Operational Research to Support Rapid Evidence-Based Responses to Outbreaks: Learnings from COVID-19.

During the COVID-19 pandemic, the need for making testing readily available was recognized as an important factor for individuals to help make informed decisions, including to isolate or seek care, and for policymakers to control transmission. Toward this end, FIND and the Access to COVID-19 Tools Accelerator funded 16 rapid operational research studies and one implementation project in Africa, the Caribbean, and Asia evaluating the utility, acceptability, and feasibility of different community-based SARS-CoV-2 testing approaches. Here, we discuss common factors and challenges encountered during study implementation.

Impact of macroeconomic indicators and regime change on debt stress in Zambia.

This paper quantifies the economic impact of regime changes and macroeconomic indicators on debt stress in Zambia using the Autoregressive Distributed Lag (ARDL) Bounds test. A 1% short run increase in gross domestic products (GDP) increases debt stress by 3.16% and in the subsequent year lowers it by 7.

Determinants of COVID-19 vaccine acceptance and hesitancy among adolescents and youths aged 10-35 years in sub-Saharan African countries: A systematic review and meta-analysis.

The COVID-19 pandemic has overwhelmed health systems, especially in sub-Saharan African countries. Vaccination is one of the easily accessible interventions that can help reduce the burden on the health system. However, vaccination coverage remains low in sub-Saharan African countries.

Adherence, Adverse Events and Viral Control among Children and Adolescents with HIV in Zambia Switched to an Integrase Inhibitor Regimen.

Background: Based on recent World Health Organization recommendations, there has been a large-scale transition in Sub-Saharan Africa to integrase inhibitor (II)-based antiretroviral therapy (ART) regimens.

Setting: This study was conducted at an urban referral center in Lusaka, Zambia.

Methods: This study included 297 children and adolescents with HIV (CAWH) on ART for one year prior to enrollment and followed for 1-4 years after enrollment.

Causes of Pediatric Deaths in Lusaka, Zambia: A Quantitative Geographic Information Systems Approach.

Background: While childhood mortality has been declining in Zambia, it remains high at 58 per 1000 live births. Importantly, many leading causes of mortality in Zambia are preventable. This study was conducted to identify clusters of childhood mortality, causes of death of recently deceased children, barriers to care, and risk factors for mortality in Lusaka, Zambia.

Executive Function and Adherence in Children and Adolescents Living with HIV: Evidence from the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) Study.

Introduction: Executive function (EF) may be impaired in people with human immunodeficiency virus (HIV) infection, and poor EF may affect medication adherence. However, there is little data on EF in children with HIV in sub-Saharan Africa.

Methods: 208 children/adolescents with perinatally acquired HIV and 208 HIV-exposed uninfected controls were recruited in Zambia for this prospective cohort study.

Cost-effectiveness of SARS-CoV-2 self-testing at routine gatherings to minimize community-level infections in lower-middle income countries: A mathematical modeling study.

Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited.

Community-Based Delivery and Administration of Sars-CoV-2 Antigen Rapid Diagnostic Tests: An Operational Research Study in Marketplaces in Malawi and Zambia.

To expand access to testing beyond public health facilities and to strengthen surveillance efforts for COVID-19, community testing using COVID-19 antigen-based rapid diagnostic tests (Ag-RDTs) was identified as a major area of focus in Malawi and Zambia. This research aimed to gather evidence on the feasibility and acceptability of community testing in marketplaces. A cross-sectional study with a mixed-methods design was conducted in marketplaces in Malawi and Zambia to understand operational considerations for the implementation of Ag-RDTs for SARS-CoV-2 in a community setting.

Phenotypic divergence of (Diptera: Glossinidae) populations in Zambia: Application of landmark-based wing geometric morphometrics to discriminate population-level variation.

An important consequence of the discontinuous distribution of insect populations within their geographic range is phenotypic divergence. Detection of this divergence can be challenging when it occurs through subtle shifts in morphological traits with complex geometries, such as insect wing venation. Here, we used landmark-based wing geometric morphometrics to investigate the population-level phenotypic variation of the two subspecies of , Machado and Westwood that occur in Zambia.

Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study.

Background: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia's prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa.

Co-occurrence of contagious caprine pleuropneumonia and pasteurellosis in goats of sub-Saharan region: systematic review.

The reported incidences of co-participation of Mycoplasma capricolum capripneumoniae (Mccp) and Pasteurella multocida in increased severity and pathogenesis of goats with Contagious caprine pleuropneumonia (CCPP) in sub-Saharan Africa elicited the study's purpose. Using the preferred reporting items for systematic review and meta-analysis (PRISMA) guideline, two search engines, namely Google Scholar and PubMed, were queried to systematically review all the available literature on the current epidemiological status of CCPP and Pneumonic Pasteurellosis co-concurrently detected in goats and assess the available treatment and control measures and their challenges in the Sub-Saharan region. The search was limited to papers published between 1998 and 2024, whereby only peer-reviewed English articles were included in the study.

Including the voice of children <15-years-old in paediatric global health research.

Purpose Of Review: Despite evidence of the benefits of including children's voices in global health research, they continue to be underrepresented. Implementation of how to include children's voices appears to remain an obstacle to their inclusion in global health research. In this manuscript, we present an epistemological frame that advocates children as experts of their own experiences and knowledge-bearers.

Combination of serological and cytokine release assays for improved diagnosis of childhood tuberculosis in Zambia (PROMISE-TB).

Objectives: The diagnostic gaps for childhood tuberculosis (TB) remain considerable in settings with high TB incidence and resource constraints. We established and evaluated the performance of a scoring system based on a combination of serological tests and T-cell cytokine release assays, chosen for their ability to detect immune responses indicative of TB, in a context of high prevalence of pediatric HIV infection.

Methods: We enrolled 628 consecutive children aged ≤15 years, admitted for TB suspicion.

The Ambiguous Correlation of with Obesity: A Systematic Review.

Obesity is a complex and multifactorial disease with global epidemic proportions, posing significant health and economic challenges. Whilst diet and lifestyle are well-established contributors to the pathogenesis, the gut microbiota's role in obesity development is increasingly recognized. , as one of the major intestinal bacteria of the Firmicutes phylum, is reported with both potential probiotic properties and causal factors for obesity in different studies, making its role controversial.

Evaluation of Anopheline Diversity and Abundance across Outdoor Collection Schemes Utilizing CDC Light Traps in Nchelenge District, Zambia.

In the global fight against malaria, standard vector control methods such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs) are intended to protect inside residential structures and sleeping spaces. However, these methods can still leave individuals vulnerable to residual transmission from vectors that they may be exposed to outdoors. Nchelenge District in northern Zambia experiences persistently high malaria transmission even with ITNs and IRS in place.

Using best-worst scaling to inform policy decisions in Africa: a literature review.

Background: Stakeholder engagement in policy decision-making is critical to inform required trade-offs, especially in low-and-middle income settings, such as many African countries. Discrete-choice experiments are now commonly used to engage stakeholders in policy decisions, but other methods such as best-worst scaling (BWS), a theory-driven prioritization technique, could be equally important. We sought to document and explore applications of BWS to assess stakeholder priorities in the African context to bring attention to BWS as a method and to assess how and why it is being used to inform policy.

An assessment of excess mortality during the COVID-19 pandemic, a retrospective post-mortem surveillance in 12 districts - Zambia, 2020-2022.

Background: The number of COVID-19 deaths reported in Zambia (N = 4069) is most likely an underestimate due to limited testing, incomplete death registration and inability to account for indirect deaths due to socioeconomic disruption during the pandemic. We sought to assess excess mortality during the COVID-19 pandemic in Zambia.

Methods: We conducted a retrospective analysis of monthly-death-counts (2017-2022) and individual-daily-deaths (2020-2022) of all reported health facility and community deaths at district referral health facility mortuaries in 12 districts in Zambia.

Rapid fabrication of polyoxometalate-enhanced photo responsive films from ethyl cellulose (EC) and polyvinylpyrrolidone (PVP).

Ethyl cellulose (EC), polyvinylpyrrolidone (PVP), and phosphomolybdic acid (PMoA) were the components of a new photochromic hybrid film composed of heteropoly acids (abbreviated EC-PVP/PMoA), created by solvent evaporation. The EC-PVP/PMoA mechanism, visible light photochromic behaviors, and microstructure were closely studied by transmission electron microscopy (TEM), atomic force microscopy (AFM), ultraviolet-visible (UV-visible) spectroscopy, X-ray photo electronics (XPS), and Fourier transmission infrared spectroscopy (FTIR). FTIR spectra show that neither the core structures of EC, PVP, nor the Keggin structure of PMoA in the EC-PVP/PMoA composite hybrid film were damaged during fabrication.

Navigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia.

Introduction: Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW).

Highly virulent avian brood-parasitic species show elevated embryonic metabolic rates at specific incubation stages compared to less virulent and non-parasitic species.

As the avian embryo grows and develops within the egg, its metabolic rate gradually increases. Obligate avian brood-parasitic birds lay their eggs in the nests of other species to avoid the costs of parental care, and all but one of these brood-parasitic species are altricial at hatching. Yet the chicks of some altricial brood-parasitic species perform the physically demanding task of evicting, stabbing or otherwise killing host progeny within days of hatching.

Characteristics of inpatient and outpatient respiratory syncytial virus mortality in Gavi-eligible countries.

The current understanding of the RSV-related mortality age distribution in low- and lower-middle-income countries (LMICs) relies on a limited number of disease incidence studies reporting wide age bands, and lacking specificity to Gavi-eligible countries. Understanding the age distribution of RSV-related deaths is crucial for the implementation of RSV interventions in LMICs that rely on support from Gavi. This study aims to provide the age profile of RSV mortality specifically in Gavi-eligible countries.