RESUMO
Introduction: on October 18, 2023, the Ministry of Health declared an outbreak of cholera in the Lusaka district. Public health interventions were implemented using a multisectoral approach in the Lusaka district and other hotspots in the country. We documented the multisectoral response efforts and their impacts on the cholera epidemic in the Lusaka district of Zambia. We highlighted the major challenges and their associated impacts on the epidemiologic patterns of disease in hotspot areas. Methods: we conducted a descriptive observational study of cholera response activities in the Lusaka district. We used quantitative and qualitative non-participant techniques using the Centers for Disease Prevention and Control's direct in-person observation tool in healthcare settings. We reviewed surveillance records to estimate the magnitude of the outbreak, and characterized cases by person, place, and time. We documented the response interventions and challenges using situation reports. Results: during the 2023 - 2024 cholera outbreak, Lusaka district was the most affected district with 13,122 cases and 498 deaths as of 12th February 2024. Despite having a well-established system for coordinating technical support and resource mobilization, inadequate sanitation and limited access to clean water remained potential risks for cholera outbreaks in Lusaka district. Conclusion: Lusaka district may have experienced one of the most severe cholera epidemics in the nation's history, as indicated by its rapid spread and increased mortality reported from both the community and treatment centers. A multisectoral coordination for improved sanitary systems, access to clean water, health education strategies, and vaccination campaigns contributed to the decline in cholera cases.
Assuntos
Cólera , Surtos de Doenças , Saúde Pública , Saneamento , Cólera/prevenção & controle , Cólera/epidemiologia , Zâmbia/epidemiologia , Humanos , Surtos de Doenças/prevenção & controle , Saneamento/normas , Saneamento/métodosRESUMO
INTRODUCTION: Zambia has moved from accelerated malaria burden reduction to malaria elimination which requires the national malaria surveillance system to capture all cases from both the public and private sector. This study investigated challenges and factors associated with private health facilities reporting malaria in the national health management information system (HMIS). METHODS: a structured questionnaire was administered to the heads of 139 private health facilities in three provinces where approximately 85% of private health facilities are found in Zambia. Logistic regression was performed, and the outcome variable was reporting malaria in the HMIS. Epi Info® version 7 was used to conduct multivariable logistic regression to determine factors associated with private facilities reporting malaria in HMIS. RESULTS: private health facilities that had been operating for more than 20 years had three (3) times increased odds of reporting malaria in HMIS (AOR = 3.22, 95% CI: 1.23, 8.42; P-value = 0.02) compared to those that had been operating for less than 20 years. The private facilities that had staff who were aware about malaria surveillance (AOR = 2.06 95% CI: 1.38, 3.99, P-value = 0.01) had two times greater odds to report malaria in HMIS compared to those that were not aware. Lack of information and training in surveillance was identified as the main barrier for private facilities to report malaria in HMIS. CONCLUSION: as Zambia progresses towards malaria elimination, there is need to increase awareness and training of private providers on malaria surveillance to improve reporting in HMIS.
Assuntos
Notificação de Doenças/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Malária/epidemiologia , Vigilância da População/métodos , Estudos Transversais , Sistemas de Informação em Saúde , Humanos , Instalações Privadas/estatística & dados numéricos , Inquéritos e Questionários , ZâmbiaRESUMO
On October 6, 2017, the Zambia Ministry of Health declared a cholera outbreak in Lusaka. By December, 1,462 cases and 38 deaths had occurred (case fatality rate, 2.6%). We conducted a case-control study to identify risk factors and inform interventions. A case was any person with acute watery diarrhea (≥ 3 loose stools in 24 hours) admitted to a cholera treatment center in Lusaka from December 16 to 21, 2017. Controls were neighbors without diarrhea during the same time period. Up to two controls were matched to each case by age-group (1-4, 5-17, and ≥ 18 years) and neighborhood. Surveyors interviewed cases and controls, tested free chlorine residual (FCR) in stored water, and observed the presence of soap in the home. Conditional logistic regression was used to generate matched odds ratios (mORs) based on subdistricts and age-groups with 95% CIs. We enrolled 82 cases and 132 controls. Stored water in 71% of case homes had an FCR > 0.2 mg/L. In multivariable analyses, those who drank borehole water (mOR = 2.4, CI: 1.1-5.6), had close contact with a cholera case (mOR = 6.2, CI: 2.5-15), and were male (mOR = 2.5, CI: 1.4-5.0) had higher odds of being a cholera case than their matched controls. Based on these findings, we recommended health education about household water chlorination and hygiene in the home. Emergency responses included providing chlorinated water through emergency tanks and maintaining adequate FCR levels through close monitoring of water sources.
Assuntos
Cloro/análise , Cólera/epidemiologia , Água Potável/química , Saneamento/estatística & dados numéricos , Sabões , Purificação da Água/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Epidemias , Feminino , Educação em Saúde , Humanos , Higiene , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Poços de Água , Adulto Jovem , Zâmbia/epidemiologiaRESUMO
The Republic of Zambia declared a cholera outbreak in Lusaka, the capital, on October 6, 2017. By mid-December, 20 of 661 reported cases had died (case fatality rate 3%), prompting the CDC and the Zambian Ministry of Health through the Zambia National Public Health Institute to investigate risk factors for cholera mortality. We conducted a study of cases (cholera deaths from October 2017 to January 2018) matched by age-group and onset date to controls (persons admitted to a cholera treatment center [CTC] and discharged alive). A questionnaire was administered to each survivor (or relative) and to a family member of each decedent. We used univariable exact conditional logistic regression to calculate matched odds ratios (mORs) and 95% CIs. In the analysis, 38 decedents and 76 survivors were included. Median ages for decedents and survivors were 38 (range: 0.5-95) and 25 (range: 1-82) years, respectively. Patients aged > 55 years and those who did not complete primary school had higher odds of being decedents (matched odds ratio [mOR] 6.3, 95% CI: 1.2-63.0, P = 0.03; mOR 8.6, 95% CI: 1.8-81.7, P < 0.01, respectively). Patients who received immediate oral rehydration solution (ORS) at the CTC had lower odds of dying than those who did not receive immediate ORS (mOR 0.1, 95% CI: 0.0-0.6, P = 0.02). Cholera prevention and outbreak response should include efforts focused on ensuring access to timely, appropriate care for older adults and less educated populations at home and in health facilities.