Browsing by Author "Lumpa, Mwansa"

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Active TB case finding in a high burden setting; comparison of community and facility-based strategies in Lusaka, Zambia.
(2020) Kagujje, Mary; Chilukutu, Lophina; Somwe, Paul; Mutale, Jacob; Chiyenu, Kanema; Lumpa, Mwansa; Mwanza, Winfrida; Muyoyeta, Monde
INTRODUCTION: We conducted an implementation science study to increase TB case detection through a combination of interventions at health facility and community levels. We determined the impact of the study in terms of additional cases detected and notification rate and compared the yield of bacteriologically confirmed TB of facility based and community based case finding. METHODOLOGY: Over a period of 18 months, similar case finding activities were conducted at George health facility in Lusaka Zambia and its catchment community, an informal peri-urban settlement. Activities included awareness and demand creation activities, TB screening with digital chest x-ray or symptom screening, sputum evaluation using geneXpert MTB/RIF, TB diagnosis and linkage to treatment. RESULTS: A total of 18,194 individuals were screened of which 9,846 (54.1%) were screened at the facility and 8,348 (45.9%) were screened in the community. The total number of TB cases diagnosed during the intervention period were 1,026, compared to 759 in the pre-intervention period; an additional 267 TB cases were diagnosed. Of the 563 bacteriologically confirmed TB cases diagnosed under the study, 515/563 (91.5%) and 48/563 (8.5%) were identified at the facility and in the community respectively (P<0.0001). The TB notification rate increased from 246 per 100,000 population pre-intervention to 395 per 100,000 population in the last year of the intervention. CONCLUSIONS: Facility active case finding was more effective in detecting TB cases than community active case finding. Strengthening health systems to appropriately identify and evaluate patients for TB needs to be optimised in high burden settings. At a minimum, provider initiated TB symptom screening with completion of the TB screening and diagnostic cascade should be provided at the health facility in high burden settings. Community screening needs to be systematic and targeted at high risk groups and communities with access barriers.
Evaluating InferVision's Computer-Aided Detection (CAD) algorithm for Tuberculosis (TB) screening, Lusaka, Zambia.
(2025) Somwe, Paul; Maimbolwa, Minyoi; Chiyenu, Kanema; Lumpa, Mwansa; Kagujje, Mary; Muyoyeta, Monde
The objective of this study was to evaluate the diagnostic performance of InferRead DR Chest for tuberculosis (TB) screening in a high HIV and TB burden setting. The study assessed the performance of InferRead DR Chest using anonymized chest X-ray images from an active TB case finding study in Lusaka, Zambia, for individuals aged 15 and older. The Xpert MTB/RIF or MTB culture was the composite reference standard. Performance was evaluated using the Area Under the Receiver Operating Characteristic Curve (AUC), and a binary classification point was selected where the sensitivity aligned with the WHO target product profile for TB screening tools. Of the 1,890 chest X-ray images that met the inclusion criteria, 91.5% of participants reported at least one TB symptom. The median age was 38 years (IQR: 29-47), and 1,186 (62.8%) were male. From the study sample, 449 participants (23.8%) reported a history of previous TB, and 704 (37.2%) were HIV positive. Among the analyzed images, 289 (15.3%) were classified as TB positive based on the composite reference standard test results. The overall area under the curve (AUC) was 0.81 (95% CI: 0.78-0.83). Among individuals with a history of previous TB and those who were HIV positive, the AUCs were 0.71 (95% CI: 0.63-0.79) and 0.77 (95% CI: 0.72-0.82), respectively. At a sensitivity of 90.3% (95% CI: 86.3%-93.5%), InferRead DR Chest achieved a specificity of 39.2% (95% CI: 36.8%-41.7%) at TB score cut point of 0.12. InferRead DR Chest had acceptable performance in our population. Additional training and piloting of InferRead DR Chest in this population is recommended.
One Health Baseline Study Report
(Centre for Infectious Disease Research in Zambia (CIDRZ), 2026-12-17) Somwe, Paul; Barry Walsh, Paula; Riblet, Michelle; Butler, David; Lumpa, Mwansa; Sharma, Anjali; Rios, Rafaella; Whelan, Niamh; Chipungu, Jenala; Banda, Humphrey; Mataa, Liywalii
The One Health Baseline Research Study was conducted to assess knowledge, practices, and regulatory frameworks related to food safety, animal health and disease surveillance, and the control of animal medicines in Zambia. The study aimed to inform a just transition toward a sustainable and resilient food system by strengthening One Health interventions that reduce production and consumption shocks and mitigate crisis risks. Using a mixed-methods approach, quantitative and qualitative data were collected from 340 stakeholders, including livestock and crop farmers, food processors, buyers and retailers, and regulators across six districts in Eastern, Lusaka, Northern, and Southern Provinces. Findings indicate that stakeholders possess a holistic understanding of One Health, recognising the interdependence of food safety, animal health, environmental sustainability, and socio-economic factors. Positive progress was observed, including strong awareness of zoonotic diseases among livestock farmers, high compliance with food business registration requirements, and recognition of inspectors as trusted information sources. However, significant challenges persist, particularly related to limited institutional capacity, regulatory overlaps, inadequate risk management skills, weak oversight of animal medicines, and insufficient infrastructure and training. Misuse of veterinary drugs and pesticides poses risks to public health, animal health, and the environment, contributing to antimicrobial resistance and undermining disease control efforts. The study highlights the importance of strengthened institutional coordination, improved policy communication, risk-based approaches, and inclusive stakeholder engagement from farm to fork. Digital innovations such as the Zambia Animal Health Information System demonstrate potential for enhancing disease surveillance and evidence-based decision-making. Overall, the findings underscore the need for integrated, risk-based, and community-informed One Health strategies to improve food safety, support sustainable livelihoods, and strengthen Zambia’s agri-food system resilience.