Unlocking Trust in Community Health Systems: Lessons From the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia.

BACKGROUND: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHSs) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. METHODS: Qualitative data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs) (n=45) in February 2020 in Luangwa District. Thirty-one IDIs were conducted with hydrocele patients, community health workers (CHWs), health workers, traditional leaders and traditional healers. Two FGDs were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. RESULTS: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. CONCLUSION: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

Bacteriological Quality and Heavy Metal Analysis of Packaged Water Produced in Lusaka, Zambia and Associated Quality Control Measures.

Many people in the world lack safe basic drinking water sources and rely on untreated water source. Packaged water can be considered as an alternative to other water sources if measures are put in place to ensure its safety for consumption. This study aimed to assess the bacteriological quality and heavy metal analysis of packaged water produced in Lusaka, Zambia and associated quality control measures. A cross-sectional study was conducted in May 2019 where 18 brands of packaged water were analyzed for total and fecal coliforms as well as concentrations of Lead, Chromium, and Cadmium. The study found that 33.5% of the packaged water produced in Lusaka did not comply with the standard for drinking water on bacteriological quality. We also found that the concentrations for Lead were <0.01 mg/l in all the 17 samples, thus compliant to WHO/ZABS standards. Concentrations of Chromium were between 0.002 and 0.62 mg/l and compliance to the standard was 11.8%. Concentrations for Cadmium were between 0.009 and 0.2 mg/l against the acceptable concentration of <0.003 mg/l. Most brands of the packaged water did not conform to the standards for drinking water.

Large-scale determinants of intestinal schistosomiasis and intermediate host snail distribution across Africa: does climate matter?

The geographical ranges of most species, including many infectious disease agents and their vectors and intermediate hosts, are assumed to be constrained by climatic tolerances, mainly temperature. It has been suggested that global warming will cause an expansion of the areas potentially suitable for infectious disease transmission. However, the transmission of infectious diseases is governed by a myriad of ecological, economic, evolutionary and social factors. Hence, a deeper understanding of the total disease system (pathogens, vectors and hosts) and its drivers is important for predicting responses to climate change. Here, we combine a growing degree day model for Schistosoma mansoni with species distribution models for the intermediate host snail (Biomphalaria spp.) to investigate large-scale environmental determinants of the distribution of the African S. mansoni-Biomphalaria system and potential impacts of climatic changes. Snail species distribution models included several combinations of climatic and habitat-related predictors; the latter divided into "natural" and "human-impacted" habitat variables to measure anthropogenic influence. The predictive performance of the combined snail-parasite model was evaluated against a comprehensive compilation of historical S. mansoni parasitological survey records, and then examined for two climate change scenarios of increasing severity for 2080. Future projections indicate that while the potential S. mansoni transmission area expands, the snail ranges are more likely to contract and/or move into cooler areas in the south and east. Importantly, we also note that even though climate per se matters, the impact of humans on habitat play a crucial role in determining the distribution of the intermediate host snails in Africa. Thus, a future contraction in the geographical range size of the intermediate host snails caused by climatic changes does not necessarily translate into a decrease or zero-sum change in human schistosomiasis prevalence.

The epidemiology and small-scale spatial heterogeneity of urinary schistosomiasis in Lusaka province, Zambia.

In line with the aims of the "National Bilharzia Control Programme" and the "School Health and Nutrition Programme" in Zambia, a study on urinary schistosomiasis was conducted in 20 primary schools of Lusaka province to further our understanding of the epidemiology of the infection, and to enhance spatial targeting of control. We investigated risk factors associated with urinary schistosomiasis, and examined small-scale spatial heterogeneity in prevalence, using data collected from 1,912 schoolchildren, 6 to 15-year-old, recruited from 20 schools in Kafue and Luangwa districts. The risk factors identified included geographical location, altitude, normalized difference vegetation index (NDVI), maximum temperature, age, sex of the child and intermediate host snail abundance. Three logistic regression models were fitted assuming different random effects to allow for spatial structuring. The mean prevalence rate was 9.6%, with significance difference between young and older children (odds ratio (OR) = 0.71; 95% confidence interval (CI) = 0.51-0.96). The risk of infection was related to intermediate host snail abundance (OR = 1.03; 95% CI = 1.00-1.05) and vegetation cover (OR = 1.04; 95% CI = 1.00-1.07). Schools located either on the plateau and the valley also differed in prevalence and intensity of infection for moderate infection to none (OR = 1.64; 95% CI = 1.36- 1.96). The overall predictive performance of the spatial random effects model was higher than the ordinary logistic regression. In addition, evidence of heterogeneity of the infection risk was found at the micro-geographical level. A sound understanding of small-scale heterogeneity, caused by spatial aggregation of schoolchildren, is important to inform health planners for implementing control schistosomiasis interventions.