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Understanding the origin and evolution of the unique mammalian respiratory system hinges on our knowledge of the osteological changes in the pectoral apparatus (i.e., scapulocoracoid, cleithrum, clavicle, interclavicle, sternum) throughout the synapsid fossil record. Among non-mammalian therapsids, documentation of this anatomy is woefully incomplete, with groups such as dinocephalians and gorgonopsians remaining poorly documented. Here we provide a detailed anatomical description of an articulated sternum and interclavicle of a well-preserved specimen of Aelurognathus tigriceps (Broom & Haughton, 1913) from the Lopingian upper Madumabisa Mudstone Formation, Luangwa Basin of Zambia. The sternal morphology reveals new anatomical details on the attachment sites for the ribs, showing three distinct facets, and a previously undescribed depression on the ventral surface for the attachment of the interclavicle. We also provide a preliminary discussion of the morphological variation of these elements both within Gorgonopsia and across Therapsida. [ABSTRACT FROM AUTHOR]

Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) 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.)

To problematise Western discourses of a homophobic Africa, there is a need to analyse evidence of homophobia and its interplay with other attitudes, in ways that explore contextual differences. Hence, this article offers an original sociological analysis of quantitative data on homophobia in African states, examining how this inter-relates with xenophobia. Social attitudes data are drawn from the Afrobarometer research project as a unique and important source, and compared in five diverse contexts: Kenya, Mozambique, Nigeria, Senegal and Zambia. Data are examined from Round 6 (2014–2015) and Round 7 (2016–2018). Findings are interpreted in light of specific national literatures on the relations between sexuality, gender and nationalism, as well as wider critical and postcolonial perspectives – especially conceptualisation of sexual nationalisms, and recent literatures on political homophobia. Whereas analyses of homonationalism in Western societies have explored alignments of lesbian, gay, bisexual, transgender and intersex rights affirmation with anti-immigrant attitudes, this study explores such relationships between homophobic and xenophobic attitudes in alternative patterns within specific African contexts. The analysis delivered not only challenges Western discourses of generalised African homophobia (especially discussing the counterexample of Mozambique) but also advances understanding of the complexity of how attitudes inter-relate in different postcolonial states. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

With the enactment of Statutory Instrument No. 72 (2019), Zambia is extending pension coverage to workers in the informal economy. We present evidence on the experiences and perspectives of domestic workers and bus and taxi drivers regarding pension scheme coverage in Zambia. We use data generated through interviews and focus group discussions. The analysis shows that pension schemes, as conventionally designed for formal economy employees, are not compatible with the values, beliefs and needs of informal economy workers, and pension coverage was not a priority for them. As a form of social innovation, extending access to pension coverage had a lower relative advantage and lacked incentives to attract informal economy workers. We propose a member‐centred framework for initiating the extension of social security coverage to informal economy workers. [ABSTRACT FROM AUTHOR]

Objectives: Adherence to antiretroviral therapy (ART) leads to viral suppression for people living with HIV (PLHIV) and is critical for both individual health and reducing onward HIV transmission. HIV stigma is a risk factor that can undermine adherence. We explored the association between HIV stigma and self‐reported ART adherence among PLHIV in 21 communities in the HPTN 071 (PopART) trial in Zambia and the Western Cape of South Africa. Methods: We conducted a cross‐sectional analysis of baseline data collected between 2013 and 2015, before the roll‐out of trial interventions. Questionnaires were conducted, and consenting participants provided a blood sample for HIV testing. Poor adherence was defined as self‐report of not currently taking ART, missing pills over the previous 7 days or stopping treatment in the previous 12 months. Stigma was categorised into three domains: community, health setting and internalised stigma. Multivariable logistic regression was used for analysis. Results: Among 2020 PLHIV self‐reporting ever taking ART, 1888 (93%) were included in multivariable analysis. Poor ART adherence was reported by 15.8% (n = 320) of participants, and 25.7% (n = 519) reported experiencing community stigma, 21.5% (n = 434) internalised stigma, and 5.7% (n = 152) health setting stigma. PLHIV who self‐reported previous experiences of community and internalised stigma more commonly reported poor ART adherence than those who did not (aOR 1.63, 95% CI 1.21 −2.19, P = 0.001 and aOR 1.31, 95% CI 0.96–1.79, P = 0.09). Conclusions: HIV stigma was associated with poor ART adherence. Roll‐out of universal treatment will see an increasingly high proportion of PLHIV initiated on ART. Addressing HIV stigma could make an important contribution to supporting lifelong ART adherence. [ABSTRACT FROM AUTHOR]

Notre article examine le rapport entre les capitaux chinois liés aux jeux d'argent, l'exploitation par le travail et la migration de la main-d'oeuvre. En nous concentrant sur les jeux d'argent en ligne philippins et les casinos basés en Zambie, nous montrons en quoi l'accumulation de capital dans le secteur du jeu repose sur le «travail linguistique» des travailleurs chinois pour faciliter la communication en ligne ou sur place entre les joueurs et les sociétés. Financées par des Chinois, ces dernières doivent continuellement faire venir des travailleurs chinois par des filières à la fois légales et illégales. Après avoir migré, les travailleurs sont privés de recours extérieur en raison des liens établis entre les entreprises et les élites des pays d'accueil ainsi que du statut illégal du jeu en Chine. Les entreprises peuvent arbitrairement augmenter les heures de travail et imposer à leurs employés des conditions de travail abusives. La dépendance des capitaux du jeu à l'égard du travail linguistique des employés et le statut juridique obscur de cette industrie ouvrent des voies à l'exploitation des travailleurs et à la multiplication des sites d'extraction de capitaux chinois. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disrupted Zambian life. Prior to the pandemic, persistent levels of inequality across urban/rural, educational, and socioeconomic divides characterized Zambia's health and family patterns. Zambia's government reacted decisively to the threat, shutting down many businesses, schools, and other social gatherings prior to the first confirmed cases. Fortunately, the country has not had many deaths. The indirect effects of COVID-19, however, on Zambian families mean many have lost income (via a reduction in the size of both the formal and, particularly, the informal sectors) and many businesses struggle with increased costs and reduced revenues. The healthcare system, particularly in rural areas, is strained. While the effect on the education system likely will not be fully visible for many years, it is likely that fewer children will pass their examinations this year, thereby reducing human capital in the next generation. In contrast, Zambia's wealthy, often concentrated in the two economic and population hubs of Lusaka, the capital, and the Copperbelt province, are spending greater time with their families while using their substantial resources to maintain their standard of living. The ability to engage in physical distancing varies as well, with the privileged able to do so by staying home and shopping at smaller, more expensive (but less patronized) shops while the poor crowd into congested neighborhoods and markets. These deep inequalities will likely continue to shape Zambian society in both the near and long-term future, well after the COVID-19 pandemic of 2020 has faded from collective memory. [ABSTRACT FROM AUTHOR]

Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) 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.)

Copyright of Historia is the property of Historical Association of South Africa 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.)

Objective: To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia.Methods: Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15.Results: HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females.Conclusion: HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia. [ABSTRACT FROM AUTHOR]

Key evolutionary events in hominin evolution occurred between 3.5 and 2.4 Ma, including the origins of flaked tool technology and the first appearance of the genera Homo and Paranthropus. This period remains poorly understood, however, because deposits of this age are rarely exposed across Africa. The Luangwa River Valley of eastern Zambia is part of the southernmost extension of the East African Rift System; a fossil femur from South Luangwa, identified as Theropithecus cf. darti , hints at the presence of fossiliferous beds of this age in the Luangwa Valley. Additionally, Middle Pleistocene fossils and Early and Middle Stone Age artifacts have also been recovered in sediments adjacent to the Luangwa River. Fossils from these deposits could contribute data on the diversification of hominins and mammals that occurred during the Plio-Pleistocene. The Luangwa River also supports a rich modern mammalian community that represents a critical analogue for reconstructing hominin paleoenvironments. However, no systematic ecological characterizations of living or past mammalian communities of the Luangwa River Valley have been completed. The newly initiated Zambia Rift Valley Research Project (ZRVRP) will analyze the ecology of modern and fossil Luangwa River mammalian and human communities using dental microwear, enamel and collagen isotopic composition, the distribution of bones, fossils, and vegetation on the landscape, and archaeological materials. Patterns of paleoenvironmental change, climatic seasonality, and hominin landscape use over time will provide important comparative context for other Plio-Pleistocene sites. Here, we describe the goals, methods, and community engagement of the ZRVRP, and some challenges involved in launching new paleoanthropological field research. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

Objective: Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low-resource settings. We tested an algorithm that task-shifts omphalitis diagnosis to community-level workers in sub-Saharan Africa.Methods: Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis.Results: Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%.Conclusion: Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub-Saharan African setting. [ABSTRACT FROM AUTHOR]

Objective: To assess how quality and availability of reproductive, maternal, neonatal (RMNH) services vary by district wealth and urban/rural status in Zambia.Methods: We conducted a retrospective analysis of data from the Millennium Development Goal Acceleration Initiative baseline assessment of 117 health facilities in 9 districts. Quality was assessed through a composite score of 23 individual RMNH indicators, ranging from 0 to 1. Availability was evaluated by density of providers and facilities. Districts were divided into wealth groups based on the multidimensional poverty index (MPI). Relative inequity was calculated using the concentration index for quality indicators (positive favours rich, negative favours poor). Multivariable linear regression was performed for the dependent variable composite quality indicator using MPI, urban/rural, and facility level of care as independent variables.Results: 13 hospitals, 85 health centres and 19 health posts were included. The RMNH composite quality indicator was 0.64. Availability of facilities and providers was universally low. The concentration index for the composite quality indicator was -0.015 [-0.043, 0.013], suggesting no clustering to favour either rich or poor districts. Rich districts had the highest absolute numbers of health facilities and providers, but lowest numbers per facility per 1 000 000 population. Urban districts had slightly better service quality, but not availability. Using regression analysis, only facility level of care was significantly associated with quality outcome.Conclusions: Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure. [ABSTRACT FROM AUTHOR]

Objective: To describe the associations between socio-economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era.Methods: The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio-economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients.Results: The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33-0.92) times and 0.70 (95% CI 0.54-0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university-educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12-0.54) and 0.42 (95% CI 0.25-0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status.Conclusion: These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics. [ABSTRACT FROM AUTHOR]

Objective: The zoonotic helminth Taenia solium is endemic in Zambia, causing human (taeniasis and (neuro)cysticercosis) and pig (porcine cysticercosis) diseases with high health, social and economic burdens. We aimed to evaluate the impact of a health educational program intended to lead to powerful and cumulative improvements in knowledge, attitudes and practices that decrease parasite transmission and disease occurrence.Methods: Half-day health education workshops were conducted in three primary schools in the highly endemic Eastern Province of Zambia, using the computer-based T. solium educational program 'The Vicious Worm'. Questionnaires were administered before and after the educational component to determine the program's impact on knowledge uptake in primary school students.Results: In total, 99 students participated: 38 males and 61 females, with a median age of 14 years (range 10-18 years). Baseline general knowledge of T. solium, including awareness of the different human and pig disease states, and disease diagnosis, treatment and prevention, was quite high (average score 62%) and consistent across all three study areas. Participants' knowledge had significantly increased after the educational component, particularly regarding parasite transmission and disease prevention.Conclusion: Preliminary assessment of 'The Vicious Worm' indicates it is an effective tool for the short-term T. solium education of primary school students in Zambia. Follow-up studies are planned to assess the longer term impact of the program on knowledge uptake in the study neighbourhoods. Inclusion of tailored 'The Vicious Worm' educational workshops should be considered in integrated cysticercosis control programs in endemic areas of sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objectives: Prisons act as infectious disease reservoirs. We aimed to explore the challenges of TB control and continuity of care in prisons in Zambia.Methods: We evaluated treatment outcomes for a cohort of inmates diagnosed with TB during a TB REACH funded screening programme initiated by the Zambia Prisons Service and the Centre for Infectious Disease Research in Zambia.Results: Between October 2010 and September 2011, 6282 inmates from six prisons were screened for TB, of whom 374 (6.0%) were diagnosed. TB treatment was initiated in 345 of 374 (92%) inmates. Of those, 66% were cured or completed treatment, 5% died and 29% were lost to follow-up. Among those lost to follow-up, 11% were released into the community and 13% were transferred to other prisons.Conclusions: Weak health systems within the Zambian prison service currently undermines continuity of care, despite intensive TB screening and case-finding interventions. To prevent TB transmission and the development of drug resistance, we need sufficient numbers of competent staff for health care, reliable health information systems including electronic record keeping for prison facilities, and standard operating procedures to guide surveillance, case-finding and timely treatment initiation and completion. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre 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.)

Copyright of Review of African Political Economy is the property of Review of Political Economy (ROAPE) 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.)

Cet article repose sur une enquête sur les usages sociaux du canoë en Zambie. Il a pour objectif de décrire les caractéristiques des relations sociales qui se nouent entre étrangers et « populations locales ». Si l’organisation de l’activité recouvre une visée touristique pour nombre de pays africains, touristes et habitants entrent peu en interaction en dehors de la pratique des loisirs. Pour étudier l’identité, il s’agit de caractériser la genèse du tour en canoë afin de saisir l’émergence de modes d’appréhension de l’Autre dans le cadre du loisir en Zambie. La singularité des relations sociales entre populations occidentales et africaines pose la question de la différence culturelle, au moment où la globalisation introduit à la fois une homogénéisation des pratiques et une fragmentation dans les modes de vie. L’article proposera une réflexion critique car les modes de structuration du canoë constituent un révélateur des rapports toujours ambivalents entre pays occidentaux et africains.

This paper analyzes the natural resources governance framework in Zambia. The research is the result of a broader project on natural resource governance with interviews performed in a number of countries in sub-Saharan Africa. The goal of the paper is to identify the gaps and inconsistencies within the Zambian natural resource policy framework, in an effort to broaden the understanding of how governance of the sector may be streamlined and optimized. It further offers suggestions on how other sectors, such as education, may be central to the development of a more successful natural resource framework. The paper focuses on Zambia as a country with a long history of mining and a relatively stable political environment, yet one in which tensions between government and the private sector remain, and policies on natural resource extraction which have been particularly volatile in recent years.

This paper analyzes the natural resources governance framework in Zambia. The research is the result of a broader project on natural resource governance with interviews performed in a number of countries in sub-Saharan Africa. The goal of the paper is to identify the gaps and inconsistencies within the Zambian natural resource policy framework, in an effort to broaden the understanding of how governance of the sector may be streamlined and optimized. It further offers suggestions on how other sectors, such as education, may be central to the development of a more successful natural resource framework. The paper focuses on Zambia as a country with a long history of mining and a relatively stable political environment, yet one in which tensions between government and the private sector remain, and policies on natural resource extraction which have been particularly volatile in recent years. [ABSTRACT FROM AUTHOR]

Copyright of African Population Studies is the property of Union for African Population Studies 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.)

Copyright of African Population Studies is the property of Union for African Population Studies 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.)

Copyright of Clio. Femmes, Genre, Histoire is the property of Belin Editeur 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.)

Copyright of African Population Studies is the property of Union for African Population Studies 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.)

Cet article repose sur une enquête sur les usages sociaux du canoë en Zambie. Il a pour objectif de décrire les caractéristiques des relations sociales qui se nouent entre étrangers et « populations locales ». Si l'organisation de l'activité recouvre une visée touristique pour nombre de pays africains, touristes et habitants entrent peu en interaction en dehors de la pratique des loisirs. Pour étudier l'identité, il s'agit de caractériser la genèse du tour en canoë afin de saisir l'émergence de modes d'appréhension de l'Autre dans le cadre du loisir en Zambie. La singularité des relations sociales entre populations occidentales et africaines pose la question de la différence culturelle, au moment où la globalisation introduit à la fois une homogénéisation des pratiques et une fragmentation dans les modes de vie. L'article proposera une réflexion critique car les modes de structuration du canoë constituent un révélateur des rapports toujours ambivalents entre pays occidentaux et africains. [ABSTRACT FROM AUTHOR]

Copyright of Cahiers d'Études Africaines is the property of Editions EHESS 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.)

Objective To document leprosy trends in Zambia over the past two decades to ascertain the importance of leprosy as a health problem in Zambia. Methods Retrospective study covering the period 1991-2009 of routine national leprosy surveillance data, published national programme review reports and desk reviews of in-country TB reports. Results Data reports were available for all the years under study apart from years 2001, 2002 and 2006. The Leprosy case notification rates (CNR) declined from 2.73/10 000 population in 1991 to 0.43/10 000 population in 2009. The general leprosy burden showed a downward trend for both adults and children. Leprosy case burden dropped from approximately 18 000 cases in 1980 to only about 1000 cases in 1996, and by the year 2000, the prevalence rates had fallen to 0.67/10 000 population. There were more multibacillary cases of leprosy than pauci-bacillary cases. Several major gaps in data recording, entry and surveillance were identified. Data on disaggregation by gender, HIV status or geographical origin were not available. Conclusion Whilst Zambia has achieved WHO targets for leprosy control, leprosy prevalence data from Zambia may not reflect real situation because of poor data recording and surveillance. Greater investment into infrastructure and training are required for more accurate surveillance of leprosy in Zambia. [ABSTRACT FROM AUTHOR]

Objective To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. Methods Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000-2010. Results The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti-retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV-infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co-trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. Conclusions The scale-up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti-retroviral (ARV) rollout with improved treatment outcomes among TB patients co-infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA). [ABSTRACT FROM AUTHOR]

Copyright of Historia is the property of Historical Association of South Africa 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.)

Objective Prior exposure to intrapartum/neonatal nevirapine (NVP) is associated with compromised virologic treatment outcomes once non-nucleoside reverse transcriptase inhibitor (NNRTI)–based antiretroviral therapy (ART) is initiated. We examined the longer-term clinical outcomes in a programmatic setting. Methods We compared post-12 month mortality and clinical treatment failure (defined by WHO clinical and immunologic criteria) among women with and without prior NVP exposure in Lusaka, Zambia. Results Between April 2004 and July 2006, 6740 women initiated an NNRTI-containing regimen. At 12 months, 5172 (78%) remained active and were included in this analysis. Of these, 596 (12%) reported prior NVP exposure, whose time from exposure to ART initiation was: <6 months for 11%, 6–12 months for 13%, >12 months for 37%, unknown for 39%. Overall, women with prior NVP exposure trended towards increased survival (adjusted hazard ratio [AHR]: 0.53; 95% confidence interval [CI]: 0.27–1.06, P = 0.07) and towards increased hazard of clinical treatment failure (AHR: 1.18; 95% CI: 0.95–1.47, P = 0.14), particularly those with exposure for <6 months (AHR: 1.52; 95% CI: 0.94–2.45, P = 0.09). Conclusions Prior NVP exposure appeared to increase risk for clinical treatment failure after 12 months of follow-up, but this finding did not reach statistical significance. With growing evidence linking recent NVP exposure to virologic failure, optimized monitoring algorithms should be considered for women with starting NNRTI-based ART. The association between prior NVP exposure and improved survival has not been previously shown and may be a result of residual confounding around health-seeking behaviours. [ABSTRACT FROM AUTHOR]

Copyright of ALTER: European Journal of Disability Research, Journal Europeen de Erche sur le Handicap is the property of European Society for Disability Research 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.)

Objective To assess the association of accessibility to a health facility with caregivers’ care-seeking practices for children with danger signs before and after community-based intervention in Lusaka, Zambia. Method Health education on childhood danger signs was started in September 2003 at the monthly Growth Monitoring Program Plus (GMP+) service through various channels of health talk and one-on-one communication in a peri-urban area of Lusaka. Two repeated surveys were conducted: in 2003 to collect baseline data before the intervention and in 2006 for 3-year follow-up data. Caregivers who had perceived one or more danger signs in their children within 2 months of the surveys were eligible for the analysis. The association between appropriate and timely care-seeking practices and socio-demographic and socio-economic factors, attendance at community-based intervention and the distance to a health facility was examined with logistic regression analysis. Results The percentage of caregivers immediately seeking care from health professionals increased from 56.1% (106/189) at baseline to 65.8% (148/225) at follow-up 3 years later (OR = 1.51, P < 0.05). Long distance to the health facility and low-household income negatively influenced caregivers’ appropriate and timely care-seeking practices at baseline, but 3 years later, after the implementation of a community-based intervention, distance and household income were not significantly related to caregivers’ care-seeking practices. Conclusion Poor accessibility to health facilities was a significant barrier to care-seeking in a peri-urban area. However, when caregivers are properly educated about danger signs and appropriate responses through community-based intervention, this barrier can be overcome through behavioural change in caregivers. [ABSTRACT FROM AUTHOR]

Objectives To describe the pattern of incident illness in children after initiation of antiretroviral therapy (ART) in a large public health sector programme in Lusaka, Zambia. Methods Systematic chart review to retrospectively extract data from medical records of children (i.e. <15 years) initiating ART in the Lusaka, Zambia public sector. Incident conditions were listed separately and then grouped according to broad categories. Predictors for incident diagnoses were determined using univariate and multivariable analysis. Results Between May 2004 and June 2006, 1705 HIV-infected children initiated ART. Of these, 1235 (72%) had their medical records reviewed. Median age at ART initiation was 77 months and 554 (45%) were females. Eight hundred and forty-one (68%) children had an incident condition during this period, with a median time of occurrence of 64 days from ART initiation. Twenty-eight incident conditions were documented. When categorized, the most common were mucocutaneous conditions [incidence rate (IR): 70.6 per 100 child-years, 95% CI: 64.5–77.2] and upper respiratory tract infection (IR: 70.1 per 100 child-years; 95% CI: 64.0–76.7). Children with severe immunosuppression (i.e. CD4 < 10%) were more likely to develop lower respiratory tract infection (16.3% vs. 10.2%; P = 0.003) and mucocutaneous conditions (43.9% vs. 35.3%; P = 0.005) than those with CD4 ≥ 10%. Conclusion There is a high incidence of new illness after ART initiation, emphasizing the importance of close monitoring during this period. Early initiation of ART and use of antimicrobial prophylaxis may also help to reduce the occurrence of such co-morbidities. [ABSTRACT FROM AUTHOR]

Objectives To examine the associations between household Plasmodium falciparum infection and a number of factors including domestic animal ownership, potential mosquito breeding sites, indoor darkness, density of people, distance between dwelling structures, and insecticide-treated bed net use. Methods Analyses were based on data collected from a household survey conducted in Macha, Zambia. Thirty-four households with recurrent malaria infection in 2005–2008 were selected as case households and compared with 37 control households with no malaria infection randomly selected from the same geographic area. Logistic regression models were used to identify factors associated with household P. falciparum infection. Results In multivariate analysis, cattle ownership was associated with reduced risk of P. falciparum infection (adjusted odds ratio = 0.19; 95% CI = 0.05–0.69), as was increased distance between dwelling structures (aOR = 0.26; 95% CI = 0.07–0.98). Ownership of the highest category of cattle, goats, dogs, or cats dramatically reduced the risk of P. falciparum infection (aOR = 0.13; 95% CI = 0.03–0.56). Conclusion Domestic animal, in particular cattle, ownership and greater distance between dwelling structures were associated with reduced risk of recurrent P. falciparum infection at the household level. These factors should be further investigated as supplemental measures for malaria control in rural African settings. [ABSTRACT FROM AUTHOR]

Objectives To describe our experience using satellite image-based sampling to conduct a health survey of children in an urban area of Lusaka, Zambia, as an approach to sampling when the population is poorly characterized by existing census data or maps. Methods Using a publicly available Quickbird™ image of several townships, we created digital records of structures within the residential urban study area using ArcGIS 9.2. Boundaries were drawn to create geographic subdivisions based on natural and man-made barriers (e.g. roads). Survey teams of biomedical research students and local community health workers followed a standard protocol to enrol children within the selected structure, or to move to the neighbouring structure if the selected structure was ineligible or refused enrolment. Spatial clustering was assessed using the K-difference function. Results Digital records of 16 105 structures within the study area were created. Of the 750 randomly selected structures, six (1%) were not found by the survey teams. A total of 1247 structures were assessed for eligibility, of which 691 eligible households were enroled. The majority of enroled households were the initially selected structures (51%) or the first selected neighbour (42%). Households that refused enrolment tended to cluster more than those which enroled. Conclusions Sampling from a satellite image was feasible in this urban African setting. Satellite images may be useful for public health surveillance in populations with inaccurate census data or maps and allow for spatial analyses such as identification of clustering among refusing households. [ABSTRACT FROM AUTHOR]

Objective To examine the contribution of human immunodeficiency virus (HIV) to adult death rates between 1995/1996 and 1998/1999 in some urban and rural populations in Zambia. Method A cohort of 2592 out of 3013 adults aged 15–49 years enrolled in a baseline survey in 1995/1996 in areas of Chelston Township (HIV prevalence 26.2%) and Kapiri Mposhi district (HIV prevalence 15.6%) were followed up in 1998/1999. Person years of observation (PYO) were calculated for those known to have been alive, dead and migrated between the surveys. Fixed covariates Cox proportional hazard models were fitted to assess survival prospects. Results Death rates per 1000 PYO in the rural cohort were 38.1 among those with HIV, 4.8 among those without HIV and 9.8 for all; the population attributable fraction of deaths among those with HIV was 52.3%. Respective estimates in the urban cohort were 53.8, 4.6, 17.2 and 73.6%. The hazard rate (HR) ratio of death for persons infected with HIV was 8.7 times [HR 8.65; 95% confidence interval (CI) 5.28–14.15] higher than for the uninfected after adjusting for age, area of residence, marital status, self-rated health and years spent on education. HR among those who rated their health good/excellent was 40% less, i.e. HR 0.60 (95% CI: 0.40–0.91) than those who rated it to be poor/fair. Conclusions HIV infection was the most important factor accounting for adult deaths in the communities. [ABSTRACT FROM AUTHOR]

Objective To determine to what extent antenatal clinic (ANC)-based estimates reflect HIV prevalence trends among men and women in a high prevalence urban population. Methods Examination of data from serial population-based HIV surveys in 1995 ( n = 2115), 1999 ( n = 1962) and 2003 ( n = 2692), and ANC-based surveillance in 1994 ( n = 450), 1998 ( n = 810) and 2002 ( n = 786) in the same site in Lusaka, Zambia. The population-based surveys recorded refusal rates between 6% and 10% during the three rounds. Results Among ANC attendees, prevalence declined by 20% (25.0% to 19.9%; P = 0.101) in the age group 15–24 years and was stable overall. In the general population, the prevalence declined by 49% ( P < 0.001) and by 32% ( P < 0.001) in age group 15–24 and 15–49, respectively. Among women only, HIV prevalence declined by 44% (22.5% to 12.5%; P < 0.001) and by 27% (29.6% to 21.7%; P < 0.001) in age group 15–24 and 15–49 years, respectively. In addition, prevalence substantially declined in higher educated women aged 15–24 years (20.7% to 8.5%, P < 0.001). Conclusion ANC-based estimates substantially underestimated declines in HIV prevalence in the general population. This seemed to be partially explained by a combination of marked differentials in prevalence change by educational attainment and changes in fertility-related behaviours among young women. These results have important implications for the interpretation of ANC-based HIV estimates and underscore the importance of population-based surveys. [ABSTRACT FROM AUTHOR]

The Benchmarks of Fairness instrument is an evidence-based policy tool developed in generic form in 2000 for evaluating the effects of health-system reforms on equity, efficiency and accountability. By integrating measures of these effects on the central goal of fairness, the approach fills a gap that has hampered reform efforts for more than two decades. Over the past three years, projects in developing countries on three continents have adapted the generic version of these benchmarks for use at both national and subnational levels. Interdisciplinary teams of managers, providers, academics and advocates agree on the relevant criteria for assessing components of fairness and, depending on which aspects of reform they wish to evaluate, select appropriate indicators that rely on accessible information; they also agree on scoring rules for evaluating the diverse changes in the indicators. In contrast to a comprehensive index that aggregates all measured changes into a single evaluation or rank, the pattern of changes revealed by the benchmarks is used to inform policy deliberation about which aspects of the reforms have been successfully implemented, and it also allows for improvements to be made in the reforms. This approach permits useful evidence about reform to be gathered in settings where existing information is underused and where there is a weak information infrastructure. Brief descriptions of early results from Cameroon, Ecuador, Guatemala, Thailand and Zambia demonstrate that the method can produce results that are useful for policy and reveal the variety of purposes to which the approach can be put. Collaboration across sites can yield a catalogue of indicators that will facilitate further work. [ABSTRACT FROM AUTHOR]

Abstract: The isothermal and chimeric primer-initiated amplification of nucleic acids (ICAN) is a new isothermal DNA amplification method composed of exo Bca DNA polymerase, RNaseH and DNA–RNA chimeric primers. We detected invA of Salmonella from chicken carcasses, egg yolk and cattle fecal samples. Fifty-three of 59 isolates were invA-positive in ICAN-chromatostrip detection. The result was consistent with those obtained by standard PCR. Salmonella invA was detected in 12 of 14 carcass rinses by ICAN, while in 7 of 14 rinses by standard PCR. These results indicate that ICAN is an efficient, sensitive and simple system to detect invA of Salmonella species in developing countries such as Zambia. [Copyright &y& Elsevier]