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Dolutegravir-associated resistance gene mutations among people living with human immunodeficiency virus in Malawi.
(The University of Zambia, 2024) Hussein, Felistus Zumazuma Kanjira
The emergence of drug resistance among Human Immunodeficiency Virus (HIV) patients poses a significant challenge to the success of antiretroviral therapy (ART) programs globally. In Malawi, where HIV prevalence remains a major public health concern, the incorporation of Dolutegravir (DTG) into first-line ART regimens has demonstrated significant promise in improving treatment outcomes. However, the development of resistance to DTG threatens these advancements, necessitating continuous monitoring and adjustments in treatment strategies. This retrospective study identified HIV drug resistance mutations associated with DTG use among individuals living with HIV in Malawi. Data from HIV-positive individuals aged 15 to 60 years, undergoing routine ART monitoring, were evaluated. Patients with high viral loads (≥ 1000 copies/ml) were included, and HIV-1 pol gene sequences were examined to identify mutations linked to DTG resistance. Phylogenetic analysis was performed to assess the relatedness of samples with resistance mutations. A total of 91 sequences from various districts in Malawi were reviewed, comprising 60.4% females and 39.6% males. DTG resistance mutations were found 15.4% of samples, with females accounting for 57.1% and males for 42.9% of those affected. G118R/R, G140A, Q148H/R, and R263K mutations associated DTG resistance, to varying levels, were identified. Among the 14 cases, 50% exhibited high-level resistance, 28% intermediate resistance, and 14.3% low resistance potential. The findings indicate a widespread distribution of DTG resistance mutations across Malawi, with evidence of both isolated and clustered patterns of resistance mutation from different districts emergence suggesting transmission of resistance within the communities. These DTG resistance mutations impact treatment outcomes by reducing the drug's binding efficiency to the integrase enzyme, which is essential for HIV replication inhibition. Mutations such as G118R and Q148H/R significantly impair DTG’s potency, potentially leading to treatment failure, virological rebound, and an increased risk of onward transmission of drug-resistant HIV strains. Additionally, these mutations can limit future ART options by conferring cross-resistance to other Integrase Strand Transfer Inhibitors (InSTIs), complicating treatment regimens and increasing healthcare costs.
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Determinants and barriers to rabies prevention and control in Manyinga and Mwansabombwe districts of Zambia.
(The University of Zambia, 2024) Misapa, Muma Chipo
Rabies persists as a long-standing issue in Zambia, despite being preventable. The current control measures, including dog vaccination, population control, and movement restriction, guided by Zambia's Dog Control Act, have not yielded the desired impact in Manyinga and Mwansabombwe districts. These areas continue to report low dog vaccination percentages, unrestricted dog movements, and escalating cases of animal and human rabies, along with dog bites. Aligned with global aspirations to achieve zero human rabies cases from dog-mediated rabies by 2030, this study scrutinizes the determinants and obstacles hampering the execution of rabies prevention and control initiatives in Manyinga and Mwansabombwe. Spanning approximately 11 months, this cross-sectional study targeted a population of 48,181 in Manyinga and 35,546 in Mwansabombwe were pre- and post-vaccination data from 301 households in Manyinga and 100 households in Mwansabombwe was collected. Using pretested structured questionnaire, including closed and open-ended questions we probed knowledge, attitudes and practices related to rabies prevention and control.The questionnaire comprised 10 questions on rabies knowledge, 3 questions on practices, 2 questions on attitudes, and general follow-up questions. A transect survey, key informant interviews, and assessment of rabies vaccination and dog bite records complemented the data collection. IBM SPSS Statistics version 26.0 was used for a comprehensive thematic analysis were cross tabulations and Pearson’s Chi Square were performed. Findings revealed that 68% of respondents in Manyinga and 84% in Mwansabombwe possessed knowledge about rabies, confirming affected species and transmission. Moreover, 76.8% in Manyinga and 88.6% in Mwansabombwe were acquainted with rabies prevention and control methods. Concerning dog owners, 89% were aware of rabies, 66% understood its prevention and control, and the majority identified bites as the primary mode of transmission. Vaccination coverage stood at 64% in Manyinga and 21% in Mwansabombwe. Notably, education and occupation exhibited significant associations with rabies knowledge. On the attitudes and practices on rabies vaccination 51.82% in Manyinga and 72.09% in Mwansabombwe of the dog owning respondents had valid rabies vaccination. And only 55% in Mwansabombwe and 70% in Manyinga washed the wound, visited the veterinary office and went to the hospital after a dog bite. Manyinga recorded low numbers on vaccinated dogs with valid vaccinations which is a risk to the community because majority of the dogs were not protected against rabies. Also, the two districts had beliefs which hindered the community from having their dogs vaccinated. The key informants were well vested with rabies and their role in rabies prevention, however, they faced a lot of challenges due to understaffing, lack of resources and community practices. The study underscores critical knowledge gaps which affected the practices and attitudes towards rabies prevention and control and emphasizes the need for enhanced education, awareness programs, improved rabies surveillance, free mass vaccination campaigns, and community engagement to augment vaccination coverage and knowledge about rabies. Key words: Rabies, Prevention, control, vaccination, barriers, determinants
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Seroprevalence, knowledge, attitudes and practices of people to COVID-19 in Chililabombwe and Lusaka districts of Zambia.
(The University of Zambia, 2025) Sampa, Mercy
The COVID-19 pandemic has had a profound effect on global health, economies, and societies. Understanding the seroprevalence, as well as the knowledge, attitudes, and practices (KAP) of individuals toward COVID-19, is essential for effective public health interventions. This study aimed to assess the seroprevalence of COVID-19 antibodies and the KAP of residents in Chililabombwe and Lusaka districts, Zambia. A cross-sectional study was conducted with a representative sample of 179 participants from two Zambian districts. COVID-19-specific antibodies were detected using serological tests to determine seroprevalence, while a structured questionnaire evaluated participants' knowledge, attitudes, and practices regarding COVID-19. Descriptive statistics and chi-square tests were used to analyze associations between categorical variables, and binary logistic regression was employed to identify potential risk factors for SARSCoV-2 seropositivity. The overall seroprevalence of COVID-19 antibodies was 9.5% (95% CI: 6.0-14.7), reflecting notable exposure within the districts. Seroprevalence was higher in Chililabombwe (11.0%; 95% CI: 6.1-19.1) compared to Lusaka (8.0%; 95% CI: 3.9-15.5). The study found variations in seroprevalence based on age, gender, and education level, with higher rates among individuals aged 40-49 (13.6%; 95% CI: 4.7-33.3), females (12.6%; 95% CI: 7.4- 20.8), and those with no education (22.2%; 95% CI: 6.3-54.7). However, these differences were not statistically significant (p>0.05). Both seropositive and seronegative participants exhibited moderate knowledge and attitudes, alongside high levels of preventive practices, indicating a shared understanding of health risks. Lower knowledge, attitudes, and practices were strongly associated with higher seropositivity. Confidence in preventing future pandemics was expressed by both groups, with only marginal differences between them. This study highlights important insights into the seroprevalence and KAP regarding COVID-19 in selected Zambian districts. The findings emphasize the need for targeted public health initiatives to close knowledge gaps like comparisons of KAP and seroprevalence between regions and information sources and their influence on attitudes towards COVID-19, dissemination of accurate information, and promotion effective preventive behaviours. These efforts could help limit the spread of COVID-19 and strengthen community resilience in response to the pandemic.
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Lived experiences of former drug abusers during their rehabilitation process at Chainama Hills hospital.
(The University of Zambia, 2025) Mukumwa, Julie
One of the most serious health problems affecting people of all age groups, especially young people, today is drug abuse. Considering the effects of drug use on individuals who use drugs, efforts are being made to improve the rehabilitation of drug users in Zambia. However, in Zambia, there is a lack of comprehensive research and data on the lived experiences of individuals struggling with drug use. Hence, the purpose of this study was to explore the lived experiences of former drug users during their rehabilitation process at Chainama Hills Hospital. A qualitative phenomenological study design was used and data was collected through in-depth interviews with former drug abusers at Chainama Hills Hospital. Twenty-five participants of both sexes aged 18 years and above took part in the in-depth interviews, which were determined through purposive sampling. Thematic analysis was used using both inductive and deductive approach. The study identified two themes and twenty sub-themes. The first theme was Facilitators to Recovery which encompassed treatment, psycho-emotive support (counselling and medication), familial and social support (including desire to repair relationships, and spiritual support), and personal factors (avoiding triggers, changing habits, and self-improvement), while Barriers to Recovery theme included personal struggles (dietary, cravings, stigma, and withdrawal), familial and social challenges (peer influence and loneliness), treatment-related obstacles (confinement and medication issues), and facility-related difficulties (shared wards and poor conditions). Recovery from drug abuse is influenced by a combination of treatment access, social and spiritual support, and personal factor, while factors such as stigma, cravings, poor facility conditions, and lack of social support affect recovery. These findings underscore the importance of a holistic approach to treatment, encompassing medical, psychological, social, and personal dimensions. Key Terms: Drug Abuse, Drug Rehabilitation, Recover.
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Determining potential health risks to residents from water sourced in Maloni compound of Livingstone district in Zambia.
(The University of Zambia, 2023) Mukwasa, Kamunga
This study is an investigation into the presence of bacteria from water sourced in Maloni Compound of Livingstone District in Zambia. The basic research objective of the empirical study was to investigate the presences of bacteria in water sourced from Maloni Compound of Livingstone District. Furthermore, to examine the potential health risks to the residents arising from the water sourced in Maloni Compound. A mixed research strategy was adopted that made use of questionnaire, interviews guide, observation and standard field sampling sample bottles to collect empirical data. The findings revealed that water in Maloni compound was sourced from submissive boreholes, hand pump fitted boreholes and shallow wells. The study further revealed that residents of Maloni Compound used on site sanitation system namely pit latrine and septic tanks. It also revealed that water sourced from Maloni Compound had the presence of bacteria with relatively high total coliform and faecal coliform contamination, the fact that may have compromised the public health status of the residents of Maloni Compound. The study recommended for the following: i. There is need for collaboration of various stakeholders up to the consumer level during the planning and implementation stage of urban and peri urban areas, to ensure that the allocation of residential plots is done simultaneously with the provision of necessary services such as water and sewerage reticulation systems. ii. There is need for SWASCO to directly provide water to existing residents of Maloni and to facilitate decommissioning of all contaminated water sources. iii. There is need for urban Planners and SWASCO to encourage households to also employ alternative methods in the water sector such as rain water that can be stored and used for flushing toilets. iv. There is need to formulate policies in water and sanitation, planning and in infrastructure design that will encourage research and development of innovations and technologies that will apply to our local scenario.