Cross-sectional study of face mask use during the COVID-19 pandemic-Lusaka and Mansa Districts, Zambia, December 2020.

Introduction: coronavirus disease (COVID-19) is primarily spread through respiratory secretions of infected persons, and face mask use has shown to decrease transmission. In Zambia, anecdotal evidence indicates low face mask use among the general population. We objectively assessed face masks use among Lusaka and Mansa residents in December 2020. Methods: we conducted a cross sectional study of face mask usage in Lusaka and Mansa Districts from 16-23 December 2020. A standardized tool was used to visually observe face mask usage and correct face mask usage at various outdoor locations in Lusaka and Mansa. Logistic regression was used to determine association of face mask use and correct face mask use with selected demographic variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. Results: in total, 4070 persons were observed in Lusaka and 1166 Mansa Districts. Face masks usage was 24% in Lusaka and 27% in Mansa. Among the persons wearing face masks, 621 (48%) wore them correctly (52% in Lusaka and 35% in Mansa; p < 0.01 for difference). Being at a health facility (OR: 10.11 [95% CI: 7.99 - 12.81]), shopping mall (OR: 6.38 [95% CI: 5.07 - 8.03]), and school (OR: 2.39 [95% CI: 1.85 - 3.10]) were associated with wearing face masks compared to being at a bus station. Conclusion: face masks usage in public spaces was low in the two districts in Zambia, which might reduce efforts to control COVID-19. Investigating reasons for poor face masks adherence may help formulate effective strategies to increase face masks utilization in Zambia.

Zambia field epidemiology training program: strengthening health security through workforce development.

The Zambia Field Epidemiology Training Program (ZFETP) was established by the Ministry of Health (MoH) during 2014, in order to increase the number of trained field epidemiologists who can investigate outbreaks, strengthen disease surveillance, and support data-driven decision making. We describe the ZFETP´s approach to public health workforce development and health security strengthening, key milestones five years after program launch, and recommendations to ensure program sustainability. Program description: ZFETP was established as a tripartite arrangement between the Zambia MoH, the University of Zambia School of Public Health, and the U.S. Centers for Disease Control and Prevention. The program runs two tiers: Advanced and Frontline. To date, ZFETP has enrolled three FETP-Advanced cohorts (training 24 residents) and four Frontline cohorts (training 71 trainees). In 2016, ZFETP moved organizationally to the newly established Zambia National Public Health Institute (ZNPHI). This re-positioning raised the program´s profile by providing residents with increased opportunities to lead high-profile outbreak investigations and analyze national surveillance data-achievements that were recognized on a national stage. These successes attracted investment from the Government of Republic of Zambia (GRZ) and donors, thus accelerating field epidemiology workforce capacity development in Zambia. In its first five years, ZFETP achieved early success due in part to commitment from GRZ, and organizational positioning within the newly formed ZNPHI, which have catalyzed ZFETP´s institutionalization. During the next five years, ZFETP seeks to sustain this momentum by expanding training of both tiers, in order to accelerate the professional development of field epidemiologists at all levels of the public health system.

Cholera Epidemic - Lusaka, Zambia, October 2017-May 2018.

On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018 (Figure). In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city's water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10-February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged ≥1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents.