Centre for Infectious Disease Research in Zambia
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Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021: An Individual Participant Data Analysis
(2025-09-09) Kirakoya-Samadoulougou, Fati; Ukwishaka, Joyeuse; Ngwasiri, Calypse; Subedi, Seema; Hazel, Elizabeth A.; Erchick, Daniel J.; Wu, Lee S. F.; Grandi, Carlos; Lachat, Carl; Céline, Laéticia C.; Roberfroid, Dominique; Huybregts, Lieven; Labrique, Alain B.; Rashid, Mabhubur; Shaikh, Saijuddin; Haque, Rezwanul; Baqui, Abdullah H.; Saha, Samir K.; Khanam, Rasheda; Rahman, Sayedur; Silveira, Mariângela F.; Buffarini, Romina; Shapiro, Roger L.; Zash, Rebecca; Zhu, Zhonghai; Zeng, Lingxia; Qiu, Xiu; He, Jianrong; Gebreyesus, Seifu H.; Tesfamariam, Kokeb; Chan, Grace; Bekele, Delayehu; Adu-Afarwuah, Seth; Dewey, Kathryn G.; Gyaase, Stephaney; Wylie, Blair J.; Taneja, Sunita; Chowdhury, Ranadip; Babu, Giridhara R.; Deepa R.; Rishard, Mohamed; Lazzerini, Marzia; Rodriguez-Sibaja, Maria J.; Acevedo-Gallegos, Sandra; Ashorn, Per; Maleta, Kenneth; Mullany, Luke C.; Jehan, Fyezah; Ilyas, Muhammad; Rogerson, Stephen J.; Unger, Holger W.; Ghosh, Rakesh; Musange, Sabine; Mongkolchati, Aroonsri; Keentupthai, Paniya; Fawzi, Wafaie; Wang, Dongqing; Schmiegelow, Christentze; Minja, Daniel; Hjort, Line; Lusingu, John P. A.; Smith, Emily R.; Masanja, Honorati; Kabole, Fathma M.; Slim, Salim N.; Kakuru, Abel; Kajubi, Richard; Walker, Dilys; Waiswa, Peter; Ramokolo, Vundli; Zembe-Mkabile, Wanga; Semrau, Katherine; Hamer, Davidson H.; Chico, Matthew R.; Banda, Enesia C.; Manasyan, Albert
Abstract
Objective: To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021.
Design: Descriptive multi-country secondary data analysis.
Setting: Subnational, population-based cohort studies (k = 45 for LGA, k = 25 for macrosomia) in 23 low- and middle-income countries (LMICs).
Population: Liveborn infants.
Methods: We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (> 90th centile for gestational age and sex) and macrosomia (≥ 4000 g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR).
Main outcome measures: Prevalence of LGA and macrosomia.
Results: Among 476 939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%-9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%-16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%-3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%-7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%-11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9-5.1) than preterm or post-term LGA. Among 313 064 live births, the median prevalence of macrosomia was 1.3% (n = 313 064, IQR: 0.2%-2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%-6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%-0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%-3.1%) in older studies (2000-2010) and 1.3% (17 studies, IQR: 0.5%-2.4%) in more recent studies (2011-2021). Term macrosomia was more common at 1.2% (0.2-2.0) than preterm and post-term macrosomia.
Conclusions: The overall prevalence of LGA and macrosomia was lower in these LMIC studies than is reported in high-income countries. The prevalence of large babies was highest in Latin America and the Caribbean.
DOI: 10.1111/1471-0528.70044
Cervical intraepithelial neoplasia progression and regression among women living with HIV in Zambia
(2025-10-16) Andoh, John; Taghavi, Katayoun; Moono, Misinzo; Basu, Partha; Madliwa, Thamsanqa; Mwanahamuntu, Mulindi H.; Low, Nicola; Manasyan, Albert; Rohner, Eliane
Abstract
Objectives: Cervical screening and precancer treatment are less effective in women living with HIV (WLWH) than in women without HIV. We assessed high-risk human papillomavirus (HR-HPV) infection and cervical disease progression among screened WLWH in Zambia.
Methods: Participants underwent visual inspection with acetic acid (VIA), HR-HPV testing and cervical biopsies at baseline and at follow-up 30-36 months later. Women with positive VIA results or high-grade histology were offered treatment. We assessed HR-HPV and cervical disease prevalence at both timepoints and used multivariable logistic regression to identify factors associated with cervical disease progression and regression.
Results: Among 241 included women, HR-HPV prevalence declined from 44% (95% confidence interval [CI]: 39%-49%) at baseline to 24% (95% CI: 19%-31%) at follow-up. High-grade disease decreased from 25% (95% CI: 20%-31%) to 9% (95% CI: 5%-13%). In analyses adjusted for age, CD4 cell count, HIV RNA viral load, HR-HPV infection and histological results at baseline, precancer treatment was associated with increased odds of disease regression (adjusted odds ratio [aOR]: 2.74, 95% CI: 1.08-7.06) and reduced odds of progression (aOR: 0.45, 95% CI: 0.11-1.64). One-third of women with high-grade disease at follow-up (7/21) had previously undergone precancer treatment.
Conclusions: Cervical screening and precancer treatment are key to reducing cervical disease progression among WLWH and ultimately achieving cervical cancer elimination, but efforts to improve treatment effectiveness among WLWH must be balanced with the risk of overtreatment.
Postpartum depression among newly delivered mothers based on postnatal newborn care
(2025-11-28) Manasyan, Albert; Lakhwani, Jyoti; Kapesa, Herbert; Owuor, Kevin; Menon, Anitha J.; Bosomprah, Samuel; Nalwamba, Leukanji; Machona, Sylvia; Carlo, Waldemar A.
Abstract
Background
Postpartum depression (PPD) is a serious public health problem affecting ~ 17% of women globally, with higher rates recorded in southern Africa – ~40%. Admission to the neonatal intensive care unit (NICU) is a risk factor for PPD. Our primary hypothesis was that infant care in the Kangaroo Mother Care Ward (KMC) after NICU stay would be associated with a lower prevalence of maternal PPD.
Methods
We conducted a cross-sectional study among newly delivered mothers at the University Teaching Hospitals in Lusaka, Zambia, between June 2022 – May 2023. Mothers of infants discharged home from the Newborn Nursery (if NICU admission was not required), NICU (unwell newborns requiring NICU care), or NICU/KMC Ward (unwell newborns requiring NICU care followed by further monitoring at the KMC ward) were screened for PPD using the
Edinburgh Postnatal Depression Scale (EPDS) screening tool at 6–8 weeks postnatally. Mothers who scored 11 + were categorized as having PPD. Poisson models were used to estimate prevalence ratios (PR) for screening positive for PPD. The primary outcome was PPD following KMC versus NICU discharge.
Results
We screened 1056 newly delivered women for PPD pooled from mother-infant pairs discharged from the newborn nursery (n = 352), NICU/KMC (n = 352), or NICU (n = 352). Overall, mothers’ average age was 27.5 years, 61.1% had secondary education, 59.2% were unemployed, and 11.2% were HIV-positive. The proportion of women who screened positive for maternal PPD among all three arms was 20.5% with anxiety reaching 50.5%. Mothers whose newborns were admitted to the NICU/KMC arm had a lower proportion of women who screened positive for PPD (21.3%) compared to those directly discharged home from the NICU (29.0%) (p < 0.001). The adjusted prevalence of PPD positivity rate was significantly higher in the NICU and KMC arms compared to the Newborn Nursery arm, RR = 2.44 (95% CI 1.61, 3.73) and RR = 1.94 (95% CI 1.04, 3.61), respectively. However, in the adjusted analysis, there was no significant difference in the PPD positivity rate between the KMC and the NICU arms.
Conclusion Admission to the KMC ward following the NICU was not associated with a lower PPD prevalence among newly delivered mothers compared to direct NICU discharge.
The cervical cancer screening and precancer treatment journey: a qualitative study of experiences among Zambian women living with and without HIV
(2025-12-13) Moono, Misinzo; Sharma, Anjali; Bohlius, Julia; Mwanahamuntu, Mulindi; Taghavi, Katayoun; Mwamba, Chanda; Katota, Ntenje; Mwamba, Kabwe; Chipungu, Mwati; Hamweemba, Esther; Manasyan, Albert
Abstract
Background: Zambia has the third highest cervical cancer incidence rate globally, and it remains the leading cause of cancer-related death among
women. We explored the experiences of Zambian women who accessed cervical cancer screening and precancer treatment services to understand factors influencing care-seeking and access across urban, peri-urban, and rural settings.
Methods: In 2020, we conducted eight focus group discussions with women living with and without Human Immunodeficiency Virus (HIV) who
underwent cervical cancer screening between 2016 and 2020. To explore their care journey, participants were grouped by screening outcome—those
with cervical precancerous lesions and those without. We also conducted 18 in-depth interviews with healthcare workers providing antiretroviral
treatment, cervical cancer screening, or precancer treatment at government health facilities. Transcripts were coded and analyzed using thematic
analysis.
Results: Care-seeking unfolded across five stages: recognition of need to screen, hesitation and consultation, screening, result interpretation,
and treatment. Women were generally knowledgeable about cervical cancer and sought screening promptly, though some delayed due to fear.
Social networks and interactions with healthcare workers facilitated screening, while logistical and financial barriers, along with delays in histopathology services particularly in rural areas, hindered access to timely diagnosis and treatment.
Conclusion: Improving cervical cancer screening and precancer treatment in Zambia requires addressing systemic inefficiencies by strengthening
laboratory capacity, decentralizing diagnostics, and training healthcare workers to provide respectful, consistent counselling. Expanding community
engagement to counter misinformation, leveraging social networks, and providing financial protection are also critical to ensuring timely, equitable,
and reassuring care.
DOI: 10.1093/oncolo/oyaf412
The impact of HIV and antiretroviral therapy on cervical cancer burden in Zambia: a modelling study
(2026-08-25) Andoh, John; Kapesa, Herbert; Msadabwe, Susan C.; Manasyan, Albert; Kamfwa, Paul; Zulu, Watson; Kerr, Cliff; Egger, Matthias; Rohner, Eliane; Stuart, Robyn; van Schalkwyk, Cari
Abstract
Cervical cancer is the leading cause of cancer death among women in Zambia, where widespread HIV infection elevates cervical cancer risk. However, HIV’s contribution to Zambia’s cervical cancer burden and the extent to which antiretroviral therapy (ART) has mitigated this burden, remain poorly quantified. We adapted HPVsim, an existing open-source mathematical model simulating human papillomavirus (HPV) and cervical cancer natural history, to capture the dual burden of cervical cancer and HIV in Zambian women. We extended HPVsim by incorporating country-specific HIV incidence data and modeled how HIV alters cervical disease progression through CD4 cell count-dependent modification of HPV susceptibility and disease severity. We calibrated the model to GLOBOCAN cervical cancer estimates and cervical cancer incidence rate ratios by HIV status estimated from the Zambian Cancer Registry. We estimated that by 2025, 49.9% of all cervical cancer cases in Zambia could be attributed to HIV co-infection. Although ART prevented at least an estimated 5.4% of cervical cancer cases nationally and 8.7% of cases among women with HIV, HIV remains a major driver of the cervical cancer burden. HIV-stratified prevention strategies will be essential for Zambia to achieve the World Health Organization’s cervical cancer elimination targets.