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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 Living mapping review of global research funding for pandemic-prone infectious diseases– Pandemic PACT Grant Tracker(2026-7-6) Furst Rodrigo; Antonio Emilia; Levanita Shanthi; Kadri-Alabi Zaharat; Cerrado Johannes Paolo; Jabin Nusrat; Khader Ibrahim Susan; Mendy Thomas; Bucher Adrian; Norton AliceBackground The COVID-19 pandemic spurred an unprecedented global research response, highlighting the need for better coordination amid limited resources and the ongoing threat of emerging diseases. The Pandemic PACT Programme has developed a live database tracking funded research on pandemic-prone diseases and broader preparedness efforts to facilitate improved pandemic preparedness. This paper presents the baseline analysis of this dataset, examining gaps in global research funding by disease, geography and research topic, and identifying which funders are supporting pandemic-prone infectious disease research. Methods As of March 1, 2025, the database includes 20,362 grants from 326 funding organisations spread across 58 different countries, representing at least $14.4 billion in financial commitments. We conducted a mapping review to provide an open, accessible analysis of the funded research portfolio on infectious diseases with pandemic potential. The review analyses global research funding trends from 2020 to 2024 across priority diseases and research areas, identifying key investment priorities and gaps. Results Analysis of the Pandemic PACT dataset reveals uneven global research investment across infectious diseases with pandemic potential. While funding has generally aligned with priority research areas, major research gaps persist, particularly in diagnostics, health systems research, and ethics. Although vaccine and therapeutic research dominate the portfolio, much of it remains focused on pre-clinical and early-phase trials. There is, however, increasing attention to vector and environmental research in comparison to prior analyses on COVID-19 research. Investments remain concentrated in high-income countries, with limited financial support for context-specific research led by institutions in low- and middle-income countries. The inclusion of vulnerable populations in funded grants is also limited. Conclusions Our findings reveal critical gaps and disparities in global pandemic preparedness research funding. The living design of this review will enable ongoing monitoring of these gaps, providing real-time evidence to support funder coordination and policy decisions.Item Gut Microbiome and Environmental Enteric Dysfunction Are Unchanged by 18 Months of Small-Quantity Lipid-Based Nutrient Supplementation among Young Children in Lusaka, Zambia.(2026-Jun-22) Lauer JM; Leng Y; Chembe M; Henderson S; Parkerson D; Chibesa K; Moono A; Fink G; Rockers PC; Locks LMSmall-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to improve growth, development, and survival among young children in low-resource settings. One hypothesized pathway is through improvements in intestinal health, including modulation of the gut microbiome and reductions in environmental enteric dysfunction (EED). This study examined the effects of SQ-LNS on the gut microbiome and markers of EED and systemic inflammation among young children in Lusaka, Zambia. We conducted intention-to-treat analyses of 302 children aged 27-35 months in a 2x2 cluster-randomized trial. Serum biomarkers of EED (soluble CD14, intestinal fatty acid binding protein) and inflammation (alpha-1-acid glycoprotein, C-reactive protein) were assessed in 240 children via the Multiple-Micronutrient and Environmental Enteric Dysfunction Assessment Tool (MEEDAT). Differences by SQ-LNS assignment were assessed using unadjusted and adjusted ordinary least squares regression models. Rectal swab samples from 299 children underwent 16S rRNA gene sequencing. Taxonomic profiles were visualized using stacked bar plots, alpha diversity was quantified using Shannon diversity indices, and beta diversity was assessed using non-metric multidimensional scaling based on Bray-Curtis dissimilarity matrices. We found that SQ-LNS had no significant effect on EED or inflammation biomarkers and was not associated with differences in gut microbiome alpha diversity, beta diversity, or overall microbial community composition. In exploratory analyses,Item Defining person-centred treatment support for multidrug-resistant TB: a discrete choice experiment.(2026-Jun) Kagujje, Mary; Mtumbi G; Sikandangwa M; Shatalimi J; Muyoyeta, Monde; Kerkhoff, Andrew D.BACKGROUND: Multidrug-resistant TB (MDR-TB) treatment remains challenging, with significant toxicity and associated hardships that undermine adherence and cure rates. Support packages may improve outcomes, but the features most valued by people with MDR-TB are unknown. METHODS: A discrete choice experiment was performed among adults receiving MDR-TB treatment in Lusaka, Zambia. Five features (3-4 levels each) comprising a support package were evaluated through 12 choice tasks comparing hypothetical packages. RESULTS: Among 99 participants (median age 36 years, 68.9% men, 42.4% HIV-positive), material support was the most valued feature (relative importance [RI] = 45.7%), with transport vouchers plus food assistance being the most preferred option. Visit frequency was also important (RI = 26.7%), with similar preferences for monthly and bimonthly visits. Participants preferred phone calls for visit reminders (RI = 11.8%), health care workers for emotional support (RI = 11.2%), and community-based health care workers or loved ones for treatment observation (RI = 4.7%). Three distinct preference groups were identified - all highly valued material support but varied in their preferences for other support features and their delivery. CONCLUSION: Among people with MDR-TB in Zambia, material support mechanisms and less frequent clinic visits were highly valued. Incorporating patient preferences into treatment programmes could optimise MDR-TB care and improve treatment adherence and outcomes.Item Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey.(2026) Zyambo, Cosmas; Somwe, Paul; Musukuma, Mwiche; Mandyata, Chomba; Bwembya, Phoebe; Phiri, Henry; Chavula, Malizgani; Halwindi, Hikabasa; Zulu, Joseph; Mutale, WilbroadBACKGROUND: In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication. AIM: Investigate factors associated with ART adherence in a clinical setting in Zambia. METHODS: National cross-sectional study involving 193 clinics across all 10 provinces of Zambia. The primary outcomes assessed were ART adherence status, associated behavioral factors, and clinical characteristics. Logistic regression analysis was conducted to evaluate associations between these factors and ART adherence. Both unadjusted odds ratios (UOR) and adjusted odds ratios (AOR) were calculated, with adjustments made for relevant covariates, and all estimates reported with 95% confidence intervals. RESULTS: Of the 5,204 PLWH, 7.1% were non-adherent to ART (9.7% males vs 5.9% females). Of those who were non adherent, 60% and 22% consumed alcohol and smoked tobacco respectively. In adjusted analysis, age; 45-59 (AOR: 0.5, 95% CI:0.32-0.79), 60+ (AOR: 0.26, 95% CI: 0.12-0.59) and education; Primary (AOR: 0.6, 95% CI: 0.4-0.9), secondary (AOR: 0.57, 95% CI: 0.4-0.82), college/university (AOR: 0.5, 95% CI: 0.29-0.89) were associated with decreased odds of being non-adherence to ART. In contrast, being male (AOR: 1.45, 95% CI:1.07-1.98), being in informal employment (AOR:1.65, 95% CI:1.15-2.36), having average yearly income; > $160 (AOR: 1.55, 95% CI: 1.16-2.06), Alcohol consumption; healthy consumption (AOR: 2.72, 95% CI: 1.9-3.89), unhealthy consumption (AOR: 2.76, 95% CI: 1.8-4.22), indeterminant consumption (AOR: 3.03, 95% CI: 2.04-4.5) and tobacco smoking (AOR: 95% CI: 2.03 1.42-2.9) were associated with increased odds of being non-adherence to ART. CONCLUSIONS: ART non-adherence among PLWH in Zambia is 7.1%, with higher rates in males. Substance use especially alcohol and tobacco are common among the non-adherent. The associations between alcohol consumption, tobacco smoking, and ART adherence highlight the potential value of targeted support strategies. These results can inform future longitudinal research and contribute to the development of evidence-based interventions.Item "That is why I trust": a qualitative study on acceptability and feasibility of novel tongue swab diagnostics to assess people presenting with tuberculosis symptoms in Viet Nam and Zambia.(2026-Jun-19) Sales A; Le H; Muzazu S; Kunda-Ng'andu E; Castro MDM; Kerkhoff AD; Phan H; Denkinger CM; Cattamanchi A; West N; Muyoyeta MBACKGROUND: Millions of tuberculosis (TB) cases are estimated to be undiagnosed and unreported annually. Sputum has been the primary approach for diagnostic testing, but tongue swabs are being investigated as an alternative to expand testing. To understand potential uptake and implementation, we explored the acceptability, usability, and feasibility of tongue swab-based TB testing from the perspectives of healthcare workers, people undergoing TB screening, and caregivers in Viet Nam and Zambia. METHODS: We interviewed people with symptoms of TB, caregivers of children undergoing TB evaluation, and healthcare workers who collected tongue swabs (n = 76 participants) between September 2023 and February 2024. Interviews were analyzed using framework analysis to elucidate preferences, experiences, and acceptability of tongue swabs vs. sputum. Findings were further organized according to acceptability and feasibility to understand barriers and facilitators to uptake. RESULTS: Most participants preferred tongue swab to sputum collection. The perceived usability and feasibility of tongue swabs were high. Key themes that influenced the acceptability of tongue swabs included ease of use, diagnostic accuracy, diagnostic yield, hygiene, risk of TB transmission during sample collection, time to test result, and trust in healthcare workers and the health system. Across interviews, many participants described tongue swabs as a comfortable and easy way to test for TB, compared to the physical discomfort and difficulty expectorating sputum. Participants described tongue swabs as suitable for everyone, yet perceived diagnostic accuracy was crucial in shaping test preference. CONCLUSION: Tongue swab-based testing for TB is likely to be highly acceptable and feasible if incorporated into TB diagnostic guidelines. Future integration of tongue swabs in facilities and communities should target drivers of acceptability.Item Advancing SDG#4 Through Early Literacy Support and Mentorship: An Analysis of Teachers’ Perspectives in Zambia(2026-6-15) Chuunga Mathias-Shimanga; Mkhize Themba-Ralph; Ndwandwe Ntokozo-DennisThe United Nations Sustainable Development Goal 4 aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Included in this is early-grade literacy in a child's life and how it impacts adulthood. This underscores the need to teach literacy effectively, which catalyses other milestones in one’s life. However, early grade literacy has been facing several challenges, including learners' inability to read and write due to low teacher competence. Low teacher competence can be boosted by teacher support and mentorship. This study aimed to examine how teachers of early-grade learners experience support and mentoring in advancing SDG#4. A qualitative study was employed using the case study design. Data were collected through semi-structured one-on-one and focus group interviews. Analysis was done through themes emerging from the data. The study's findings show that teachers for early grade learners were supported and mentored differently. Despite the positive picture, the teacher support and mentorship faced many challenges; among the major ones is the workload on the mentors. Therefore, the study suggests several recommendations.Item <b>Assessment of the Effectiveness of Trade Kings Zambia Limited Advertising Strategies in Influencing Consumer Behaviour Among Residents of Mwalubemba Village in Chongwe Zambia</b>(2026-6-6) Mwale Mirriam David; Phiri MosesThis study examined the effectiveness of Trade Kings Zambia Limited’s advertising strategies in Mwalubemba Village, a rural setting in Zambia. It explored the relationship between advertising awareness, consumer behaviour, and purchase decisions while assessing the effectiveness of various advertising channels, including radio, television, social media, print media, and billboards. A concurrent mixed-methods research design was employed, utilizing surveys, focus group discussions (FGDs), and key informant interviews (KIIs) to gain insights into consumer engagement with advertising. Data were analysed using Stata Version 16 and Excel. Quantitative data analysis revealed that about 79% of respondents were aware of Trade Kings' advertising channels, with radio (42%) and television (21%). Despite billboards being visually dominant, awareness remained low at 5%. Radio advertising emerged as the most effective channel (27%), followed by television (23%) and social media (20%), reinforcing previous studies that highlight the dominance of traditional mass media in rural markets. However, only 49% of consumers cited advertising as their primary source of product awareness, with 23% relying on word-of-mouth recommendations. Product benefits (39%) and affordability (27%) were the strongest purchase motivators, while emotional appeal (8%) and celebrity endorsements (3%) had minimal impact. Qualitative insights from FGDs and KIIs revealed that consumers preferred locally relatable radio ads delivered in native languages and voiced by familiar announcers, fostering greater trust and recall. Social media advertising showed promise among younger demographics but faced limited penetration due to digital access challenges. While Trade Kings' advertising efforts have effectively created product awareness and influenced consumer decisions, gaps remain in digital outreach, in-store engagement, and messaging for lesser-known products. The study concludes that rural consumers in Zambia prioritize functionality and affordability in purchase decisions, requiring marketing strategies that emphasize product education, affordability, and localized engagement. Recommendations include expanding radio campaigns with consumer testimonials, integrating community-driven marketing efforts, and diversifying in-store promotions to increase consumer interaction. These insights provide valuable guidance for Trade Kings, policymakers, and marketers seeking to optimize advertising strategies in rural markets.Item Financial risk management and investment decision-making: A Comparative study of commercial banks and non-bank financial institutions in Zambia(2026-5-23) Kana Julius; Chilolo BwalyaThis study examined how financial risk management influences investment decision-making and institutional performance among commercial banks and non-bank financial institutions (NBFIs) in Zambia. The study was motivated by limited comparative evidence on whether the maturity of enterprise risk management (ERM) frameworks differs between banks and NBFIs and whether those differences affect investment discipline and performance outcomes. The study was anchored in Enterprise Risk Management theory, which emphasises a firm-wide approach aligned with strategy and governance. An explanatory sequential mixed-methods research design was adopted. The target population comprised 15 commercial banks and 250 non-bank financial institutions registered in Zambia, while the sample comprised risk management, investment, finance, compliance and portfolio-related professionals working in selected commercial banks and NBFIs, including pension, insurance, microfinance and asset-management institutions. A stratified sampling approach was used to secure comparable representation across commercial banks and NBFI subsectors, while purposive selection targeted respondents with direct knowledge of risk governance, risk reporting, investment analysis and portfolio monitoring. Quantitative data were collected through structured questionnaires from 422 valid respondents, consisting of 210 bank respondents and 212 NBFI respondents, and qualitative evidence was obtained from practitioner interviews and open-ended questionnaire responses. Quantitative data were analysed using descriptive statistics, independent-samples t-tests, analysis of variance, correlation and regression analysis, while qualitative evidence was analysed thematically. The findings showed that commercial banks had higher ERM maturity, broader risk-tool adoption, stronger risk-appetite alignment and stronger performance outcomes than NBFIs. ERM maturity significantly predicted investment decision quality, and both ERM maturity and investment decision quality significantly predicted performance outcomes. Regulation supported performance where institutions translated supervisory expectations into internal governance discipline. The study concludes that financial risk management should be treated as a strategic capability that strengthens investment discipline, resilience and sustainable performance rather than as a narrow compliance activity. The study recommends that NBFIs strengthen proportionate ERM frameworks, risk dashboards, stress testing, risk-appetite alignment and post-investment portfolio monitoring, while regulators should support capability-based supervision across banking and non-bank financial sectors.Item Advancing SDG#4 Through Early Literacy Support and Mentorship: An Analysis of Teachers’ Perspectives in Zambia(2026-5-29) Chuunga Mathias-Shimanga; Mkhize Themba-Ralph; Ndwandwe Ntokozo-DennisThe United Nations Sustainable Development Goal 4 aims to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Included in this is early-grade literacy in a child's life and how it impacts adulthood. This underscores the need to teach literacy effectively, which catalyses other milestones in one’s life. However, early grade literacy has been facing several challenges, including learners' inability to read and write due to low teacher competence. Low teacher competence can be boosted by teacher support and mentorship. This study aimed to examine how teachers of early-grade learners experience support and mentoring in advancing SDG#4. A qualitative study was employed using the case study design. Data were collected through semi-structured one-on-one and focus group interviews. Analysis was done through themes emerging from the data. The study's findings show that teachers for early grade learners were supported and mentored differently. Despite the positive picture, the teacher support and mentorship faced many challenges; among the major ones is the workload on the mentors. Therefore, the study suggests several recommendations.Item Workforce Capacity and Operational Processes on Delivery of Healthcare Services in Zambia: A Case of Chikuni Mission Hospital in Monze District(2026-5-21) Kanyamuna Vincent; Muyunda CeciliaThis study aimed to assess the Public Service Delivery Performance (PSDP) systems at Chikuni Mission Hospital in Monze District, Southern Province, Zambia. Utilizing a qualitative case study design, the research employed a purposive sampling method to select 20 participants, including healthcare professionals, support staff, and administrators, who provided insights into the hospital’s service delivery dynamics. Data was collected through interviews and review of existing literature. Data was analysed thematically. Zambia’s [12] aims to achieve equitable access to quality healthcare for all by 2030. However, [19] highlights persistent challenges in the healthcare sector, including inconsistent supply of essential medical supplies, shortages of health personnel, and ineffective management of Non-Communicable Diseases (NCDs). Rural areas, such as Chikuni, face even greater barriers to healthcare access due to low health-seeking behaviors, limited healthcare workforce, long distances to health facilities, inadequate medical supplies, and a shortage of specialists to handle complex cases. The study focused on Chikuni Mission Hospital and aimed to assess the workforce capacity in delivering healthcare services and evaluate the effectiveness of operational processes in improving public service delivery at the hospital. The study revealed inadequate medical equipment, and inconsistent supply chains, which compromise the quality of healthcare delivery. Workforce issues, such as staffing shortages and gaps in specialized skills, further strained the hospital’s capacity to manage patient care effectively. Despite the hospital’s commitment to improving service delivery through systems like electronic health records (smart care) and centralized pharmacy management, inadequate staff training hindered the full utilization of these systems. The study concluded that Chikuni Mission Hospital requires urgent interventions to address these challenges. Further, the study revealed critical staffing shortages and a lack of specialized skills, which place additional strain on existing healthcare workers. Overburdened staff often experience burnouts and reduced efficiency, leading to compromised patient care. The study concludes that without modern and well-maintained, healthcare providers struggle to deliver timely and effective treatment, potentially leading to delays in diagnosis, increased patient referrals, and higher mortality rates. The inconsistent supply chain further exacerbates these issues, as a lack of essential medical supplies can disrupt treatment plans, leaving patients without necessary medications or equipment. Recommendations include recruiting additional healthcare professionals, and enhancing training programs. Implementing these changes is essential for improving service delivery and ensuring the hospital can meet the healthcare needs of its community effectively.