Cholera Epidemic — Lusaka, Zambia, October 2017–May 2018

Sinyange, Nyambe; Brunkard, Joan; Kapata, Nathan; Mazaba, Mazyanga L.; Musonda, Kunda; Hamoonga, Raymond; Kapina, Muzala; Kapaya, Fred; Mutale, Lwito Salifya; Kateule, Ernest; Nanzaluka, Francis; Zulu, James Exnobert; Musyani, Chileshe Lukwesa; Winstead, Alison; Davis, William W.; N’cho, Hammad S.; Mulambya, Nelia L.; Sakubita, Patrick; Chewe, Orbie; Nyimbili, Sulani; Onwuekwe, Ezinne V C; Adrien, Nedghie; Blackstock, Anna J.; Brown, Travis W.; Derado, Gordana; Garrett, Nancy; Kim, Sun Kyung; Hubbard, Sydney; Kahler, Amy M.; Malambo, Warren; Mintz, Eric D.; Murphy, Jennifer L.; Narra, Rupa; Rao, Gouthami G.; Riggs, Margaret A.; Weber, Nicole; Yard, Ellen E.; Zyambo, Khozya; Bakyaita, Nathan; Monze, Namani; Malama, Kennedy; Mulwanda, Jabbin; Mukonka, Victor

doi:10.15585/mmwr.mm6719a5

Cited by 41 publications

(52 citation statements)

References 6 publications

(5 reference statements)

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“…This observation corroborates the results of several studies in African countries that have shown similar seasonality [14,33,35]. Previous studies have reported an association between rainfall and diarrhoeal disease outbreaks [21,31]. Similarly, we observed a higher number of cryptosporidiosis cases towards the end of the rainy season, which peaked in March for the years 2015, 2018, and 2019.…”

Section: Discussionsupporting

confidence: 92%

Molecular characterization ofCryptosporidiumspp. from patients with diarrhoea in Lusaka, Zambia

et al. 2020

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Cryptosporidium is a major etiological agent of diarrhoeal diseases among children and immune-compromised individuals in sub-Saharan African countries. We conducted a study to determine the prevalence and genetic characteristics of Cryptosporidium spp. in stool samples from patients with diarrhoea who presented at the University Teaching Hospital in Lusaka, Zambia. Cryptosporidium species and subtypes from 71 microscopically confirmed cryptosporidiosis stool samples collected between 2017 and 2019 were determined by polymerase chain reaction followed by partial sequencing of the small subunit rRNA and 60-kDa glycoprotein (gp60) gene. Additionally, data for the period between 2014 and 2019 were reviewed and analysed for cryptosporidiosis seasonal and age distribution. Cryptosporidium was more prevalent in the rainy season. The highest number of cases was reported among the 1–4 year age group. By sequence analysis of the 71 positive isolates, Cryptosporidium hominis (n = 42; 59.2%), C. parvum (n = 27; 38%), C. felis (n = 1; 1.4%), and C. meleagridis (n = 1; 1.4%) were identified. Four C. hominis subtype families (Ia, Ib, Id, and Ie) and three C. parvum subtype families (IIc, IIe, and IIs) were identified. The most frequent subtypes were IeA11G3T3 (n = 20; 28.2%), IIcA5G3 (n = 12; 16.9%), IIeA12G1 (n = 11; 15.5%) and IaA30R3 (n = 10; 14.1%). The observed species/subtypes of C. hominis and C. parvum indicated that the infection was mainly transmitted through the anthroponotic route. The identification of C. felis and C. meleagridis suggests that an atypical zoonotic transmission cycle also exists.

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Section: Discussionsupporting

confidence: 92%

Molecular characterization ofCryptosporidiumspp. from patients with diarrhoea in Lusaka, Zambia

et al. 2020

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“…Data collection was done in September-October, Zambia's hot and dry season. During this time of year, there is no rainfall and therefore, diarrhoea prevalence is generally low [13,22]. As the point of understanding diarrhoea prevalence was to understand risk related to sanitation choices, assessing risk during low prevalence periods would give better revelations pertaining to sanitation choices.…”

Section: Household Wash Characteristics and Diarrhoea Prevalencementioning

confidence: 99%

The improved and the unimproved: Factors influencing sanitation and diarrhoea in a peri-urban settlement of Lusaka, Zambia

2020

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Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards allin-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.

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“…The most recent cholera outbreak in Zambia began in October 2017 and was concentrated in the peri-urban communities of Lusaka, starting in Chipata and spreading to Kanyama (Sladoje, 2018) as well as Garden, Ngombe, Mazyopa and Chazanga (IFRCRCS, 2018). The outbreak resulted in 5,414 cases and 98 deaths of Lusaka residents between October 4, 2017 and May 12, 2018 (Sinyange et al, 2018).…”

Section: Water Use and Water-borne Disease In Lusakamentioning

confidence: 99%

Drinking Water Quality and Provision in Six Low‐Income, Peri‐Urban Communities of Lusaka, Zambia

et al. 2020

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Lusaka, Zambia, is a rapidly growing city located on a vulnerable karstic dolomite aquifer that provides most of the city's drinking water. Over 65% of residents live in peri‐urban communities with inadequate sanitation leading to widespread groundwater contamination and the spread of waterborne diseases such as cholera. To fill the water service gap, Water Trusts were created: public/private partnerships designed to provide clean water to peri‐urban community residents. Water Trusts extract groundwater via boreholes, treat it with chlorine, and distribute it to residents via public kiosks. We investigated the efficacy of drinking water provision to residents in six of Lusaka's peri‐urban communities with Water Trusts. Water samples were collected from Water Trust boreholes and kiosks, privately owned boreholes, and shallow wells during four sampling efforts. To assess potential risk to human health, water samples were analyzed for Escherichia coli ( E. coli ) and nitrate. Shallow wells were significantly more contaminated with E. coli than Water Trust boreholes, kiosks, and private boreholes (Tukey‐adjusted p values of 9.9 × 10 −6 ). Shallow wells and private boreholes had significantly higher nitrate‐N concentrations (mean of 29.6 mg/L) than the Water Trust boreholes and kiosks (mean of 8.8 mg/L) ( p value = 1.1 × 10 −4 ). In 2016, a questionnaire was distributed to Water Trust managers to assess their ability to meet demands. In the six communities studied, Water Trusts served only about 60% of their residents. Water Trusts provide a much safer alternative to shallow wells with respect to nitrate and E. coli , but they struggle to keep pace with growing demand.

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Cholera Epidemic — Lusaka, Zambia, October 2017–May 2018

Cited by 41 publications

References 6 publications

Molecular characterization ofCryptosporidiumspp. from patients with diarrhoea in Lusaka, Zambia

Molecular characterization ofCryptosporidiumspp. from patients with diarrhoea in Lusaka, Zambia

The improved and the unimproved: Factors influencing sanitation and diarrhoea in a peri-urban settlement of Lusaka, Zambia

Drinking Water Quality and Provision in Six Low‐Income, Peri‐Urban Communities of Lusaka, Zambia

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