CIDRZ Research
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The CIDRZ Research Repository serves as an open-access archive for peer-reviewed publications, conference papers, and other scholarly outputs from CIDRZ researchers. Our goal is to promote the dissemination of knowledge and support evidence-based public health initiatives.
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Item Systematic review of associations between gut microbiome composition and stunting in under-five children.(2024-May-23) Chibuye M; Mende DR; Spijker R; Simuyandi M; Luchen CC; Bosomprah S; Chilengi R; Schultsz C; Harris VC; Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.; The Zambia National Public Health Institute (ZNPHI), Lusaka, Zambia.; Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.; Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Amsterdam Institute of Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; Department of Medical Microbiology and Infection Control, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Department of Global Health, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. v.c.harris@amsterdamumc.nl.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)Childhood stunting is associated with impaired cognitive development and increased risk of infections, morbidity, and mortality. The composition of the enteric microbiota may contribute to the pathogenesis of stunting. We systematically reviewed and synthesized data from studies using high-throughput genomic sequencing methods to characterize the gut microbiome in stunted versus non-stunted children under 5 years in LMICs. We included 14 studies from Asia, Africa, and South America. Most studies did not report any significant differences in the alpha diversity, while a significantly higher beta diversity was observed in stunted children in four out of seven studies that reported beta diversity. At the phylum level, inconsistent associations with stunting were observed for Bacillota, Pseudomonadota, and Bacteroidota phyla. No single genus was associated with stunted children across all 14 studies, and some associations were incongruent by specific genera. Nonetheless, stunting was associated with an abundance of pathobionts that could drive inflammation, such as Escherichia/Shigella and Campylobacter, and a reduction of butyrate producers, including Faecalibacterium, Megasphera, Blautia, and increased Ruminoccoccus. An abundance of taxa thought to originate in the oropharynx was also reported in duodenal and fecal samples of stunted children, while metabolic pathways, including purine and pyrimidine biosynthesis, vitamin B biosynthesis, and carbohydrate and amino acid degradation pathways, predicted linear growth. Current studies show that stunted children can have distinct microbial patterns compared to non-stunted children, which could contribute to the pathogenesis of stunting.Item Preterm birth among women with HIV: impact of preconception cART initiation.(2024-Oct-01) Duffy CR; Herlihy JM; Zulu E; Mwananyanda L; Forman L; Heeren T; Gill CJ; Harper M; Chilengi R; Chavuma R; Payne-Lohman B; Thea DM; Boston University, Chobanian & Avedisian School of Medicine, Department of Pediatrics, Boston Medical Center, Boston, MA, USA.; Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA.; Department of Global Health, Boston University School of Public Health.; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health.; Centre for Infectious Disease Research in Zambia.; Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School.; Department of Biostatistics, Boston University School of Public Health, Boston, MA.; Institute for Immunology and Informatics, University of Rhode Island, South Kingstown, RI, USA.; Right to Care Zambia, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)OBJECTIVE: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes. DESIGN: Prospective observational cohort. SETTING: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia. PARTICIPANTS: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating. METHODS: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis. MAIN OUTCOME MEASURES: PTB (<37 weeks) and SGA. RESULTS: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection. CONCLUSIONS: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.Item Managing multiple funding streams and agendas to achieve local and global health and research objectives: lessons from the field.(2014-Jan-01) Holmes CB; Sikazwe I; Raelly RL; Freeman BL; Wambulawae I; Silwizya G; Topp SM; Chilengi R; Henostroza G; Kapambwe S; Simbeye D; Sibajene S; Chi H; Godfrey K; Chi B; Moore CB; *Centre for Infectious Disease Research in Zambia; †School of Medicine, University of North Carolina, Chapel Hill, NC; ‡School of Medicine, University of Alabama, Birmingham, AL; and §Division of Acquired Immunodeficiency Syndrome, National Institutes of Allergy and Infectious Diseases.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)Multiple funding sources provide research and program implementation organizations a broader base of funding and facilitate synergy, but also entail challenges that include varying stakeholder expectations, unaligned grant cycles, and highly variable reporting requirements. Strong governance and strategic planning are essential to ensure alignment of goals and agendas. Systems to track budgets and outputs, as well as procurement and human resources are required. A major goal of funders is to transition leadership and operations to local ownership. This article details successful approaches used by the newly independent nongovernmental organization, the Centre for Infectious Disease Research in Zambia.Item Lessons learnt from the first controlled human malaria infection study conducted in Nairobi, Kenya.(2015-Apr-28) Hodgson SH; Juma E; Salim A; Magiri C; Njenga D; Molyneux S; Njuguna P; Awuondo K; Lowe B; Billingsley PF; Cole AO; Ogwang C; Osier F; Chilengi R; Hoffman SL; Draper SJ; Ogutu B; Marsh K; Sanaria Inc, Rockville, MD, USA. pbillingsley@sanaria.com.; Sanaria Inc, Rockville, MD, USA. shoffman@sanaria.com.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. smolyneux@kemri-wellcome.org.; The Jenner Institute, University of Oxford, Oxford, UK. Susanne.hodgson@ndm.ox.ac.uk.; Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya. omandi.cole@gmail.com.; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. danielnjengah@yahoo.com.; Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya. eajuma@kemri.org.; Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya. bernhards.ogutu@indepth-network.org.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. asalim@kemri-wellcome.org.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. fosier@kemri-wellcome.org.; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. eajuma@kemri.org.; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. charles.magiri@usamru-k.org.; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. omandi.cole@gmail.com.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. patwnju@yahoo.co.uk.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. blowe@kemri-wellcome.org.; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya. bernhards.ogutu@indepth-network.org.; The Jenner Institute, University of Oxford, Oxford, UK. simon.draper@ndm.ox.ac.uk.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. Roma.Chilengi@cidrz.org.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. kevin.marsh@ndm.ox.ac.uk.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. kawuondo@kemri-wellcome.org.; Kenya Medical Research Institute - Wellcome Trust, Centre for Geographical Medical Research (Coast), Kilifi, Kenya. COgwang@kemri-wellcome.org.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Controlled human malaria infection (CHMI) studies, in which healthy volunteers are infected with Plasmodium falciparum to assess the efficacy of novel malaria vaccines and drugs, have become a vital tool to accelerate vaccine and drug development. CHMI studies provide a cost-effective and expeditious way to circumvent the use of large-scale field efficacy studies to deselect intervention candidates. However, to date few modern CHMI studies have been performed in malaria-endemic countries. METHODS: An open-label, randomized pilot CHMI study was conducted using aseptic, purified, cryopreserved, infectious P. falciparum sporozoites (SPZ) (Sanaria® PfSPZ Challenge) administered intramuscularly (IM) to healthy Kenyan adults (n = 28) with varying degrees of prior exposure to P. falciparum. The purpose of the study was to establish the PfSPZ Challenge CHMI model in a Kenyan setting with the aim of increasing the international capacity for efficacy testing of malaria vaccines and drugs, and allowing earlier assessment of efficacy in a population for which interventions are being developed. This was part of the EDCTP-funded capacity development of the CHMI platform in Africa. DISCUSSION: This paper discusses in detail lessons learnt from conducting the first CHMI study in Kenya. Issues pertinent to the African setting, including community sensitization, consent and recruitment are considered. Detailed reasoning regarding the study design (for example, dose and route of administration of PfSPZ Challenge, criteria for grouping volunteers according to prior exposure to malaria and duration of follow-up post CHMI) are given and changes other centres may want to consider for future studies are suggested. CONCLUSIONS: Performing CHMI studies in an African setting presents unique but surmountable challenges and offers great opportunity for acceleration of malaria vaccine and drug development. The reflections in this paper aim to aid other centres and partners intending to use the CHMI model in Africa.Item Prevalence of hypertension and its treatment among adults presenting to primary health clinics in rural Zambia: analysis of an observational database.(2015-Sep-21) Yan LD; Chi BH; Sindano N; Bosomprah S; Stringer JS; Chilengi R; Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana. samuel.bosomprah@cidrz.org.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. jeffrey_stringer@med.unc.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. roma.chilengi@cidrz.org.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. lilyyan@stanford.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. benjamin_chi@med.unc.edu.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. samuel.bosomprah@cidrz.org.; Primary Care and Health Systems Department, Center for Infectious Disease Research Zambia, Lusaka, Zambia. ntazana.sindano@cidrz.org.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. benjamin_chi@med.unc.edu.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. roma.chilengi@cidrz.org.; Stanford University School of Medicine, Stanford, California, USA. lilyyan@stanford.edu.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: Hypertension constitutes a growing burden of illness in developing countries like Zambia. Adequately screening and treating hypertension could greatly reduce the complications of stroke and coronary disease. Our objective was to determine the prevalence of hypertension and identify current treatment practices among adult patients presenting for routine care to rural health facilities in the Better Health Outcomes through Mentoring and Assessments (BHOMA) project. METHODS: We conducted a retrospective analysis of routinely collected clinical data from 46 rural government clinics in Zambia. Our analysis cohort comprised patients ≥ 25 years with recorded blood pressure measurements, who sought care at primary health centers. Consistent with prior research, in our primary analysis, we only included data from first visits. Hypertension was defined as a systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or reported use of antihypertensive medication. A sensitivity analysis was performed using median blood pressure for individuals with multiple visits. RESULTS AND DISCUSSION: From January 2011 to December 2014, 116,130 first visits by adult patients met eligibility criteria. The crude prevalence of hypertension by onsite measurement or reported use of antihypertensive medication was 23.1% [95% CI: 22.8-23.3] (23.6% in females, 22.3% in males). The age standardized prevalence of hypertension across participating sites was 28.0 [95% CI: 27.7-28.3] (29.7% in females, 25.8% in males). Sensitivity analysis revealed a similar prevalence using data from all visits. Only 5.6% of patients had a diagnosis of hypertension documented in their medical record. Among patients with hypertension, only 18.0% had any antihypertensive drug prescribed, with nifedipine (8.9%), furosemide (8.3%), and propranolol (2.4%) as the most common. CONCLUSIONS: Age standardized prevalence of hypertension in rural primary health clinics in Zambia was high compared to other studies in rural Africa; however, we diagnosed hypertension with only one measurement and this may have biased our findings. Future efforts to improve hypertension control should focus on population preventive care and primary healthcare provider education on individual management.Item Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.(2016-Mar-03) Rathod SD; Timæus IM; Banda R; Thankian K; Chilengi R; Banda A; Lemba M; Stringer JS; Chi BH; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.; Department of Population Studies, University of Zambia, Lusaka, Zambia.; Research, Publications and Dissemination Unit, Zambia Central Statistical Office, Lusaka, Zambia.; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.; Department of Gender Studies, University of Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)OBJECTIVES: To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. SETTING: Households in Lusaka District, Zambia, 2004-2011. PARTICIPANTS: 43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years. PRIMARY OUTCOME: Premature adult mortality. RESULTS: The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. CONCLUSIONS: To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services.Item Theory-based formative research on oral rehydration salts and zinc use in Lusaka, Zambia.(2016-Apr-12) Greenland K; Chipungu J; Chilengi R; Curtis V; Centre for Infectious Disease Research in Zambia, P.O. Box 34681, Lusaka, 10101, Zambia.; Department of Disease Control, Faculty for Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.; Department of Disease Control, Faculty for Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Katie.Greenland@lshtm.ac.uk.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)BACKGROUND: A theoretically grounded formative research study was carried out to investigate behaviour related to the use of Oral Rehydration Salts (ORS) and zinc tablets. The purpose was to inform the design of the behaviour change component of the Programme for Awareness and Elimination of Diarrhoea in Lusaka Province, Zambia, which aims to reduce childhood morbidity and mortality from diarrhoeal disease. METHODS: Fourteen behaviour trials were conducted among caregivers of children under-five with diarrhoea. Caregivers were recruited from two clinics situated in rural and peri-urban Lusaka. Trials took ten days and data were captured using video, observation and repeated interviews. Additional data were collected through focus group discussions with mothers, observations in clinics and pharmacies and interviews with clinic and pharmacy staff. Findings were organised according to categories of behavioural determinants from Evo-Eco theory. RESULTS: Participants were all familiar with ORS and most knew its purpose. ORS use was motivated by symptoms of dehydration, rather than the start of a diarrhoea episode, and was stopped when the child had visibly recovered energy. Only four of 14 behaviour trial participants were observed to correctly prepare ORS. Errors were mainly associated with measurement, resulting in a solution that was too concentrated. ORS was not observed to be given to children at clinics. Although zinc was unknown in this population, it was positively received by mothers keen to learn whether zinc would work better than alternative treatments to stop diarrhoea. CONCLUSIONS: ORS was sub-optimally prepared and used at home. It was not used while waiting to be seen at a clinic. In homes, the behaviour change intervention should promote early and continued use of correctly prepared ORS. In the longer-term, these behaviours may best be encouraged by changing the product design or sachet size. Despite its unfamiliarity, this population was well disposed to the use of zinc as a treatment for diarrhoea; when zinc is new to a population, promoting zinc as a solution to stopping diarrhoea, which mothers seek, may drive initial trial. Ensuring the availability of zinc in public clinics and private pharmacies prior to commencement of any promotion activities is crucial.Item Phase 1 randomized controlled trial to evaluate the safety and immunogenicity of recombinant Pichia pastoris-expressed Plasmodium falciparum apical membrane antigen 1 (PfAMA1-FVO [25-545]) in healthy Malian adults in Bandiagara.(2016-Aug-30) Thera MA; Coulibaly D; Kone AK; Guindo AB; Traore K; Sall AH; Diarra I; Daou M; Traore IM; Tolo Y; Sissoko M; Niangaly A; Arama C; Baby M; Kouriba B; Sissoko MS; Sagara I; Toure OB; Dolo A; Diallo DA; Remarque E; Chilengi R; Noor R; Sesay S; Thomas A; Kocken CH; Faber BW; Imoukhuede EB; Leroy O; Doumbo OK; European Vaccine Initiative, European Vaccine Initiative, Im Neuenheimer Feld 307, 69120, Heidelberg, Germany.; Center for Infectious Diseases Research in Zambia (CIDRZ), P.O. Box 34681, Lusaka, 10101, Zambia.; African Malaria Network Trust (AMANET), P.O. Box 33207, Dar Es Salaam, Tanzania.; Biomedical Primate Research Center (BPRC), P.O. Box 3306, 2280 GH, Rijswijk, The Netherlands.; Medical Research Council, P.O. Box 273, Banjul, The Gambia.; Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies, Bamako, Mali. mthera@icermali.org.; Malaria Research and Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies, Bamako, Mali.BACKGROUND: The safety and immunogenicity of PfAMA1, adjuvanted with Alhydrogel(®) was assessed in malaria-experienced Malian adults. The malaria vaccine, PfAMA1-FVO [25-545] is a recombinant protein Pichia pastoris-expressed AMA-1 from Plasmodium falciparum FVO clone adsorbed to Alhydrogel(®), the control vaccine was tetanus toxoid produced from formaldehyde detoxified and purified tetanus toxin. METHODS: A double blind randomized controlled phase 1 study enrolled and followed 40 healthy adults aged 18-55 years in Bandiagara, Mali, West Africa, a rural setting with intense seasonal transmission of P. falciparum malaria. Volunteers were randomized to receive either 50 µg of malaria vaccine or the control vaccine. Three doses of vaccine were given on Days 0, 28 and 56, and participants were followed for 1 year. Solicited symptoms were assessed for seven days and unsolicited symptoms for 28 days after each vaccination. Serious adverse events were assessed throughout the study. The titres of anti-AMA-1 antibodies were measured by ELISA and P. falciparum growth inhibition assays were performed. RESULTS: Commonest local solicited adverse events were the injection site pain and swelling more frequent in the PfAMA1 group. No vaccine related serious adverse events were reported. A significant 3.5-fold increase of anti-AMA-1 IgG antibodies was observed in malaria vaccine recipients four weeks after the third immunization compared to the control group. CONCLUSION: The PfAMA1 showed a good safety profile. Most adverse events reported were of mild to moderate intensity. In addition, the vaccine induced a significant though short-lived increase in the anti-AMA1 IgG titres. Registered on www.clinicaltrials.gov with the number NCT00431808.Item Norovirus infections in young children in Lusaka Province, Zambia: clinical characteristics and molecular epidemiology.(2017-Jan-23) Howard LM; Mwape I; Siwingwa M; Simuyandi M; Guffey MB; Stringer JS; Chi BH; Edwards KM; Chilengi R; Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, D-7228 MCN; 1161 21st Ave S, Nashville, TN, 37232, USA. leigh.howard@vanderbilt.edu.; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O. Box 34681, Lusaka, 10101, Zambia.; Division of Global Women's Health, University of North Carolina (UNC) - Chapel Hill, 130 Mason Farm Rd., 2nd Floor, Campus Box #7030, 27599-7030, Chapel Hill, NC, USA. Roma.Chilengi@cidrz.org.; Division of Global Women's Health, University of North Carolina (UNC) - Chapel Hill, 130 Mason Farm Rd., 2nd Floor, Campus Box #7030, 27599-7030, Chapel Hill, NC, USA.; Centre for Infectious Disease Research in Zambia (CIDRZ), P.O. Box 34681, Lusaka, 10101, Zambia. Roma.Chilengi@cidrz.org.; Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, D-7228 MCN; 1161 21st Ave S, Nashville, TN, 37232, USA.BACKGROUND: The burden, clinical features, and molecular epidemiology of norovirus infection in young children in southern Africa are not well defined. METHODS: Using data from a health facility-based surveillance study of children <5 years in Lusaka Province, Zambia presenting with diarrhea, we assessed the burden of norovirus infection. A convenience sample of 454 stool specimens was tested for norovirus using reverse-transcriptase polymerase chain reaction (RT-PCR). RT-PCR positive samples underwent additional nucleotide sequencing for genogroup and genotype identification. Clinical features and severity of diarrheal illnesses were compared between norovirus-positive and -negative subjects using Chi-squared and t-tests. RESULTS: Norovirus was detected in 52/454 (11.5%) specimens tested. Abdominal pain, fever, and vomiting were the most common presenting features in norovirus-associated illnesses. However, there were no significant differences in the clinical features of norovirus-positive compared to norovirus-negative illnesses. Of 43 isolates that were available for sequencing, 31 (72.1%) were genogroup II (GII) and 12 (27.9%) were genogroup I (GI). The distribution of genotypes was diverse. CONCLUSIONS: Noroviruses were detected in approximately 10% of young children with diarrhea in the Lusaka Province of Zambia, with GII representing the majority of infections. These findings support the role of norovirus in symptomatic diarrhea disease in Africa. Further studies are needed to confirm these observations and to evaluate prevention strategies.Item Exploring community participation in project design: application of the community conversation approach to improve maternal and newborn health in Zambia.(2017-Mar-23) Mutale W; Masoso C; Mwanza B; Chirwa C; Mwaba L; Siwale Z; Lamisa B; Musatwe D; Chilengi R; Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia. wmutale@yahoo.com.BACKGROUND: The United Nations Development Programme (UNDP) has adopted an approach entitled Community Conversation (CC) to improve community engagement in addressing health challenges. CCs are based on Paulo Freire's transformative communication approach, in which communities pose problems and critically examine their everyday life experiences through discussion. We adopted this approach to engage communities in maternal and newborn health discussions in three rural districts of Zambia, with the aim of developing community-generated interventions. METHODS: Sixty (60) CCs were held in three target districts, covering a total of 20 health facilities. Communities were purposively selected in each district to capture a range of rural and peri-urban areas at varying distances from health facilities. Conversations were held four times in each community between May and September 2014. All conversations were digitally recorded and later transcribed. NVivo version 10 was used for data analysis. RESULTS AND DISCUSSION: The major barriers to accessing maternal health services included geography, limited infrastructure, lack of knowledge, shortage of human resources and essential commodities, and insufficient involvement of male partners. From the demand side, a lack of information and misconceptions, and, from the supply side, inadequately trained health workers with poor attitudes, negatively affected access to maternal health services in target districts either directly or indirectly. At least 17 of 20 communities suggested solutions to these challenges, including targeted community sensitisation on the importance of safe motherhood, family planning and prevention of teenage pregnancy. Community members and key stakeholders committed time and resources to address these challenges with minimal external support. CONCLUSION: We successfully applied the CC approach to explore maternal health challenges in three rural districts of Zambia. CCs functioned as an advocacy platform to facilitate direct engagement with key decision makers within the community and to align priorities while incorporating community views. There was a general lack of knowledge about safe motherhood and family planning in all three districts. However, other problems were unique to health facilities, demonstrating the need for tailored interventions.