participants, 201 met criteria for migraine (20%), 259 for tension-type headache (26%), 18 for probable medication-overuse headache (2%), and 121 for undetermined headache (12%). Prevalence for tension-type headache was significantly higher than that of migraine (P < 0.001). After adjusting for age and sex, higher CD4 counts were associated with migraine. No other associations were observed between overall headache or headache type with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis. Headaches are highly prevalent among this cohort of PLHIV in Zambia. Optimizing headache treatment and integrating it into routine HIV care may improve quality of life for a substantial proportion of PLHIV in Zambia. • Headache affected more than half of all persons living with HIV. • Tension-type headache was the most common type among persons living with HIV. • Migraine was associated with higher CD4 counts. • Rates of medication-overuse headache were low in this cohort. [ABSTRACT FROM AUTHOR]

• Inequitable burden of hearing loss: approximately 1.6 billion people suffer from hearing loss worldwide, and more than 80 % of them reside in low- and middle-income countries. • Preventable hearing loss: the majority of hearing loss cases are preventable or treatable through interventions targeting various stages of life, such as early treatment of otitis media for children and use of hearing aids and cochlear implants across the lifespan. • Limited access to hearing care: gaps in ear and hearing care resources and workforce hinder early identification and intervention for hearing loss. • Policy prioritization: integrating ear and hearing care into national health policies is essential to address systemic inequities and ensure adequate resources for hearing care, as seen in examples from Zambia and Nigeria. Hearing loss affects 1.6 billion people worldwide and disproportionately affects those in low- and middle-income countries. Despite being largely preventable or treatable, ear and hearing conditions result in significant and lifelong morbidity such as delayed language development, reduced educational attainment, and diminished social well-being. There is a need to augment prevention, early identification, treatment, and rehabilitation for these conditions. Expanded access to hearing screening, growth of the hearing health workforce, and innovations in ear and hearing care delivery systems are among the changes that are needed. To that end, the World Health Organization has prioritized ear and hearing care as a component of Universal Health Coverage, and recent publications have advanced the priority for ear and hearing care. Efforts are underway at the national levels around the world, as evidenced by countries like Zambia and Nigeria that have integrated ear and hearing care within national health strategies. While significant strides have been made in improving access, a critical need remains for additional research, advocacy, and intervention to ensure that no one is left behind in the goal to achieve universal access to ear and hearing care. [ABSTRACT FROM AUTHOR]

• We examine the influence of proximity to large-scale farms on competitiveness of smallholders. • The effect of large-scale farms on competitiveness is particularly large for female smallholders. • Our result extends to the competitive behavior of girls, shedding light on intra-household tasks. We investigate how exposure to large-scale farms affects smallholders' competitive behavior. Based on lab-in-the-field experimental measures covering more than 900 smallholders and 400 children in Zambia, we find that smallholders who are traditionally dependent on subsistence agriculture behave more competitively when they are located close to large-scale farms. This effect is especially pronounced for female smallholders and closes the gender gap associated with competitiveness. This result replicates for their children. We identify female employment and shifting intra-household tasks as a possible mechanism. Our results provide new insights for understanding how changes in societal arrangements like market integration influence economic behavior. [ABSTRACT FROM AUTHOR]

The Itezhi-tezhi Dam on the Kafue River in Zambia is a major capture fishery. However, the upstream reaches of the Kafue River receive effluents from copper mines. It was unclear whether fish health in the dam is adversely affected due to the mining effluents. We investigated the health status of fish in Itezhi-tezh Dam using a histology-based fish health assessment protocol with Oreochromis andersonii as a bioindicator. Fish were sampled in the Itezhi-tezh Dam and at a reference site further upstream on the Kafue River before it enters the mining region. Metal bioaccumulation, biometric indices and histological alterations in the gills, gonads, hearts, kidneys and livers were assessed. The findings revealed significantly higher copper and selenium sediment concentrations (p = 0.02843 and p = 0.02107 respectively), bioaccumulation of copper and selenium, and increased histological alterations in the gills, kidneys and livers of fish in the Itezhi-tezhi Dam. • Higher levels of metal pollution downstream of the mining region. • Metal bioaccumulation in fish muscle, particularly copper and selenium. • Histological alterations in Oreochromis andersonii downstream of the mining region. [ABSTRACT FROM AUTHOR]

In developing countries, approximately one in three girls marry before the age of 18; however, early marriage is not a homogenous experience. Cohabitation can be either a precursor or an alternative to marriage, yet studies and programs often conflate marriage types. The purpose of this study is to understand the underlying factors and stability of cohabiting and formal child marriage unions among adolescent girls. This mixed-methods study draws on four rounds of quantitative data collected annually between 2013 and 2016 as part of a longitudinal study among girls 10–19 years old in Zambia. In-depth interviews were conducted in 2017 with 32 girls, divided by formal unions and informal unions, randomly selected from the quantitative sample. Multivariate logistic models were estimated to test key associations and Cox regression models used to estimate the hazard of separation/divorce by a certain age. Qualitative findings highlighted that informal unions did not typically have approval of the couples' parents and frequently ended in separation. As compared to formal unions, having both families' approval was associated with 69% lower odds of cohabiting (odds ratio = 0.31, p <.001), while forced entry into union due to pregnancy was associated with 61% greater odds of cohabiting (OR = 1.61, p <.05). Being in a cohabiting union was associated with a 43% greater hazard of union dissolution (hazard ratio = 1.43, p <.05). There are key differences between formal marriages and cohabitation among adolescent girls and young women that should be considered when addressing early marriage in research and programs. [ABSTRACT FROM AUTHOR]

• Cysticercosis is a neglected human zoonosis worldwide. • Reports of cardiac cysticercosis causing sudden community deaths are rare. • Forensic autopsies of unexpected deaths can reveal undetected cysticercosis. • Cardiac cysticercosis is an important differential to consider in sudden deaths. Cysticercosis is a World Health Organization designated neglected human zoonosis worldwide. Data on cardiac cysticercosis and its contribution to sudden and unexpected community deaths are scarce and require study. A study was performed of cysticercosis-related deaths and other incidental cases of cysticercosis seen at forensic post-mortem examination over a period of 12 months, in individuals who died suddenly and unexpectedly in the community in Lusaka, Zambia. Whole-body post-mortem examinations were performed according to standard operating procedures for post-mortem examinations. Representative samples were obtained from all body organs and subjected to histopathological examination. Information was obtained on circumstances surrounding the death. Data were collated on patient demographics, history, co-morbidities, pathological gross and microscopic findings, and forensic autopsy cause(s) of death. The available literature on cardiac cysticercosis was also reviewed. Nine cases of cysticercosis were identified. Eight of the nine cases had cardiac cysticercosis. There was no prior history of cysticercosis before death. All were male, aged between 28 and 56 years, and from high population density and low socioeconomic communities. There was no community case clustering identified. Cardiac cysticercosis and neurocysticercosis are important incidental findings in sudden and unexpected deaths in the community and can easily be missed antemortem. More investment in forensic autopsy services is required to define the undiagnosed burden of deaths due to treatable communicable diseases. [ABSTRACT FROM AUTHOR]

• MIRU-VNTR and spoligotyping revealed a high clustering rate of MDR-TB in Lusaka • Clonal expansion of LAM1 and CAS1-Kili was implicated in the spread of MDR-TB • Increased MDR-TB was due to recent transmission rather than independent acquisition of MDR • 9-loci MIRU-VNTR was proposed for screening of MDR M. tuberculosis strains Zambia is among the 30 high tuberculosis burden countries in the world. Despite increasing reports of multidrug-resistant tuberculosis (MDR-TB) in routine surveillance, information on the transmission of MDR Mycobacterium tuberculosis strains is largely unknown. This study elucidated the genetic diversity and transmission of MDR M. tuberculosis strains in Lusaka, Zambia. Eighty-five MDR M. tuberculosis samples collected from 2013 to 2017 at the University Teaching Hospital were used. Drug-resistance associated gene sequencing, spoligotyping, 24-loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR), and multiplex PCR for RD-Rio sub-lineage identification were applied. The identified clades were LAM (48%), CAS (29%), T (14%), X (6%) and Harlem (2%). Strains belonging to SITs 21/CAS1-Kili and 20/LAM1 formed the largest clonal complexes. Combined spoligotyping and 24 loci-MIRU-VNTR revealed 47 genotypic patterns with a clustering rate of 63%. Ninety-five percent of LAM strains belonged to the RD-Rio sub-lineage. The high clustering rate suggested that a large proportion of MDR-TB was due to recent transmission rather than the independent acquisition of MDR. This spread was attributed to clonal expansion of SIT21/CAS1-Kili and SIT20/LAM1 strains. Therefore, TB control programs recommending genotyping coupled with conventional epidemiological methods can guide measures for stopping the spread of MDR-TB. [ABSTRACT FROM AUTHOR]