Browsing by Author "Fwoloshi S"

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Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study.
(2023) Aiken AM; Nyamwaya B; Madrid L; Edessa D; Labi AK; Obeng-Nkrumah N; Mwabaya W; Chimenya M; Cocker D; Iregbu KC; Princewill-Nwajiobi PIP; Dramowski A; Sonda T; Mmbaga BT; Ojok D; Fwoloshi S; Scott JAG; Whitelaw A; School of Pharmacy, Haramaya University, Harar, Ethiopia.; Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.; Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania.; Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.; Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana.; KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya.; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.; Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.; Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK.; Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana.; Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria.; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
COVID-19 vaccine uptake and associated risk factors among first antenatal care attendees in Zambia, 2021-2022: A repeated cross-sectional study.
(2024) Tembo T; Somwe P; Bosomprah S; Heilmann E; Kalenga K; Moyo N; Kabamba B; Seffren V; Fwoloshi S; Rutagwera MR; Musunse M; Mwiinga L; Gutman JR; Hines JZ; Sikazwe I; Analysis Unit, Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Biostatistics, School of Public Health, University of Ghana, Accra, Accra.; Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.; Centers for Disease Control and Prevention, Lusaka, Zambia.; PATH, Lusaka, Zambia.; Reproductive, Maternal, Newborn and Child Health (RMNCH), Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; University Teaching Hospital, Ministry of Health, Lusaka, Zambia.; Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Strategic Information Unit, Center for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
Pregnant women are considered a high-risk group for COVID-19, and a priority for vaccination. Routine antenatal care (ANC) provides an opportunity to track trends and factors associated with vaccine uptake. We sought to evaluate COVID-19 vaccine uptake among pregnant women attending ANC and assess the factors associated with vaccine in Zambia. We conducted a repeated cross-sectional study in 39 public health facilities in four districts in Zambia from September 2021 to September 2022. Pregnant women who were aged 15-49 years were enrolled during their first ANC visit. Every month, ~20 women per facility were interviewed during individual HIV counseling and testing. We estimated vaccine uptake as the proportion of eligible participants who self-reported having received the COVID-19 vaccine. A total of 9,203 pregnant women were screened, of which 9,111 (99%) were eligible and had vaccination status. Of the 9,111 included in the analysis, 1,818 (20%) had received the COVID-19 vaccine during the study period, with a trend of increasing coverage with time (0.5% in September 2020, 27% in September 2022). Conversely, 3,789 (42%) reported not being offered a COVID-19 vaccine. We found that women aged 40-49 years, had no education or attained some primary school education, were not employed, and had prior COVID-19 infection were significantly associated with vaccine uptake. COVID-19 vaccine uptake among pregnant women was lower than estimates from the general population (27% across the four districts in September 2022), pointing to missed opportunities to protect this high-risk group. ANC visits were a viable point for conducting COVID-19 surveillance. Incorporating the vaccine as part of the routine ANC package might increase coverage in this group.
Implementing SARS-CoV-2 routine surveillance in antenatal care in Zambia, 2021-2022: best practices and lessons learned.
(2025-Feb-28) Tembo T; Heilmann E; Kabamba BM; Fwoloshi S; Kalenga K; Chilambe F; Siwinga M; Rutagwera MR; Musunse M; Kangale C; Yingst S; Yadav R; Savory T; Gutman JR; Sikazwe I; Mulenga LB; Moore CB; Hines JZ; Public Health Institute, Oakland, CA, USA.; University of Alabama at Birmingham, Tuscaloosa, USA.; PATH, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O Box 34681, Lusaka, Zambia. Taniya.Tembo@cidrz.org.; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O Box 34681, Lusaka, Zambia.; University Teaching Hospital, Lusaka, Zambia.; U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.; U.S. Centers for Disease Control and Prevention, Lusaka, Zambia.
BACKGROUND: In Zambia, the true extent of SARS-CoV-2 infections is unknown because initial surveillance focused on patients with symptoms or severe disease. Antenatal sentinel surveillance had not been used to assess infection trends. The ANC COVID-19 surveillance study sought to determine SARS-CoV-2 seroprevalence and COVID-19 vaccine uptake among pregnant women. We provide insight into the study implementation, challenges encountered, best practices, and lessons learned. METHODS: A repeated cross-sectional seroprevalence survey was implemented at 39 health facilities in four districts from September 2021 to September 2022. Pregnant women aged 15-49 years were enrolled at their first antenatal care visits. An electronic questionnaire gathered demographics and other COVID-19 related information from consenting participants. A dried blood sample was collected to detect IgG antibodies using a multiplex bead assay. Seropositive results were categorized as infection, infection and vaccination or infection based on anti-RBD and anti-nucleocapsid test results. Problems and their root causes were identified as they occurred. Practical problem-solving strategies were devised, implemented, and monitored to ensure that goals were accomplished. RESULTS: In the primary analysis, 7% of the 9,221 samples collected from participants were not tested because they were missing. COVID-19 vaccine uptake of 9,111 pregnant women was assessed. Approximately 64% of participants were cumulatively seropositive for SARS-CoV-2 antibodies. Seroprevalence increased from 27.8% in September 2021 to 56.6% in July 2022. We observed an increase in vaccine coverage (0.5-27%) over time. Women aged 40-49 years old, without education and with prior COVID-19 infection were associated with higher vaccine uptake. The Delta variant of COVID-19 and the reallocation of health facilities between two partners delayed surveillance activities and increased the cost of implementation (e.g., the purchase of additional calibration and validation kits and DBS cards). Protocol deviations were attributed to the lack of experience in conducting research but, the district RAs repeatedly trained health facility staff to enhance their research knowledge. CONCLUSIONS: Incorporating SARS-CoV-2 surveillance into routine antenatal care is feasible and potentially sustainable when existing health system infrastructure, human resources, and surveillance systems are leveraged. Yet, careful planning is needed to anticipate implementation challenges and ensure high-quality data collection.
Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study.
(2023-Nov) Aiken AM; Rehman AM; de Kraker MEA; Madrid L; Kebede M; Labi AK; Obeng-Nkrumah N; Nyamwaya B; Kagucia E; Cocker D; Kawaza K; Lester R; Iregbu KC; Medugu N; Nwajiobi-Princewill PI; Dramowski A; Sonda T; Hemed A; Fwoloshi S; Ojok D; Scott JAG; Whitelaw A; Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.; Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana.; Infection Control Program and WHO Collaborating Center on Patient Safety and Antimicrobial Resistance, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.; Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.; Department of Paediatrics and Child Health, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.; Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.; Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK.; Department of Medicine, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK.; Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.; Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria.; Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria; Nile University of Nigeria, Abuja, Nigeria.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.; Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: alexander.aiken@lshtm.ac.uk.; Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.; Department of Medicine, Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK; Liverpool School of Tropical Medicine, Liverpool, UK.; KEMRI Centre for Geographic Medical Research, Kilifi, Kenya.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Bacteria of the order Enterobacterales are common pathogens causing bloodstream infections in sub-Saharan Africa and are frequently resistant to third-generation cephalosporin antibiotics. Although third-generation cephalosporin resistance is believed to lead to adverse outcomes, this relationship is difficult to quantify and has rarely been studied in this region. We aimed to measure the effects associated with resistance to third-generation cephalosporins in hospitalised patients with Enterobacterales bloodstream infection in Africa. METHODS: We conducted a prospective, matched, parallel cohort study at eight hospitals across sub-Saharan Africa. We recruited consecutive patients of all age groups with laboratory-confirmed Enterobacterales bloodstream infection and matched them to at least one patient without bloodstream infection on the basis of age group, hospital ward, and admission date. Date of infection onset (and enrolment) was defined as the day of blood sample collection for culturing. Patients infected with bacteria with a cefotaxime minimum inhibitory concentration of 1 mg/L or lower were included in the third-generation cephalosporin-susceptible (3GC-S) cohort, and the remainder were included in the third-generation cephalosporin-resistant (3GC-R) cohort. The primary outcomes were in-hospital death and death within 30 days of enrolment. We used adjusted multivariable regression models to first compare patients with bloodstream infection against matched patients within the 3GC-S and 3GC-R cohorts, then compared estimates between cohorts. FINDINGS: Between Nov 1, 2020, and Jan 31, 2022, we recruited 878 patients with Enterobacterales bloodstream infection (221 [25·2%] to the 3GC-S cohort and 657 [74·8%] to the 3GC-R cohort) and 1634 matched patients (420 [25·7%] and 1214 [74·3%], respectively). 502 (57·2%) bloodstream infections occurred in neonates and infants (age 0-364 days). Klebsiella pneumoniae (393 [44·8%] infections) and Escherichia coli (224 [25·5%] infections) were the most common Enterobacterales species identified. The proportion of patients who died in hospital was higher in patients with bloodstream infection than in matched controls in the 3GC-S cohort (62 [28·1%] of 221 vs 22 [5·2%] of 420; cause-specific hazard ratio 6·79 [95% CI 4·06-11·37] from Cox model) and the 3GC-R cohort (244 [37·1%] of 657 vs 115 [9·5%] of 1214; 5·01 [3·96-6·32]). The ratio of these cause-specific hazard ratios showed no significant difference in risk of in-hospital death in the 3GC-R cohort versus the 3GC-S cohort (0·74 [0·42-1·30]). The ratio of relative risk of death within 30 days (0·82 [95% CI 0·53-1·27]) also indicated no difference between the cohorts. INTERPRETATION: Patients with bloodstream infections with Enterobacterales bacteria either resistant or susceptible to third-generation cephalosporins had increased mortality compared with uninfected matched patients, with no differential effect related to third-generation cephalosporin-resistance status. However, this finding does not account for time to appropriate antibiotic treatment, which remains clinically important to optimise. Measures to prevent transmission of Enterobacterales could reduce bloodstream infection-associated mortality from both drug-resistant and drug-susceptible bacterial strains in Africa. FUNDING: Bill & Melinda Gates Foundation.
Trends in SARS-CoV-2 seroprevalence among pregnant women attending first antenatal care visits in Zambia: A repeated cross-sectional survey, 2021-2022.
(2024) Heilmann E; Tembo T; Fwoloshi S; Kabamba B; Chilambe F; Kalenga K; Siwingwa M; Mulube C; Seffren V; Bolton-Moore C; Simwanza J; Yingst S; Yadav R; Rogier E; Auld AF; Agolory S; Kapina M; Gutman JR; Savory T; Kangale C; Mulenga LB; Sikazwe I; Hines JZ; Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.; Public Health Institute, Oakland, California, United States of America.; Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia.; PATH, Lusaka, Zambia.; Adult Centre of Excellence, University Teaching Hospital, Lusaka, Zambia.; Surveillance and Disease Intelligence, Zambia National Public Health Institute, Lusaka, Zambia.; Division of Infectious Diseases, Ministry of Health, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
SARS-CoV-2 serosurveys help estimate the extent of transmission and guide the allocation of COVID-19 vaccines. We measured SARS-CoV-2 seroprevalence among women attending ANC clinics to assess exposure trends over time in Zambia. We conducted repeated cross-sectional SARS-CoV-2 seroprevalence surveys among pregnant women aged 15-49 years attending their first ANC visits in four districts of Zambia (two urban and two rural) during September 2021-September 2022. Serologic testing was done using a multiplex bead assay which detects IgG antibodies to the nucleocapsid protein and the spike protein receptor-binding domain (RBD). We calculated monthly SARS-CoV-2 seroprevalence by district. We also categorized seropositive results as infection alone, infection and vaccination, or vaccination alone based on anti-RBD and anti-nucleocapsid test results and self-reported COVID-19 vaccination status (vaccinated was having received ≥1 dose). Among 8,304 participants, 5,296 (63.8%) were cumulatively seropositive for SARS-CoV-2 antibodies from September 2021 through September 2022. SARS-CoV-2 seroprevalence primarily increased from September 2021 to September 2022 in three districts (Lusaka: 61.8-100.0%, Chongwe: 39.6-94.7%, Chipata: 56.5-95.0%), but in Chadiza, seroprevalence increased from 27.8% in September 2021 to 77.2% in April 2022 before gradually dropping to 56.6% in July 2022. Among 5,906 participants with a valid COVID-19 vaccination status, infection alone accounted for antibody responses in 77.7% (4,590) of participants. Most women attending ANC had evidence of prior SARS-CoV-2 infection and most SARS-CoV-2 seropositivity was infection-induced. Capturing COVID-19 vaccination status and using a multiplex bead assay with anti-nucleocapsid and anti-RBD targets facilitated distinguishing infection-induced versus vaccine-induced antibody responses during a period of increasing COVID-19 vaccine coverage in Zambia. Declining seroprevalence in Chadiza may indicate waning antibodies and a need for booster vaccines. ANC clinics have a potential role in ongoing SARS-CoV-2 serosurveillance and can continue to provide insights into SARS-CoV-2 antibody dynamics to inform near real-time public health responses.