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In ministerial training, effective integration of academic excellence, spiritual formation and vocational training is critical to produce holistically trained Christian leaders. This article positions integration as an educational approach that attempts to coordinate and synthesise the major learning dimension and can bring about significant learning, since it takes account of the lifeworld of the student and engages a custom-designed curriculum. This article reports on an empirical research project on integrative theological education at Justo Mwale University, Zambia. It reports on various dimensions within the formal and informal curriculum in the residential Bachelor of Theology programme. The article provides key findings and a discussion on the contextual and institutional challenges that shaped curriculum design. It reflects on the learning gained through this action research and concludes with strategies to move towards a more integrative model of theological education. [ABSTRACT FROM AUTHOR]

Micrometer-sized composite polymer-magnetic spheres consisting of a magnetic-spherical core with a polystyrene shell were produced. The magnetic-spherical core was produced by plasma thermal conversion of waste powders precursor (iron oxide) generated during the conventional process of steel production. Precursor powders were projected into an Ar-He plasma plume using industrial thermal-spray equipment. The results are a total conversion of the precursor powders into magnetic-spherical particles with diameters in the micrometer size range. The surfaces of the magnetic-spheres were functionalized by a chemistry hydrolysis method using 3-aminopropyltrimethoxysilane (APTMS) and creating superficial amine structures that improved the adherence of the final polystyrene shells that was polymerized by adapting the miniemulsion process. The products at the different synthesis steps were characterized by diverse techniques, such as: X-ray diffraction (XRD), scanning electron microscopy (SEM), field emission scanning electron microscopy (FE-SEM), X-ray energy dispersive spectroscopy (EDS), Fourier Transformed Infrared spectroscopy (FTIR) and the magnetic properties were investigated with a vibrating sample magnetometer. [ABSTRACT FROM AUTHOR]

Abstract Background Streptococcus pneumoniae (pneumococcus) is responsible for over one million deaths per year, with young children, the elderly and immunocompromised individuals being most at risk. Approximately half of East African children have been reported to be asymptomatic carriers of pneumococcus with invasive infection occurring after the disruption of the respiratory membrane which is believed to be caused by the host immune response. Racial incidence of invasive pneumococcal disease (IPD) is higher in certain populations even after adjusting for environmental factors suggesting a genetic component to disease susceptibility. The nitric oxide synthase 2A (NOS2A) gene is responsible for the production of nitric oxide under pathological conditions including host defence against bacterial infection. Nitric oxide is a modulator of apoptotic and inflammatory cascades and endothelial permeability. We hypothesised that genetic variants within this gene may predispose to disease risk and survival. Methods A cohort of 299 children with IPD (221 meningitis, 41 pneumonia and 37 with bacteraemia) and 931 age matched controls from Malawi were used in this study. We investigated nine haplotype tagging single nucleotide polymorphisms within the NOS2A gene and compared the presence or absence of the minor alleles in cases and controls and survivors and non-survivors within the cases. Results We observed no significant associations between cases and controls or with survival in either all IPD cases or in the separate analysis of meningitis cases. A near significant association was obtained for the comparison of rs8078340 in cases and controls (p-value, 0.078). However, results were unadjusted for multiple testing. Conclusion Our results suggest that polymorphic variation within the NOS2A gene does not influence invasive pneumococcal disease susceptibility or survival.

BACKGROUND: Current knowledge of the situation of anaesthesia in developing countries is limited. A survey of the status of education and research based on hospital records, records of the anaesthesia section, nursing records, personal observations as well as personal communication with staff, patients and hospital managers was carried out in a 1863-bed university teaching hospital located in the capital of a least developed Sub-Saharan African Country. METHODS: Classification and evaluation of the data was based on the three aspects of the role of university teaching hospitals in Western countries: (I) patient care, (II) university teaching and post-graduation training, as well as (III) research activities. The section 'patient care' was sub-divided into anaesthesia, intensive care medicine, emergency medicine, and pain therapy. The Department of Anaesthesia at the University Teaching Hospital of Lusaka, Zambia, is organized as a subdivision of the surgical department and is not involved in emergency medicine or pain therapy. Thirteen out of seventeen operating theatres, one recovery room, and a ten bed intensive care unit are serviced by the Department of Anaesthesia. RESULTS: Anaesthetic equipment, medical supplies, drugs, and consumables are all in limited supply. There are limited statistics on perioperative complications and mortality. Anaesthesia at the university teaching hospital of a least developed Sub-Saharan African Country is severely short of both a workforce and resources. CONCLUSION: We have described strategies which may help to reverse this trend, the most important of which is to promote anaesthesia as an essential specialty within hospitals in developing countries. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship programmes (ASPs) aim to optimize antibiotic use and prevent antimicrobial resistance., Objective: This study assessed the impact of ASPs, initiated using a hub-and-spoke approach, on antibiotic use in Zambian public hospitals., Methods: A pre-post study was conducted in 10 ASP-naive hospitals across Zambia using the Centers for Disease Control and Prevention (CDC)'s hospital-based ASP core elements (i.e. leadership, accountability, pharmacy expertise, stewardship actions, tracking progress, reporting and education) checklist and the global point prevalence survey methodology. The intervention involved technical staff from a national 'hub' hospital with an established ASP providing on-site orientation and mentorship to multidisciplinary teams of healthcare workers at 10 'spoke' hospitals to build capacity in antimicrobial stewardship. ASP core elements and inpatient antibiotic use prevalence (AUP) were assessed before and 12 months after ASP implementation. Data were statistically analysed., Results: The adoption of ASP core elements improved significantly ( P  = 0.001, 95% CI: -17.8 to -5.42). AUP decreased from 50.1% (±5.8, n  = 1477) to 44.3% (±4.6, n  = 1400) after 12 months, though the reduction was not statistically significant ( P  = 0.442; 95% CI: -9.8 to 21.6), with 'Watch' list antibiotics remaining the most commonly prescribed across the hospitals., Conclusions: The hub-and-spoke approach successfully catalysed ASPs in public hospitals in Zambia, demonstrating the potential for improving antibiotic use practices over time, provided structural challenges are addressed. This approach and insights can guide stakeholders in Zambia and similar settings in enhancing hospital ASPs., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Malaria, caused by parasitic protozoans of the Plasmodium genus, continues to be one of the greatest global health crises, especially in Africa. The emergence of antimalarial drug resistance continues to be a health problem necessitating an urgent need for alternative and cost-effective antimalarials. Using a molecular hybridization approach, we report the design and synthesis of an efficacious novel class of antiprotozoal agents; (E)-1-(4-(4,6-diphenylpyrimidin-2-yl)piperazin-1-yl)-3-phenyl prop-2-en-1-one derivatives (8a-r). The in vitro inhibitory activity of the synthesized compounds was evaluated against the NF54 chloroquine-sensitive strain of Plasmodium falciparum. From the antiprotozoal screening, three compounds displayed propitious activity with IC 50 values (0.18-0.21 μM), using quinine and chloroquine as standard antimalarials. Compounds 8o and 8l emerged as the most potent candidates with IC 50 values of 0.18 ± 0.02 μM and 0.21 ± 0.001 μM with an associated good safety index of 18.59 and 16.75 to human kidney epithelial (HEK293) cells, respectively. The synthesized analogues present a new chemical architecture structurally unrelated to the current regime of antimalarial drugs, representing a valid strategy to combat resistance in P. falciparum species to current commercial drugs. We further investigated the binding affinities of the compounds against recombinant forms of two P. falciparum heat shock protein 70 homologues; PfHsp70-1 and PfHsp70-z, both of which are essential and promising druggable candidates. Compound 8l exhibited the highest binding affinity for PfHsp70-1 and PfHsp70-z. Furthermore, molecular docking revealed that compounds 8k, 8l, 8m, and 8o exhibited better fitness to PfHsp70-1, with compounds 8l and 8o showing the highest binding affinity of -10.5 kcal/mol and -10.1 kcal/mol, respectively. Therefore, it can be speculated that PfHsp70-1 may be a possible target of some of the inhibitors tested in this study. The presence of electron-donating groups on the phenyl ring of 4,6-pyrimidine moiety and cinnamoyl group demonstrated a positive correlation between the observed computational data and the biological activity. Taken together, this paper demonstrates the importance of using the molecular hybridization approach in the development of newer cinnamoyl clubbed with 4,6-diphenyl pyrimidine hybrids as potential antiprotozoal agents., Competing Interests: Declaration of competing interest The authors declare that they have no known conflicting financial or personal interests that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: People often have an innate interest in both platonic and romantic relationships. In fact, feelings toward sexuality and sexuality education do not differ between various individuals. Yet, autistic individuals have been shown to score significantly lower on measures of sexual awareness than their typically developing counterparts. Aims: The current project sought to investigate the benefits of a specially tailored socio-sexuality curriculum on the interpersonal relationship knowledge of 12 autistic young adults. Methods and Procedures: The eight-session sexuality education intervention was carefully tailored from an existing, online guide from the Organization for Autism Research. Pre- and post-test data were collected via the Assessment of Functional Living Skills Interpersonal Relationships domain. T -tests were conducted to determine significance. Outcomes and Results: Results from paired-sample t -tests indicated significant gains in interpersonal relationship knowledge from pre- to post-intervention. Conclusions and Implications: When provided with specifically tailored sexuality education, young autistic adults can experience socially valid, significant gains on interpersonal relationship knowledge., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The study aim was to evaluate vaccine effectiveness (VE) of COVID-19 vaccines in preventing symptomatic COVID-19 among healthcare workers (HCWs) in Zambia. We sought to answer the question, 'What is the vaccine effectiveness of a complete schedule of the SARS-CoV-2 vaccine in preventing symptomatic COVID-19 among HCWs in Zambia?', Design/setting: We conducted a test-negative case-control study among HCWs across different levels of health facilities in Zambia offering point of care testing for COVID-19 from May 2021 to March 2022., Participants: 1767 participants entered the study and completed it. Cases were HCWs with laboratory-confirmed SARS-CoV-2 and controls were HCWs who tested SARS-CoV-2 negative. Consented HCWs with documented history of vaccination for COVID-19 (vaccinated HCWs only) were included in the study. HCWs with unknown test results and unknown vaccination status, were excluded., Primary and Secondary Outcome Measures: The primary outcome was VE among symptomatic HCWs. Secondary outcomes were VE by: SARS-CoV-2 variant strains based on the predominant variant circulating in Zambia (Delta during May 2021 to November 2021 and Omicron during December 2021 to March 2022), duration since vaccination and vaccine product., Results: We recruited 1145 symptomatic HCWs. The median age was 30 years (IQR: 26-38) and 789 (68.9%) were women. Two hundred and eighty-two (24.6%) were fully vaccinated. The median time to full vaccination was 102 days (IQR: 56-144). VE against symptomatic SARS-CoV-2 infection was 72.7% (95% CI: 61.9% to 80.7%) for fully vaccinated participants. VE was 79.4% (95% CI: 58.2% to 90.7%) during the Delta period and 37.5% (95% CI: -7.0% to 63.3%) during the Omicron period., Conclusions: COVID-19 vaccines were effective in reducing symptomatic SARS-CoV-2 among Zambian HCWs when the Delta variant was circulating but not when Omicron was circulating. This could be related to immune evasive characteristics and/or waning immunity. These findings support accelerating COVID-19 booster dosing with bivalent vaccines as part of the vaccination programme to reduce COVID-19 in Zambia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of 'Access' over 'Watch' and 'Reserve' antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of 'Watch' antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.

The United Nations Organization (UNO) has revealed that approximately 2.1 billion people do not have access to treated water. Methylene blue (MB) and rhodamine B are produced as water pollutants in textile, plastic, and dye industries. In this study, oxalic acid or lactic acid surface-modification were applied to TiO 2 /ZnO nanoparticles aiming to improve antibacterial and adsorption properties. The mixtures containing the corresponding acid and nanoparticles in 0.25 : 1/0.5 : 1 ratios of ZnO and TiO 2 correspondingly were subjected to ultrasonic treatment with a catenoidal ultrasonic probe coupled to a homemade ultrasonic generator with an output power of 750 W, wave amplitude of 50% and variable frequency in the range of 15-50 kHz. To verify the influence of the ultrasonic treatment, different treatment times of 30, 45, 60, and 90 min were applied. Unmodified and modified TiO 2 /ZnO nanoparticles were characterized by FTIR, TGA, XRD, SEM, and XPS. From the results, obtained from the physicochemical characterization, in the ZTO90 and ZTL90 samples a greater modification was shown. The SEM images showed that a coating was present on the surface of the ceramic particles of the ZTL90 sample. The O 1s deconvolution in the XPS spectra indicates a greater presence of C[double bond, length as m-dash]O bonds in the ZTL90 sample. In parallel, the sample ZTL90 presented 85 and 89% adsorption efficiency for MB and rhodamine B dyes in a time of 12 min, and important antibacterial activity against E. coli and S. epidermis could be evidenced., Competing Interests: The authors declare that they have no conflict of interest., (This journal is © The Royal Society of Chemistry.)

According to the weak version of linguistic relativity, also called the Sapir-Whorf hypothesis, the features of an individual's native language influence his worldview and perception. We decided to test this hypothesis on the sufficient conditional and the necessary conditional, expressed differently in Chinese and French. In Chinese, connectors for both conditionals exist and are used in everyday life, while there is only a connector for the sufficient conditional in French. A first hypothesis follows from linguistic relativity: for the necessary conditional, better logic performance is expected in Chinese participants rather than French participants. As a second hypothesis, for all participants, we expect performance on the sufficient conditional to be better than on the necessary conditional. Indeed, despite the isomorphism of the two conditionals, they differ in how information is processed for reasoning. We decided to study reasoning under uncertainty as it reflects reality more accurately. To do so, we analyzed the coherence of participants using de Finetti's theory for deduction under uncertainty. The results of our study show no significant difference in performance between Chinese and French participants, neither on the sufficient conditional nor on the necessary conditional. Thus, our first hypothesis derived from the weak version of linguistic relativity is not confirmed. In contrast, our results confirm the second hypothesis in two out of three inference schemas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Shao, Tikiri Banda and Baratgin.)

Introduction: COVID-19 is often characterized by an acute upper respiratory tract infection. However, information on longer-term clinical sequelae following acute COVID-19 is emerging. We followed a group of persons with COVID-19 in Zambia at two months to assess persistent symptoms., Methods: in September 2020, we re-contacted participants from SARS-CoV-2 prevalence studies conducted in Zambia in July 2020 whose polymerase chain reaction (PCR) tests were positive. Participants with valid contact information were interviewed using a structured questionnaire that captured demographics, pre-existing conditions, and types and duration of symptoms. We describe the frequency and duration of reported symptoms and used chi-square tests to explore variability of symptoms by age group, gender, and underlying conditions., Results: of 302 participants, 155 (51%) reported one or more acute COVID-19-related symptoms in July 2020. Cough (50%), rhinorrhoea (36%) and headache (34%) were the most frequently reported symptoms proximal to diagnosis. The median symptom duration was 7 days (IQR: 3-9 days). At a median follow up of 54 days (IQR: 46-59 day), 27 (17%) symptomatic participants had not yet returned to their pre-COVID-19 health status. These participants most commonly reported cough (37%), headache (26%) and chest pain (22%). Age, sex, and pre-existing health conditions were not associated with persistent symptoms., Conclusion: a notable percentage of persons with SARS-CoV-2 infection in July still had symptoms nearly two months after their diagnosis. Zambia is implementing ´post-acute COVID-19 clinics´ to care for patients with prolonged symptoms of COVID-19, to address their needs and better understand how the disease will impact the population over time., Competing Interests: The authors declare no competing interest., (Copyright: James Exnobert Zulu et al.)

Background: Typhoid fever caused by multidrug-resistant H58 Salmonella Typhi is an increasing public health threat in sub-Saharan Africa., Methods: We conducted a phase 3, double-blind trial in Blantyre, Malawi, to assess the efficacy of Vi polysaccharide typhoid conjugate vaccine (Vi-TCV). We randomly assigned children who were between 9 months and 12 years of age, in a 1:1 ratio, to receive a single dose of Vi-TCV or meningococcal capsular group A conjugate (MenA) vaccine. The primary outcome was typhoid fever confirmed by blood culture. We report vaccine efficacy and safety outcomes after 18 to 24 months of follow-up., Results: The intention-to-treat analysis included 28,130 children, of whom 14,069 were assigned to receive Vi-TCV and 14,061 were assigned to receive the MenA vaccine. Blood culture-confirmed typhoid fever occurred in 12 children in the Vi-TCV group (46.9 cases per 100,000 person-years) and in 62 children in the MenA group (243.2 cases per 100,000 person-years). Overall, the efficacy of Vi-TCV was 80.7% (95% confidence interval [CI], 64.2 to 89.6) in the intention-to-treat analysis and 83.7% (95% CI, 68.1 to 91.6) in the per-protocol analysis. In total, 130 serious adverse events occurred in the first 6 months after vaccination (52 in the Vi-TCV group and 78 in the MenA group), including 6 deaths (all in the MenA group). No serious adverse events were considered by the investigators to be related to vaccination., Conclusions: Among Malawian children 9 months to 12 years of age, administration of Vi-TCV resulted in a lower incidence of blood culture-confirmed typhoid fever than the MenA vaccine. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT03299426.)., (Copyright © 2021 Massachusetts Medical Society.)

Background: Healthcare workers (HCWs) in Zambia have become infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). However, SARS-CoV-2 prevalence among HCWs is not known in Zambia., Methods: We conducted a cross-sectional SARS-CoV-2 prevalence survey among Zambian HCWs in 20 health facilities in 6 districts in July 2020. Participants were tested for SARS-CoV-2 infection using polymerase chain reaction (PCR) and for SARS-CoV-2 antibodies using enzyme-linked immunosorbent assay (ELISA). Prevalence estimates and 95% confidence intervals (CIs), adjusted for health facility clustering, were calculated for each test separately, and a combined measure for those who had PCR and ELISA was performed., Results: In total, 660 HCWs participated in the study, with 450 (68.2%) providing a nasopharyngeal swab for PCR and 575 (87.1%) providing a blood specimen for ELISA. Sixty-six percent of participants were females, and median age was 31.5 years (interquartile range, 26.2-39.8). The overall prevalence of the combined measure was 9.3% (95% CI, 3.8%-14.7%). PCR-positive prevalence of SARS-CoV-2 was 6.6% (95% CI, 2.0%-11.1%), and ELISA-positive prevalence was 2.2% (95% CI, .5%-3.9%)., Conclusions: SARS-CoV-2 prevalence among HCWs was similar to a population-based estimate (10.6%) during a period of community transmission in Zambia. Public health measures such as establishing COVID-19 treatment centers before the first cases, screening for COVID-19 symptoms among patients who access health facilities, infection prevention and control trainings, and targeted distribution of personal protective equipment based on exposure risk might have prevented increased SARS-CoV-2 transmission among Zambian HCWs., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

During the July 2020 first wave of severe acute respiratory syndrome coronavirus 2 in Zambia, PCR-measured prevalence was 13.4% among outpatients at health facilities, an absolute difference of 5.7% compared with prevalence among community members. This finding suggests that facility testing might be an effective strategy during high community transmission.

The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR.

Background: Inadequate and unequal distribution of health workers are significant barriers to provision of health services in Malawi, and challenges retaining health workers in rural areas have limited scale-up initiatives. This study therefore aims to estimate cost-effectiveness of monetary and non-monetary strategies in attracting and retaining nurse midwife technicians (NMTs) to rural areas of Malawi., Methods: The study uses a discrete choice experiment (DCE) methodology to investigate importance of job characteristics, probability of uptake, and intervention costs. Interviews and focus groups were conducted with NMTs and students to identify recruitment and retention motivating factors. Through policymaker consultations, qualitative findings were used to identify job attributes for the DCE questionnaire, administered to 472 respondents. A conditional logit regression model was developed to produce probability of choosing a job with different attributes and an uptake rate was calculated to estimate the percentage of health workers that would prefer jobs with specific intervention packages. Attributes were costed per health worker year., Results: Qualitative results highlighted housing, facility quality, management, and workload as important factors in job selection. Respondents were 2.04 times as likely to choose a rural job if superior housing was provided compared to no housing (CI 1.71-2.44, p<0.01), and 1.70 times as likely to choose a rural job with advanced facility quality (CI 1.47-1.96, p<0.01). At base level 43.9% of respondents would choose a rural job. This increased to 61.5% if superior housing was provided, and 72.5% if all facility-level improvements were provided, compared to an urban job without these improvements. Facility-level interventions had the lowest cost per health worker year., Conclusions: Our results indicate housing and facility-level improvements have the greatest impact on rural job choice, while also creating longer-term improvements to health workers' living and working environments. These results provide practical evidence for policymakers to support development of workforce recruitment and retention strategies., Competing Interests: Six authors are employees of the Clinton Health Access Initiative, including the lead author. The Clinton Health Access Initiative (CHAI) funded this study through a grant from the Royal Norwegian Embassy of Malawi to CHAI. This affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Between March and December, 2020, more than 20 000 laboratory-confirmed cases of SARS-CoV-2 infection were reported in Zambia. However, the number of SARS-CoV-2 infections is likely to be higher than the confirmed case counts because many infected people have mild or no symptoms, and limitations exist with regard to testing capacity and surveillance systems in Zambia. We aimed to estimate SARS-CoV-2 prevalence in six districts of Zambia in July, 2020, using a population-based household survey., Methods: Between July 4 and July 27, 2020, we did a cross-sectional cluster-sample survey of households in six districts of Zambia. Within each district, 16 standardised enumeration areas were randomly selected as primary sampling units using probability proportional to size. 20 households from each standardised enumeration area were selected using simple random sampling. All members of selected households were eligible to participate. Consenting participants completed a questionnaire and were tested for SARS-CoV-2 infection using real-time PCR (rtPCR) and anti-SARS-CoV-2 antibodies using ELISA. Prevalence estimates, adjusted for the survey design, were calculated for each diagnostic test separately, and combined. We applied the prevalence estimates to census population projections for each district to derive the estimated number of SARS-CoV-2 infections., Findings: Overall, 4258 people from 1866 households participated in the study. The median age of participants was 18·2 years (IQR 7·7-31·4) and 50·6% of participants were female. SARS-CoV-2 prevalence for the combined measure was 10·6% (95% CI 7·3-13·9). The rtPCR-positive prevalence was 7·6% (4·7-10·6) and ELISA-positive prevalence was 2·1% (1·1-3·1). An estimated 454 708 SARS-CoV-2 infections (95% CI 312 705-596 713) occurred in the six districts between March and July, 2020, compared with 4917 laboratory-confirmed cases reported in official statistics from the Zambia National Public Health Institute., Interpretation: The estimated number of SARS-CoV-2 infections was much higher than the number of reported cases in six districts in Zambia. The high rtPCR-positive SARS-CoV-2 prevalence was consistent with observed community transmission during the study period. The low ELISA-positive SARS-CoV-2 prevalence might be associated with mitigation measures instituted after initial cases were reported in March, 2020. Zambia should monitor patterns of SARS-CoV-2 prevalence and promote measures that can reduce transmission., Funding: US Centers for Disease Control and Prevention., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Municipal solid waste (MSW) generated in Ahmedabad, India, and the surrounding area is dumped at the Pirana site; rag pickers collect materials for re-sale. We have compared genotoxicity and oxidative stress in samples from women rag pickers working at this site, with women involved only in door-to-door waste picking (in residential areas near the university campus) as "controls". The buccal Cytokinesis-Block Micronucleus (CBMN) assay showed significantly higher frequencies of Micronucleus (MN), Nucleoplasmic Bridges (NPB), and Nuclear Buds (NB) in the rag pickers than in the "controls". The buccal Micronuclei Cytome (BMCyt) assay showed significantly higher prevalence of nuclear anomalies, such as micronucleus, karyorrhexis, karyolytic cells, and nuclear buds. Blood samples from the rag pickers showed lower levels of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase), lower total serum protein concentrations, and greater lipid peroxidation compared to the "control" group. Exposure to hazardous solid waste may lead to increased oxidative damage and genotoxicity; improved safety procedures and the use of personal protective equipment are recommended., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Approximately 142 million people worldwide are infected with hepatitis C virus (HCV). Although potent direct acting antivirals are available, high costs limit access to treatment. Chronic hepatitis C virus infection remains a major cause of orthotopic liver transplantation. Moreover, re-infection of the graft occurs regularly. Antivirals derived from natural sources might be an alternative and cost-effective option to complement therapy regimens for global control of hepatitis C virus infection. We tested the antiviral properties of a mixture of different Chinese herbs/roots named Zhi Bai Di Huang Wan (ZBDHW) and its individual components on HCV. One of the ZBDHW components, Penta-O-Galloyl-Glucose (PGG), was further analyzed for its mode of action in vitro, its antiviral activity in primary human hepatocytes as well as for its bioavailability and hepatotoxicity in mice. ZBDHW, its component Cortex Moutan and the compound PGG efficiently block entry of HCV of all major genotypes and also of the related flavivirus Zika virus. PGG does not disrupt HCV virion integrity and acts primarily during virus attachment. PGG shows an additive effect when combined with the well characterized HCV inhibitor Daclatasvir. Analysis of bioavailability in mice revealed plasma levels above tissue culture IC 50 after a single intraperitoneal injection. In conclusion, PGG is a pangenotypic HCV entry inhibitor with high bioavailability. The low cost and wide availability of this compound make it a promising candidate for HCV combination therapies, and also emerging human pathogenic flaviviruses like ZIKV., (Copyright © 2017. Published by Elsevier B.V.)