Browsing by Author "Zulu EM"

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    Present or Absent: Risks and protective factors of sudden infant death syndrome (SIDS) in the Zambian context.
    (2025-May-13) Zulu EM; Mwananyanda L; Pieciak RC; Forman LS; Shah J; Heeren T; Gill CJ; Chilengi R; Payne-Lohman B; Duffy CR; Osei-Poku G; Thea DM; Wa Somwe S; Herlihy JM; University of Rhode Island.; University of Zambia.; Commonwealth of Massachusetts.; Boston University School of Public Health.; Centre for Infectious Disease Research in Zambia.; Right to Care Zambia.; Beth Israel Deaconess Medical Center, Harvard Medical School.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Despite a reduction in Sudden Unexplained Infant Death (SUID) in high-income countries, the incidence of SUID and the prevalence of its risk and protective factors remain poorly understood in Zambia due to limited research. The aim of our study was to describe the infant sleep positions and sleep environments in an urban Zambian population to gain a better understanding of the modifiable risk factors for SUID. METHODS: Data from the Zambian Infant Cohort Study (ZICS), a prospective birth cohort, were collected to describe infant sleep practices in Chawama, a densely populated peri-urban community in Lusaka, Zambia. During the 20-week study visit a structured questionnaire was administered to obtain data about the sleeping and environmental risks associated with SUID. RESULTS: Data were collected from 596 caregivers and 605 infants. Only 6.4% of caregivers did attain an education beyond secondary school, and a significant proportion of infants (20.2%) had low birth weights, with 10.7% of infants confirmed by ultrasound as preterm. Furthermore, 96.5% of infants were placed to sleep on their side or in a prone position, and 98.2% of infants shared a sleep surface with their caregiver. Breastfeeding, a protective factor, was highly prevalent, with 90.2% of infants receiving some form of breastfeeding at the 24-week visit. CONCLUSION: The results of this study show that both modifiable (bed-sharing and prone sleep position) and non-modifiable risk factors (low birthweight and prematurity) of SUID are prevalent in this low socioeconomic setting in Zambia. Public health strategies to prevent SUID will need to be innovative and culturally congruent in addressing modifiable risks, such as bedsharing, in settings where there is a lack of space. TRIAL REGISTRATION: Trial number: 1R01HD094650.
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    Single-test syphilis serology: A case of not seeing the forest for the trees.
    (2024) Zulu EM; Herlihy JM; Duffy CR; Mwananyanda L; Chilengi R; Forman L; Heeren T; Gill CJ; Chavuma R; Payne-Lohman B; Thea DM; Department of Pediatrics, Boston Medical Center, Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America.; Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America.; Right to Care Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Institute for Immunology and Informatics, University of Rhode Island, Kingston, Rhode Island, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    INTRODUCTION: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. METHODS: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. RESULTS: Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. CONCLUSION: Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.