Lusaka Apex Medical University is a private university in Zambia. It was established in 2008 and has continued to provide the most modern way of learning medicine in the country.
Tuberculosis remains the leading cause of death from a single infectious agent globally. The WHO Global Tuberculosis Report 2025 indicates that progress towards the WHO End TB Strategy targets remains off track despite modest declines in incidence and mortality. In 2024, an estimated 10·7 million people developed tuberculosis and 1·23 million died from the disease. In this Series paper, we examine evidence published between Jan 6, 2020, and Jan 6, 2026, to provide an updated overview of tuberculosis vaccines and tuberculosis preventive treatment (TPT). As of June 4, 2026, 18 tuberculosis vaccine candidates are in active clinical development, including six in phase 3 (M72/AS01E, MTBVAC, VPM1002, GamTBvac, Immuvac [MIP], and BCG revaccination trials), representing the most diverse and advanced pipeline since the introduction of BCG in 1921. Platforms include live-attenuated mycobacterial vaccines (eg, MTBVAC), recombinant BCG-derived approaches (eg, VPM1002), protein-adjuvant subunit vaccines (eg, M72/AS01E), viral-vectored candidates (eg, AdHu5Ag85A, ChAdOx1.85A, and TB/FLU-04L), and inactivated whole-cell strategies (eg, DAR-901, RUTI, and Immuvac [MIP]). However, only a few candidates have progressed to late-stage efficacy evaluation. Short-course rifamycin-containing TPT regimens-1 month of daily isoniazid plus rifapentine, 3 months of once-weekly isoniazid plus rifapentine, 3 months of daily isoniazid plus rifampicin, and 4 months of daily rifampicin-show non-inferior efficacy and higher completion rates than 6-9 months of daily isoniazid monotherapy and are WHO-preferred options for drug-susceptible tuberculosis. In 2024, 5·3 million people at high risk of tuberculosis initiated TPT globally, including 3·5 million household contacts and 1·8 million people with HIV. For contacts of multidrug-resistant or rifampicin-resistant tuberculosis, randomised trials and pooled analyses support 6 months of daily levofloxacin to reduce incident multidrug-resistant tuberculosis. Bedaquiline-containing preventive regimens and shorter fluoroquinolone-based combinations are under clinical evaluation, but definitive phase 3 efficacy data are not yet available. The expansion of the vaccine pipeline alongside improved short-course preventive regimens offers a credible opportunity to accelerate tuberculosis incidence decline, although translation into population-level impact will depend on shown efficacy, sustained financing, reliable drug and vaccine supply, and effective implementation in high-burden settings.
BACKGROUND:Klebsiella pneumoniae is the leading cause of sepsis among neonates in low- and middle-income countries (LMICs) in Africa and Asia, contributing substantially to the overall burden of antimicrobial-resistant infections and mortality among neonates globally. Pathogen sequencing has been used to investigate case clusters and confirm nosocomial transmission in a small number of neonatal units. Here we utilise pathogen sequence data to estimate the fraction of K. pneumoniae neonatal sepsis attributable to nosocomial transmission in African and South Asian countries. METHODS AND FINDINGS:We estimated the proportion of invasive K. pneumoniae disease involved in nosocomial transmission clusters in a given neonatal unit, using single-linkage clustering based on pairwise temporal and genetic distances estimated from bacterial whole-genome sequences aggregated from 10 contributing studies. Analysing 1,523 K. pneumoniae isolates from 27 units in 13 countries in Africa and South Asia between 2013 and 2023, we inferred 156 nosocomial transmission clusters, ranging from 2 to 188 neonates each (83 of the clusters comprised ≥3 cases). Overall, we estimated that 1,035 neonatal infections (68.0%) were part of nosocomial transmission clusters. Excluding the first infection in each cluster as a potential index case, we estimate at least 879 (57.7%) infections were acquired via nosocomial transmission. Sensitivity analyses showed that results were robust to the choice of genetic distance estimation methods and thresholds used to define clusters, and cluster estimates were stable over temporal distance thresholds ranging from 2 to 8 weeks. Isolates were mostly extended-spectrum beta-lactamase (ESBL) producers (90.9%) and included 172 multi-locus sequence types (STs). Fourteen STs, including several globally recognised multidrug-resistant lineages, were associated with transmission clusters at multiple units, and these were collectively responsible for two-thirds of all infections. Carriage of carbapenemase genes (adjusted odds ratio, aOR = 2.08 [95% confidence interval, CI: 1.04, 4.14]; p = 0.04) and ESBL genes (aOR = 2.48 [95% CI: 1.26, 4.90]; p = 0.006) were significantly positively associated with transmission in a logistic regression model with site as a covariate. Limitations of this study include the lack of sufficient clinical data to allow high-resolution investigation of transmission dynamics and lack of facility-level data to investigate contributors to the observed differences in transmission burden across sites. CONCLUSIONS:Nosocomial transmission contributes to a substantial proportion of K. pneumoniae sepsis in neonatal care units in Africa and South Asia. Reducing transmission within these settings through improved infection prevention and control and other measures could substantially reduce the neonatal sepsis burden. A high burden of transmission clusters is associated with the same drug-resistant lineages that are recognised as high-risk clones associated with hospital outbreaks in high-income countries, indicating global connectivity of the antimicrobial-resistant pathogen population.
Klebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts.
Introduction: Scabies, a contagious skin infestation caused by Sarcoptes scabiei, remains a significant public health concern, particularly in resource-limited settings. Despite its widespread occurrence, limited evidence exists on its burden and determinants in Zambia, especially among children in rural areas. This study aimed to determine the prevalence of scabies and identify factors contributing to its outbreak among children in Kabanga Village, Samfya District, Zambia. Methods: A quantitative cross-sectional descriptive study was conducted among 255 caregivers selected through systematic random sampling (interval = 2). Data were collected using structured questionnaires and analysed using SPSS version 29. Descriptive and inferential statistics were performed, with Chi- square tests used to explore associations between scabies prevalence and potential determinants. Statistical significance was set at p ≤0.05. Results: Among participating children, 54% were female, and 60.6% were aged between 5 and 9 years. Most caregivers (65.2%) had completed primary education. The overall prevalence of scabies among children was 54.0% (95% CI: 47.1%–60.8%). Factors significantly associated with scabies occurrence included the child's age (p = 0.037), caregiver's education level (p = 0.043), household size (p = 0.043), contact with known scabies cases (p = 0.001), and bathing frequency. Common preventive practices included daily skin checks for rashes (89.3%), surface disinfection several times per week (54.5%), and waiting for symptoms to subside before seeking care (47.5%). Despite some preventive behaviours, inconsistent practices contributed to continued transmission. Conclusion: The high prevalence of scabies among children in Kabanga Village is strongly linked to social, behavioural, and environmental factors. Strengthening community education, promoting improved hygiene behaviours, and enhancing access to healthcare services are critical interventions to reduce scabies transmission and improve child health outcomes in rural Zambia.
Dietary diversity is an important indicator of diet quality and nutritional adequacy in children; however, evidence among school-aged children in Zambia remains limited. This cross-sectional study assessed dietary diversity and associated factors among 638 upper primary schoolchildren aged 9–18 years from 12 schools in Lusaka District, Zambia, between August and October 2022. Data were collected using a 24-hour dietary recall, the Food Choice Questionnaire, and anthropometric measurements, and were analyzed in Stata version 14 using descriptive statistics and chi square tests at a 95% confidence level. Overall, 384 participants (60.2%) had high dietary diversity, and 254 (39.8%) had low dietary diversity. All participants consumed staple foods, but the intake of other important food groups was lower, including vegetables (57.5%), legumes (51.3%), fruits (50.2%), and animal products (49.7%). Higher dietary diversity was significantly associated with male sex (p = 0.009) and private school attendance (p = 0.004). No significant associations were found between dietary diversity and the perceived importance of vitamins and minerals, maintaining health, being nutritious, protein, good for skin and teeth, or fiber. The majority of upper primary schoolchildren in Lusaka had high dietary diversity; however, a substantial proportion still had low dietary diversity, highlighting the need for targeted school- and community-based nutrition interventions.
