Tropical Diseases Research Center

Ndola, Zambia

Tropical Diseases Research Center

Ndola, Zambia

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Hamainza B.,Operational Research Unit | Moonga H.B.,Parasitology Unit | Chalwe V.,Tropical Diseases Research Center | Pagnoni F.,World Health Organization
Malaria Journal | Year: 2011

Background: Access to prompt and effective treatment is a cornerstone of the current malaria control strategy. Delays in starting appropriate treatment is a major contributor to malaria mortality. WHO recommends home management of malaria using artemisininbased combination therapy (ACT) and Rapid Diagnostic tests (RDTs) as one of the strategies for improving access to prompt and efective malaria case management. Methods. A prospective evaluation of the effectiveness of using community health workers (CHWs) as delivery points for ACT and RDTs in the home management of malaria in two districts in Zambia. Results: CHWs were able to manage malaria fevers by correctly interpreting RDT results and appropriately prescribing antimalarials. All severe malaria cases and febrile non-malaria fevers were referred to a health facility for further management. There were variations in malaria prevalence between the two districts and among the villages in each district. 100% and 99.4% of the patients with a negative RDT result were not prescribed an antimalarial in the two districts respectively. No cases progressed to severe malaria and no deaths were recorded during the study period. Community perceptions were positive. Conclusion: CHWs are effective delivery points for prompt and effective malaria case management at community level. Adherence to test results is the best ever reported in Zambia. Further areas of implementation research are discussed. © 2011 Chanda et al; licensee BioMed Central Ltd.


Hamainza B.,Operational Research Unit | Moonga H.B.,Parasitology Unit | Chalwe V.,Tropical Diseases Research Center | Banda P.,Ministry of Health | Pagnoni F.,World Health Organization
Malaria Journal | Year: 2011

Background: Malaria case management is one of the key strategies to control malaria. Various studies have demonstrated the feasibility of home management of malaria (HMM). However, data on the costs and effectiveness of artemisinin-based combination therapy (ACT) and rapid diagnostic tests via HMM is limited. Method. Cost-effectiveness of home management versus health facility-based management of uncomplicated malaria in two rural districts in Zambia was analysed from a providers' perspective. The sample included 16 community health workers (CHWs) and 15 health facilities. The outcome measure was the cost per case appropriately diagnosed and treated. Costs of scaling-up HMM nationwide were estimated based on the CHW utilisation rates observed in the study. Results: HMM was more cost effective than facility-based management of uncomplicated malaria. The cost per case correctly diagnosed and treated was USD 4.22 for HMM and USD 6.12 for facility level. Utilization and adherence to diagnostic and treatment guidelines was higher in HMM than at a health facility. Conclusion: HMM using ACT and RDTs was more efficient at appropriately diagnosing and treating malaria than the health facility level. Scaling up this intervention requires significant investments. © 2011 Chanda et al; licensee BioMed Central Ltd.


Manyando C.,Tropical Diseases Research Center | Njunju E.M.,Tropical Diseases Research Center | Chileshe J.,Tropical Diseases Research Center | Siziya S.,Copperbelt University
Malaria Journal | Year: 2014

Background: In Zambia, there has been a large scaling up of interventions to control malaria in recent years including the deployment of rapid diagnostic tests (RDTs) to improve malaria surveillance data as well as guide malaria treatment in health facilities. The practical challenge is the impact of RDT results on subsequent management of patients. This study explored the role of RDTs in malaria diagnosis and the health workers' adherence to test results. Methods. An observational prospective study was carried out at health centres in four districts, namely Chibombo, Chingola, Chipata, and Choma. Children under the age of five years with history of fever were recruited and the clinicians' use of RDT results was observed to establish whether prescriptions were issued prior to the availability of parasitological results or after, and whether RDT results influenced their prescriptions. Results: Of the 2, 393 recruited children, 2, 264 had both RDT and microscopic results. Two in three (68.6%) children were treated with anti-malarials despite negative RDT results and almost half (46.2%) of these were prescribed Coartem®. Only 465 (19.4%) of the 2,393 children were prescribed drugs before receiving laboratory results. A total of 76.5% children were prescribed drugs after laboratory results. Children with RDT positive results were 2.66 (95% CI (2.00, 3.55)) times more likely to be prescribed anti-malarial drugs. Children who presented with fever at admission (although history of fever or presence of fever at admission was an entry criterion) were 42% less likely to be prescribed an anti-malarial drug compared to children who had no fever (AOR = 0.58; 95% CI (0.52, 0.65)). It was noted that proportions of children who were RDT- and microscopy-positive significantly declined over the years from 2005 to 2008. Conclusions: RDTs may contribute to treatment of febrile illness by confirming malaria cases from non-malaria cases in children under the age of five. However, the adherence of the health workers to prescribing anti-malarials to only RDT-positive cases at health facility level will still require to be explored further as their role is crucial in more precise reporting of malaria cases in this era towards malaria elimination as the target. © 2014 Manyando et al.; licensee BioMed Central Ltd.


Grant
Agency: European Commission | Branch: FP7 | Program: CSA-SA | Phase: HEALTH-2007-2.3.2-14 | Award Amount: 1.67M | Year: 2009

To bridge the gap between the biological sciences, health and development in Africa, a consortium is created and named the PRD College, which proposes to reorganise and educate young African and European scientists to perform research, on poverty related and neglected diseases (PR&ND) that is relevant to development. These diseases are common ground for both the African nations who wish to develop and the European Union who wishes to contribute to and collaborate with Africa for development. Experiences with members of this consortium on the Multilateral Initiative on Malaria (MIM) that was begun by the TDR of World Health Organisation and subsequently the Gates Malaria Partnership of the London School of Hygiene and Tropical Medicine and recently with the EU funded Network of Excellence (BioMALPAR) post-doctoral programmes, confirmed that scientific capacity building in Africa is beneficial for both disease control as well as for national development, but that the scientific sector in Africa cannot yet stand on its own feet and needs to be enhanced and directed towards development in order to be sustainable. The PRD College will stimulate an early collaboration and enable young scientists to place science within the context of development in Africa. Certain capacity areas will be given focus through elective and mandatory courses followed by an internship in development at an African institution and a science exchange program. Divided into a 6 work packages and 4 committees, training capacity will be strengthened at 3 PRD Centres in Uganda, South Africa and Cameroon and involve MDs, advanced PhD Students or Post-Docs participants from Africa (12) and Europe (12). The PRD College will transform every trainee scientist to a level where participants can become trainers in their own country, using the oil-stain effect principle to spread knowledge and this new approach.


Mwanakasale V.,Tropical Diseases Research Center | Mwanakasale V.,Copperbelt University | Songolo P.,World Health Organization | Daka V.,Tropical Diseases Research Center
BMC Research Notes | Year: 2013

Background: Human African Trypanosomiasis is one of the Neglected Tropical Diseases that is targeted for elimination by the World Health Organization. Strong health delivery system in endemic countries is required for a control program to eliminate this disease. In Zambia, Human African Trypanosomiasis is lowly endemic in the northeastern part of the country. Findings. We conducted a cross-sectional survey of health institutions in Mpika district in Northern Province of Zambia from 9§ssup§th§esup§ to 23§ssup§rd§esup§ November 2011. The aim of this study was to assess current health delivery system in the management of Human African Trypanosomiasis cases in Mpika district, Northern Province of Zambia. Ten health institutions were covered in the survey. Two structured questionnaires targeting health workers were used to collect the data on general knowledge on HAT and state of health care facilities in relation to HAT management from the surveyed health institution.Only 46% of the 28 respondents scored more than 50% from the questionnaire on general knowledge about Human African Trypanosomiasis disease. None of the respondents knew how to differentiate the two clinical stages of Human African Trypanosomiasis disease. There were only three medical doctors to attend to all Human African Trypanosomiasis cases and other diseases at the only diagnostic and treatment hospital in Mpika district. The supply of antitrypanosomal drugs to the only treatment centre was erratic. Only one refresher course on Human African Trypanosomiasis case diagnosis and management for health staff in the district had been organized by the Ministry of Health in conjunction with the World Health Organization in the district in 2009. The referral system for suspected Human African Trypanosomiasis cases from Rural Health Centres (RHCs) to the diagnostic/treatment centre was inefficient. Conclusions: There are a number of challenges that have been identified and need to be addressed if Human African Trypanosomiasis is to be eliminated in a lowly endemic country such as Zambia. These include shortage of trained health workers, inadequate diagnostic and treatment centres, lack of more sensitive laboratory diagnostic techniques, shortage of trypanosomicides among others discussed in detail here. © 2013 Mwanakasale et al.; licensee BioMed Central Ltd.


Manyando C.,Tropical Diseases Research Center | Kayentao K.,Malaria Research and Training Center | Dalessandro U.,Institute of Tropical Medicine | Dalessandro U.,Medical Research Council Unit | And 3 more authors.
Malaria Journal | Year: 2012

Malaria during pregnancy, particularly Plasmodium falciparum malaria, has been linked to increased morbidity and mortality, which must be reduced by both preventive measures and effective case management. The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) to treat uncomplicated falciparum malaria during the second and third trimesters of pregnancy, and quinine plus clindamycin during the first trimester. However, the national policies of many African countries currently recommend quinine throughout pregnancy. Therefore, the aim of this article is to provide a summary of the available data on the safety and efficacy of artemether-lumefantrine (AL) in pregnancy. An English-language search identified 16 publications from 1989 to October 2011 with reports of artemether or AL exposure in pregnancy, including randomized clinical trials, observational studies and systematic reviews. Overall, there were 1,103 reports of AL use in pregnant women: 890 second/third trimester exposures; 212 first trimester exposures; and one case where the trimester of exposure was not reported. In the second and third trimesters, AL was not associated with increased adverse pregnancy outcomes as compared with quinine or sulphadoxine-pyrimethamine, showed improved tolerability relative to quinine, and its efficacy was non-inferior to quinine. There is evidence to suggest that the pharmacokinetics of antimalarial drugs may change in pregnancy, although the impact on efficacy and safety needs to be studied further, especially since the majority of studies report high cure rates and adequate tolerability. As there are fewer reports of AL safety in the first trimester, additional data are required to assess the potential to use AL in the first trimester. Though the available safety and efficacy data support the use of AL in the second and third trimesters, there is still a need for further information. These findings reinforce the WHO recommendation to treat uncomplicated falciparum malaria with quinine plus clindamycin in early pregnancy and ACT in later pregnancy. © 2012 Manyando et al.; licensee BioMed Central Ltd.


Gannon B.,University of Wisconsin - Madison | Kaliwile C.,National Food and Nutrition Commission of Zambia | Arscott S.A.,University of Wisconsin - Madison | Arscott S.A.,Standard Process Inc | And 7 more authors.
American Journal of Clinical Nutrition | Year: 2014

Background: Biofortification is a strategy to relieve vitamin A (VA) deficiency. Biofortified maize contains enhanced provitamin A concentrations and has been bioefficacious in animal and small human studies.Objective: The study sought to determine changes in total body reserves (TBRs) of vitamin Awith consumption of biofortified maize.Design: A randomized, placebo-controlled biofortified maize efficacy trial was conducted in 140 rural Zambian children. The paired 13C-retinol isotope dilution test, a sensitive biomarker for VA status, was used to measure TBRs before and after a 90-d intervention. Treatments were white maize with placebo oil (VA2), orange maize with placebo (orange), and white maize with VA in oil [400 mg retinol activity equivalents (RAEs) in 214 mL daily] (VA+).Results: In total, 133 children completed the trial and were analyzed for TBRs (n = 44 or 45/group). Change in TBR residuals were not normally distributed (P , 0.0001); median changes (95% CI) were as follows: VA2, 13 (219, 44) mmol; orange, 84 (21, 146) mmol; and VA+, 98 (24, 171) mmol. Nonparametric analysis showed no statistical difference between VA+ and orange (P = 0.34); both were higher than VA2 (P = 0.0034). Median (95% CI) calculated liver reserves at baseline were 1.04 (0.97, 1.12) mmol/g liver, with 59% .1 mmol/g, the subtoxicity cutoff; none were ,0.1 mmol/g, the deficiency cutoff. The calculated bioconversion factor was 10.4 mg b-carotene equivalents/1 mg retinol by using the middle 3 quintiles of change in TBRs from each group. Serum retinol did not change in response to intervention (P = 0.16) but was reduced with elevated C-reactive protein (P = 0.0029) and a-1-acid glycoprotein (P = 0.0023) at baseline.Conclusions: b-Carotene from maize was efficacious when consumed as a staple food in this population and could avoid the potential for hypervitaminosis A that was observed with the use of preformed VA from supplementation and fortification. Use of more sensitive methods other than serum retinol alone, such as isotope dilution, is required to accurately assess VA status, evaluate interventions, and investigate the interaction of VA status and infection. This trial was registered at clinicaltrials.gov as NCT01814891. © 2014 American Society for Nutrition.


Manyando C.,Tropical Diseases Research Center | Njunju E.M.,Tropical Diseases Research Center | D'Alessandro U.,Institute of Tropical Medicine | D'Alessandro U.,Medical Research Council Unit | Van geertruyden J.-P.,University of Antwerp
PLoS ONE | Year: 2013

Introduction: Cotrimoxazole (CTX) has been used for half a century. It is inexpensive hence the reason for its almost universal availability and wide clinical spectrum of use. In the last decade, CTX was used for prophylaxis of opportunistic infections in HIV infected people. It also had an impact on the malaria risk in this specific group. Objective: We performed a systematic review to explore the efficacy and safety of CTX used for P.falciparum malaria treatment and prophylaxis. Result: CTX is safe and efficacious against malaria. Up to 75% of the safety concerns relate to skin reactions and this increases in HIV/AIDs patients. In different study areas, in HIV negative individuals, CTX used as malaria treatment cleared 56%-97% of the malaria infections, reduced fever and improved anaemia. CTX prophylaxis reduces the incidence of clinical malaria in HIV-1 infected individuals from 46%-97%. In HIV negative non pregnant participants, CTX prophylaxis had 39.5%-99.5% protective efficacy against clinical malaria. The lowest figures were observed in zones of high sulfadoxine-pyrimethamine resistance. There were no data reported on CTX prophylaxis in HIV negative pregnant women. Conclusion: CTX is safe and still efficacious for the treatment of P.falciparum malaria in non-pregnant adults and children irrespective of HIV status and antifolate resistance profiles. There is need to explore its effect in pregnant women, irrespective of HIV status. CTX prophylaxis in HIV infected individuals protects against malaria and CTX may have a role for malaria prophylaxis in specific HIV negative target groups. © 2013 Manyando et al.


Mwanakasale V.,Tropical Diseases Research Center | Songolo P.,World Health Organization
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2011

We conducted a situation analysis of human African trypanosomiasis (HAT) in Zambia from January 2000 to April 2007. The aim of this survey was to identify districts in Zambia that were still recording cases of HAT. Three districts namely, Mpika, Chama, and Chipata were found to be still reporting cases of HAT and thus lay in HAT transmission foci in North Eastern Zambia. During the period under review, 24 cases of HAT were reported from these three districts. We thereafter reviewed literature on the occurrence of HAT in Zambia from the early 1960. s to mid 1990. s. This revealed that HAT transmission foci were widespread in Western, North Western, Lusaka, Eastern, Luapula, and Northern Provinces of Zambia during this period. In this article we have tried to give possible reasons as to why the distribution of HAT transmission foci is so different between before and after 2000 when there has been no active national tsetse fly and trypanosomiasis control program in Zambia. © 2010 Royal Society of Tropical Medicine and Hygiene.


Bresnahan K.A.,University of Wisconsin - Madison | Chileshe J.,Tropical Diseases Research Center | Tanumihardjo S.A.,University of Wisconsin - Madison
Experimental Biology and Medicine | Year: 2014

Vitamin A supplementation improves status, which may protect against malarial infection. Provitamin A carotenoid biofortified staple crops may provide a more sustainable approach to alleviate vitamin A deficiency than supplementation, but the impact of febrile illness on food intake must be considered in malaria endemic regions. Morbidity data and food logs from a three-month efficacy trial on provitamin A biofortified (orange) maize in preschool Zambian children (n = 181, age 3-5 years) were systematically analyzed over time to determine the impact of malaria on food intake. Nutrients examined included macronutrients, iron, zinc, and vitamin A. Comparisons based on individual intakes in healthy and malarial states over three-day intervals were made including children from both the orange and white maize groups (n = 100). Malaria prevalence did not differ overall or between treatment groups over time (all P > 0.05). Lower nutrient intakes were observed for all variables during malaria outbreaks (food 289 ± 412 g; energy 248 ± 346 kcal; carbohydrate 42 ± 62 g; protein 8 ± 12 g; fat 5 ± 7 g; iron 1 ± 2 mg; zinc 1 ± 1 mg; vitamin A 58 ± 100 retinol activity equivalents; all P < 0.05). No differences were observed between nutrient decreases in orange and white maize groups (P > 0.05). Considering the impact of malaria on food and nutrient intakes and increased vitamin A utilization and excretion due to the acute phase response, biofortification targets for provitamin A carotenoids may need to be elevated in malaria endemic regions. © 2013 by the Society for Experimental Biology and Medicine.

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