Background Depression and anxiety are leading causes of disability globally, yet national epidemiological evidence from Zambia remains scarce. This study estimated the prevalence of depression and/or anxiety among Zambian adults, identified individual and community-level factors associated with these conditions, and quantified the contribution of community-level clustering to outcome variation. Methods We conducted a secondary cross-sectional analysis of the 2024 Zambia Demographic and Health Survey (ZDHS), which included 26,536 adults aged 15–59 years. Probable depression was defined as a PHQ-9 score ≥ 10 and probable anxiety as a GAD-7 score ≥ 6; a binary composite outcome was positive if either threshold was met. Bivariate associations were tested using Rao–Scott adjusted chi-square tests. Two-level random-intercept multilevel logistic regression models were fitted with survey clusters as the grouping factor, and results are reported as adjusted odds ratios (AORs) with 95% confidence intervals. Results The overall prevalence of depression and/or anxiety was 8.2% (95% CI: 7.8–8.6%), rising with age from 4.2% (15–19 years) to 11.5% (40–44 years). Prevalence was notably higher among daily alcohol consumers (35.5%), women who experienced sexual violence (16.7% vs. 8.2%; p < 0.001), and those widowed, divorced, or separated (12.5%), with provincial prevalence ranging from 3.3% (North-Western) to 14.4% (Copperbelt). In the full multilevel model, daily alcohol consumption (AOR: 3.74, 95% CI: 2.25–6.21), HIV-positive status (AOR: 1.71, 95% CI: 1.30–2.26), and older age (AOR 40–44: 2.56, 95% CI: 1.99–3.28) were the strongest risk factors, while female sex (AOR: 0.70) and being married (AOR: 0.85) were protective. The ICC of 0.116 (MOR: 1.87) indicated meaningful community-level clustering that remained largely unexplained after full adjustment (ICC: 0.113; LRT χ²=247.64, p < 0.001). Conclusion Approximately one in twelve Zambian adults experiences depression and/or anxiety, with burden concentrated among older adults, people living with HIV, heavy alcohol users, survivors of sexual violence, and those who have experienced marital dissolution. Substantial and largely unexplained community-level clustering points to structural and contextual determinants beyond individual risk factors. These findings support integrating mental health screening into HIV care and chronic disease platforms, prioritising task-sharing models to expand coverage, and directing resources toward high-burden provinces.

BackgroundAnemia remains a major global health crisis, affecting over 500 million women of reproductive age, with high burdens in resource-limited regions like Sub-Saharan Africa. Despite ongoing interventions such as iron supplementation programs, 49% of women of reproductive age in Zambia are anemic. Thus, the purpose of this study was to establish the national and subnational prevalence of anemia and identify its determinants among women of reproductive age in Zambia.MethodsData were drawn from the 2018 Zambia Demographic and Health Survey (ZDHS), a nationally representative survey employing a stratified two-stage cluster sampling design across 545 enumeration areas. A multilevel mixed-effects logistic regression model was used to identify individual- and community-level factors associated with anemia among women aged 15-49 years (n = 13,055). Four hierarchical models were constructed (null, individual-level, community-level, and full) to assess fixed and random effects, with model selection guided by Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) criteria. Spatial analysis was conducted using Quantum Geographic Information System (QGIS), incorporating displaced GPS coordinates in accordance with Demographic Health Survey (DHS) protocols. All analyses applied sampling weights and assessed multicollinearity (Variance Inflation Factor -VIFs < 5).ResultsThe national prevalence of anemia among women of reproductive age was 31% (95% Confidence Interval [CI]: 29-33%), with the highest rates observed in Western (38%) and Lusaka (36%) provinces, and the lowest in Central Province (24%). In adjusted analyses, pregnancy (Adjusted Odds Ratio [AOR] = 1.76; 95% CI: 1.52-2.03), Human Immunodeficiency Virus (HIV) positivity (AOR = 2.21; 95% CI: 1.97-2.49), and breastfeeding (AOR = 1.15; 95% CI: 1.02-1.30) were significantly associated with increased odds of anemia. Conversely, being married (AOR = 0.78; 95% CI: 0.68-0.90) and age 25-29 years (AOR = 0.84; 95% CI: 0.71-0.97) were protective. Spatial mapping identified Western Province as a high-burden hotspot. Community-level variance was notable (Intraclass Correlation Coefficient [ICC] = 6%, Median Odds Ratio [MOR] = 1.52), with 5% residual clustering persisting after adjusting for both individual and contextual factors, suggesting the influence of unmeasured ecological determinants.ConclusionAnemia remains a significant public health issue among Zambian women of reproductive age, shaped by both individual- and community-level factors. These findings highlight the need for integrated, targeted interventions focusing on high-risk groups in high-prevalence areas. Strengthening clinical services and implementing community-based strategies to address healthcare access and environmental determinants are essential to reducing the burden of anemia in Zambia.

Abstract Background Non-communicable diseases (NCDs) account for approximately 75% of global deaths, with 79% occurring in low- and middle-income countries. Tobacco use remains a major modifiable risk factor, contributing to more than 8 million deaths annually. In Zambia, evidence on tobacco use among individuals with hypertension, diabetes mellitus, and cardiovascular disease remains limited. This study assessed the prevalence and determinants of tobacco use among adults with NCDs in Zambia. Methods We conducted a secondary analysis of the 2017 Zambia STEPS survey. The analytic sample included 716 adults aged 18–69 years with self-reported hypertension, diabetes, and/or cardiovascular disease. Tobacco use was defined as current smoking or smokeless tobacco use. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs), accounting for the complex survey design. Results Among 716 participants, 65.5% had hypertension, 7.7% diabetes, and 26.8% cardiovascular disease; 89.5% had multimorbidity. The overall prevalence of tobacco use was 12.2%. Prevalence was 12.2% among those with hypertension, 5.5% among those with diabetes, and 14.1% among those with cardiovascular disease. Tobacco use was significantly higher among males. Female sex was associated with lower odds of tobacco use (AOR = 0.16, 95% CI: 0.05–0.54, p = 0.004). Secondary education (AOR = 0.15, 95% CI: 0.03–0.66) and higher education (AOR = 0.04, 95% CI: 0.01–0.44) were protective. Alcohol consumption increased the odds of tobacco use (AOR = 5.23, 95% CI: 1.17–23.28). Conclusion Tobacco use remains common among adults with NCDs in Zambia. Integration of tobacco cessation interventions into routine NCD care is urgently needed.

Abstract Background Anemia is a condition characterized by nutritional deficiencies and blood disorders, predominantly affecting children aged 6 to 59 months and women of reproductive age, especially in low and middle-income countries. In Zambia, anemia is a public health problem. This study aims to assess the spatial patterns and determine factors associated with anemia severity in Zambia over six years (2018 to 2024). Method The study included a total of 19,362 WRA from the two waves of the ZDHS, 2018 and 2024. The ZDHS is a periodic national survey that uses multistage sampling. We adopted an analytical cross-sectional design, and the three-level multivariable ordinal logistic regression model was used to identify variables (individual, household, and community level) associated with anemia severity. Global Moran’s I, Local Moran’s I, and Getis-Ord Gi* statistics were used to determine the hotspots and spatial patterns, while spatial scan statistics were used to detect primary and secondary clusters and their distribution over the two cycles. Results The prevalence of anemia among women of reproductive age in Zambia was 31.0% (n=3,946) and 30.4% (n=2,015) in 2018 and 2024, respectively. The factors associated with higher odds of anemia severity were HIV status (HIV-positive: AOR=2.63, 95% CI:2.25,3.09), pregnancy (AOR=1.96, 95% CI:1.67,2.31), and rural residency (AOR=1.21, 95% CI:1.08,1.35). While being in a union was protective compared to never being in a union (AOR=0.66, 95% CI:0.57,0.77), not having financial barriers for medical assistance was equally protective. Spatial analysis showed geographic disparities and a non-random distribution of anemia (Global Moran’s I, 2018: I=0.147, p<0.001; 2024: I=0.130, p<0.001). the Hotspot analysis depicted an expansion of high-risk areas Western in 2018 to the North-Western and Luapula in 2024. Spatial scan analysis identified the south-west region (Western, Southern and North-Western) as the significant primary cluster of anemia consistently for both waves. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: National Health Research Authority Lot No. 18961/M in Chalala, off Kasama Road Lusaka Email: znhrasec{at}nhra.org.zm www.nhra.org.zm I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying the results presented in the study are available from https://dhsprogram.com/

Emerging but limited evidence suggests that HIV infection does not affect in-hospital COVID-19 mortality, regardless of the prevalence of HIV infection in most parts of sub-Saharan Africa, especially the southern Africa region, and Zambia, Lusaka District in particular, is not an exception. Therefore, this study aimed to determine the effect of HIV infection, demographics, and clinical factors on mortality among hospitalized COVID-19 patients at Levy Mwanawasa University Teaching Hospital (LMUTH). A cross-sectional study was conducted with a sample size of 698 adults admitted for COVID-19 at LMUTH from 18 March 2020 to 31 December 2021. For all statistical analysis of data, STATA statistical software, version 15 MP (College Station, TX 77845, USA) was used—ensuring that appropriate statistical techniques were applied to the data. Unadjusted and adjusted logistic regressions were conducted to model COVID-19 mortality among COVID-19 patients based on their HIV status while controlling for five predictor variables. Based on the results, the best predictors of in-hospital COVID-19 mortality were HIV status, number of comorbidities, age in years, smoking, and alcohol intake. The results suggest that COVID-19 mortality among those with HIV and those without HIV infection was different. People living with HIV infection had increased odds of COVID-19 mortality compared to those without HIV. The results further suggested that a unit increase in age was associated with increased odds of COVID-19 mortality. Furthermore, drinking alcohol and having two or more comorbidities increased the odds of COVID-19 mortality compared to not drinking alcohol, having no comorbidity, or having a comorbidity. This study, therefore, concludes that HIV infection has a significant effect on COVID-19 mortality among patients hospitalized at LMUTH and that the proportion of COVID-19 mortality in the HIV-infected group is relatively higher than in the uninfected group. Therefore, there is a need for close monitoring of COVID-19 patients with HIV infection.

Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use and adherence to the World Health Organization (WHO) prescribing indicators at the Request Muntanga Hospital in the Kalomo District of Southern Province, Zambia. Materials and Methods: This cross-sectional study was conducted from July 2023 to September 2023 at Request Muntanga Hospital in Zambia and reviewed 600 medical record prescriptions which were issued from July 1, 2022 to June 30, 2023 using the WHO prescribing indicators. The collected data were analyzed using Statistical Package for Social Sciences version 23.0. Results: From the 600 prescriptions sampled, 1246 medicines were prescribed, with antibiotics making up 86.7% of the encounters. Additionally, the average number of drugs prescribed per encounter was 2.1 and the prevalence of polypharmacy was 61.3%. Further, 17.8% of medicines were prescribed as injectables. Furthermore, 76.7% of the drugs were prescribed from the Zambia Essential Medicines List and 38.9% by generic names. Conclusions: This study found a high use of antibiotics and deviations from the WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators at the Request Muntanga Hospital indicating non-adherence to the prescribing indicators. There is a need to promote adherence to the WHO/INRUD core prescribing indicators to promote the rational use of antibiotics and prevent the emergence and spread of AMR.

Abstract Introduction For decades large-scale zinc and lead mining was performed in Kabwe, Zambia. The area is heavily polluted with toxic lead dust from the past, but still today uncovered tailing hills contaminate the near-by housing areas. This exposure is a specific hazard for children. The objective is to share information of lead related health hazards in Kabwe. Methods A cross-sectional study was performed in 2020 to 2021 with 11,196 children. Blood lead levels and clinical data were assessed. Results WHO considers blood lead level 5 µg/dL as levels of concern and at levels above 45 µg/dL a medical treatment is indicated. Latest figures for Kabwe show that in townships close to the mining area 95% of the children exceed the level of concern and 15% of the children perceived treatment. Clinical parameters are just evaluated and will be presented. Discussion The results of former lead studies in Kabwe and this study proved that lead exposure is a serious health hazard for children. Conclusions The main problem remains - the lead emissions continue. The reasons for this failure are multiple and need to be discussed on the background of poverty, industry liabilities, good governance, and externalization of global pollution. Kabwe is not unique, there are many lead contaminated sites globally. Lead as a toxic substance demands more political attention and willingness to act to protect the health of each child.

BackgroundThere is persistent pressure on countries with a high burden of HIV infection to reach desired targets for HIV treatment outcomes. This has led to moving from the “one-size-fits-all” model to differentiated service delivery (DSD) models, which are meant to be more patient-centered and efficient but without compromising on the quality of patient care. However, for DSD models to be efficient, facilities should have indicators of HIV services available and ready to provide the DSD models. We aimed to assess the availability of HIV service indicators and the readiness of facilities to provide DSD models for HIV treatment in selected public health facilities in Zambia.MethodsWe conducted a nationwide cross-sectional survey among public health facilities in Zambia that provide antiretroviral therapy (ART) services. We used an interviewer-administered questionnaire based on a World Health Organization (WHO) Service Availability Readiness Assessment (SARA) tool to assess the availability of HIV service indicators and the readiness of facilities to implement DSD models for HIV treatment. Availability and readiness were considered latent constructs, and therefore, we used structural equation modeling (SEM) to determine the correlations between them and their respective indicators.ResultsOf 60 public health ART facilities, the overall availability of HIV service indicators was 80.0% (48/60), and readiness to provide the DSD models was 81.7% (48/60). However, only 48 and 39% of the facilities had all indicators of availability and readiness, respectively. Retention in care for HIV multidisciplinary teams was more likely to occur in urban areas than in rural areas. SEM showed that the standardized estimate between availability and readiness was significantly and positively correlated (r = 0.73, p < 0.0001). In addition, both availability and readiness were significantly and positively correlated with most of their respective indicators.ConclusionAlthough most facilities had available HIV service indicators and were ready to provide DSD models, most facilities did not have all indicators of availability and readiness. In addition, there were differences between rural and urban facilities in some indicators. There is a need for persistent and heightened efforts meant to implement DSD in HIV treatment, especially in rural areas to accelerate reaching the desired HIV treatment outcomes.

This article discusses the challenges of decentralising climate governance in the Global South in the context of intensifying climate change. Using qualitative methods of data collection and analysis, we interviewed a total of 112 participants who participated in the study, including traditional leaders, ward councillors, subject-matter experts, government officials and members of the public who took part in focus group discussions. Our results show that devolution, delegation, deconcentration and privatisation have been used as strategies for decentralising climate action in the Itezhi-Tezhi District. However, these methods of decentralisation are affected by several factors, including unclear rules for elected and appointed leaders, which influence the devolution of decision-making responsibilities at the local government level. Regarding delegation, decentralising climate governance is affected by inadequate public participation, particularly in the design and execution of climate initiatives in the Kafue wetlands. Furthermore, this article shows that deconcentration is likely to affect climate governance because the national government has not deconcentrated the units for climate governance from the line ministry to the local authority. Privatisation, which has been an effective way of decentralising climate governance in the Kafue wetlands, has also been problematic due to inadequate community participation. These challenges and opportunities serve as lessons for building resilience in effective decentralised climate governance in the Kafue wetlands. This article adds to the ongoing discourse on the efficacy of decentralising climate governance in the Global South and offers valuable insights for future research in this genre of academic inquiry in Sub-Saharan Africa.

Chest X-rays (CXRs) have traditionally been used to aid the diagnosis of TB-suggestive abnormalities. Using Computer-Aided Detection (CAD) algorithms, TB risk is quantified to assist with diagnostics. However, CXRs capture all other structural abnormalities. Identification of non-TB abnormalities in individuals with CXRs that have high CAD scores but don’t have bacteriologically confirmed TB is unknown. This presents a missed opportunity of extending novel CAD systems’ potential to simultaneously provide information on other non-TB abnormalities alongside TB. This study aimed to characterize and estimate the prevalence of non-TB abnormalities on digital CXRs with high CAD4TB scores from a TB prevalence survey in Zambia and South Africa. This was a cross-sectional analysis of clinical data of participants from the TREATS TB prevalence survey conducted in 21 communities in Zambia and South Africa. The study included individuals aged ≥ 15 years who had high CAD4TB scores (score ≥ 70), but had no bacteriologically confirmed TB in any of the samples submitted, were not on TB treatment, and had no history of TB. Two consultant radiologists reviewed the images for non-TB abnormalities. Of the 525 CXRs reviewed, 46.7

The burden of schistosomiasis in Zambia has remained high over the years. The World Health Assembly recommended adequate mass drug administration coverage for schistosomiasis using Praziquantel chemotherapy for school-aged children and all at-risks adults. We aimed at investigating the coverage and the factors associated to the uptake for MDA for schistosomiasis in Ng'ombe township of Lusaka, Zambia. A cross-sectional survey was conducted in May and June 2021 via phone calls to the residents of Ng'ombe township. Commcare software was used in the conduct of the survey. Pearson's Chi-square test and multiple logistic regression were conducted using the STATA version 15.0. 769 study participants were randomly selected using systematic sampling, of which 76.3% were younger than 40 years, 64.9% were female, 64.4% were married, 56.3% had reached the secondary educational level and 51.9% were employed. Coverage for MDA for schistosomiasis in Ng'ombe township in 2018 was found to be 49.8% (95% CI: 46.2%–53.4%). Positive predictors of the MDA were prior knowledge of the occurrence of the MDA in 2018 (aOR: 2.892, p < 0.001) and believing that the provision of incentives like snacks was important during the MDA with PZQ in Ng'ombe township (aOR: 1.926, p = 0.001), whereas age (aOR:0.979, p = 0.009), marital status (aOR:0.620, p = 0.006), employment status (aOR:0.587, p = 0.001) were negative predictors of the MDA. Elimination of the burden of schistosomiasis in endemic settings needs the attainment of an optimum coverage and uptake during MDA with PZQ. Therefore, prior knowledge about an impending intervention and the provision of incentives like snacks during the intervention should be prioritized by MDA implementers, while background characteristics such as age, marital status, and employment status need to be taken into consideration when planning and promoting uptake in future MDAs.

Transmission dynamics and the maintenance of mammarenaviruses in nature are poorly understood. Using metagenomic next-generation sequencing (mNGS) and RT-PCR, we investigated the presence of mammarenaviruses and co-infecting helminths in various tissues of 182 Mastomys natalensis rodents and 68 other small mammals in riverine and non-riverine habitats in Zambia. The Luna virus (LUAV) genome was the only mammarenavirus detected (7.7%; 14/182) from M. natalensis. Only one rodent from the non-riverine habitat was positive, while all six foetuses from one pregnant rodent carried LUAV. LUAV-specific mNGS reads were 24-fold higher in semen than in other tissues from males. Phylogenetically, the viruses were closely related to each other within the LUAV clade. Helminth infections were found in 11.5% (21/182) of M. natalensis. LUAV–helminth co-infections were observed in 50% (7/14) of virus-positive rodents. Juvenility (OR = 9.4; p = 0.018; 95% CI: 1.47–59.84), nematodes (OR = 15.5; p = 0.001; 95% CI: 3.11–76.70), cestodes (OR = 10.8; p = 0.025; 95% CI: 1.35–86.77), and being male (OR = 4.6; p = 0.036; 95% CI: 1.10–18.90) were associated with increased odds of LUAV RNA detection. The role of possible sexual and/or congenital transmission in the epidemiology of LUAV infections in rodents requires further study, along with the implications of possible helminth co-infection.

Background: Communities around Kabwe/Zambia are exposed to lead due to deposits from an old lead (Pb) and zinc (Zn) mining site. Children are particularly more vulnerable than adults, presenting with greatest risk of health complications because of their increased oral uptake due to their hand to mouth activities. Spatial analysis of childhood lead exposure is useful in identifying specific areas with highest risk of pollution. The objective of the current study was to use a geospatial approach investigate spatial clustering and hotspots of blood lead levels in children within Kabwe. Methods We analysed data on blood lead levels (BLL) for 363 children below the age of 15 from Kabwe town. We used spatial autocorrelation methods involving the global Morans I and local Getis-Ord Gi statistic in ArcMap 10.5.1, to test for spatial dependency among the blood lead levels in children. Results BLL in children from Kabwe are spatially autocorrelated with a Morans Index of 0.62 (p<0.001). We found distinct hot spots in communities close to the old lead and zinc-mining site, lying on its western side. We observed lower levels of BLL in areas distant to the mine and located at its eastern side. This pattern suggests a possible association between BLL and distance from the abandoned lead and zinc mine, and prevailing winds. Conclusion Using geocoded data, we found clustering of childhood blood lead and identified distinct hot spot areas with particular high lead levels for Kabwe town. The geospatial approach used is especially valuable in resource- constrained settings like Zambia, where the precise identification of the locations of risk areas allows to initiate targeted remedial and treatment programs. Keywords: Spatial cluster, Geospatial, blood lead, hot spots, Morans I

The 2021 Lancet Countdown gives a code red for health, as people's health worldwide is increasingly affected by climate change.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google Scholar Trends of environmental degradation and existing health and social inequalities are continuously worsening.The African continent is highly vulnerable to climate change and its related risks. For example, although 2020 marked an alarmingly warm year globally, ranking between the third and eighth warmest year on record,2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar Africa is heating up more and at a faster rate than the global mean.One reason that Africa is particularly vulnerable to climate variability and change is because of the substantial contribution of agriculture to most African economies. For example, almost half of the sub-Saharan African population lives below the poverty line and depends on weather-sensitive activities, such as rain-fed agriculture, herding, and fishing, for their livelihoods.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar These activities are threatened as climate change continues to increase the frequency, intensity, and duration of extreme weather events that affect food productivity and water security.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google ScholarUndermined food security poses risks to millions of lives in Africa. Compared with the previous year, food insecurity increased by 40% in 2020 and increases by 5–20 percentage points with each flood or drought.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar The Horn of Africa is particularly affected by recurrent extreme droughts.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google ScholarExtreme weather events, such as floods, droughts, and storms, not only affect food security but also contribute to internal and cross-border displacement. In 2020, around 12% of all new population displace­ments happened in east Africa and the Horn of Africa, with more than 1·2 million displacements related to disasters.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar These regions are already struggling with conflict and food insecurity, and displacement related to climate change functions as a multiplier of these issues.In addition to climate vulnerability, Africa's adaptive capacity to climate change is considered to be low. Initiatives are largely isolated, autonomous, and reactive to short-term motivation, such as the promotion of drought-resistant crop varieties, solar-powered irrigation schemes, and environmentally friendly heating mechanisms.3Niang I Ruppel OC Abdrabo MA et al.Africa.https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap22_FINAL.pdfDate: 2014Date accessed: September 22, 2022Google Scholar Incomplete, under-resourced, and fragmented institutional frame­works further inhibit the progress of policy implementation.3Niang I Ruppel OC Abdrabo MA et al.Africa.https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap22_FINAL.pdfDate: 2014Date accessed: September 22, 2022Google ScholarAlthough this narrative of Africa's vulnerability to and low adaptive capacity for climate change has a degree of truth, it is only part of the story. The dominant global narratives tend to overlook the solutions and innovations coming from Africa. As part of our activities with the Planetary Health Eastern Africa Hub, we encounter many such solutions. For example communities in the urban townships of Lusaka, Zambia, are supporting the use of environmentally friendly and renewable sources of energy for cooking and heating. Their initiative aims to provide a sustainable source of energy through the production and use of improved cook stoves based on saw dust pellets. The use of saw dust pellets reduces pressure on wood fuel (ie, charcoal), which has greatly contributed to unsustainable forest harvesting. The communities are motivated to drive the project forwards through local solutions in an effort to contribute to the reduction of greenhouse gas emissions. At the national level, the Zambian Government has committed to combat the climate crisis through the development of the National Policy on Climate Change, pledging to reduce greenhouse gas emissions by 25% by 2030, relative to 2010 levels.4Lee S Paavola J Dessai S Towards a deeper understanding of barriers to national climate change adaptation policy: a systematic review.Clim Risk Manag. 2022; 35100414Google ScholarIn Kenya, the indigenous communities of Lake Bogoria have shown autonomous adaptive measures to severe flooding.5Puzyreva M Roy D Adaptive and inclusive watershed management: assessing policy and institutional support in Kenya.https://www.iisd.org/system/files/publications/adaptive-inclusive-watershed-management-kenya.pdfDate: August, 2018Date accessed: September 21, 2022Google Scholar Their efforts include awareness and educational programmes on vector-borne diseases, the initiation of natural mosquito and tsetse fly control mechanisms, and the protection of endangered medicinal plants. Community members have further shifted to increased income diversification and resilient food production techniques to counter increasing food insecurity. Formulation, publishing, and implementation of the Kenya National Adaptation Plan 2015–2030 and the Kenya Climate Change Act 2016 and the development of Kenya's second climate change action plan, the National Climate Change Action Plan 2018–2022, together with other strategies and plans related to climate change, continue to guide Kenya's response in adapting to the impact of climate change and reducing greenhouse gas emissions.6Ministry of Environment and ForestryNational climate change adaptation plan 2018–2022.https://www.environment.go.ke/wp-content/uploads/2020/03/NCCAP_2018-2022_ExecutiveSummary-Compressed-1.pdfDate: Aug 17, 2018Date accessed: August 17, 2018Google Scholar In 2020, Kenya revised its commitment on the contribution to abate greenhouse gas emissions by 30% by 2030 by setting out priority actions to reduce greenhouse gas emissions. These actions included policies, programmes, and technologies that would help to drive the country to low carbon emissions.7Asokan SM Obando J Kwena BF Luwesi CN Climate change adaptation through sustainable water resources management in Kenya: challenges and opportunities.https://link.springer.com/referenceworkentry/10.1007/978-3-030-45106-6_148Date: May 21, 2021Date accessed: September 21, 2022Google ScholarAlthough the east African region has made substantial progress in its commitments to address the climate crisis, particularly among local and indigenous communities, moving to implementation is a crucial step.8Jegede AO Human rights implications of the climate change regulatory framework on indigenous peoples' lands in Africa. University of Pretoria, 2014: 3-11Google Scholar Policies at the sector level are needed to meet these commitments. However, insufficient technical capacity to develop multisectoral transformative policy frameworks is a challenge. East Africa continues to face many climatic threats. Communities, policy makers, and government figures are starting to address the climate crisis.9Boyle AD Leggat G Morikawa L Pappas Y Stephens JC Green new deal proposals: comparing emerging transformational climate policies at multiple scales.Energy Res Soc Sci. 2021; 81102259Google Scholar As a result, there is an opportunity to enact policies and laws that increase local communities' adaptive capacity, promote sustainable development, and implement a long-term climate strategy.10Foxon TJ Reed MS Stringer LC Governing long-term social–ecological change: what can the adaptive management and transition management approaches learn from each other?.Environ Policy Gov. 2009; 19: 3-20Google ScholarWe declare no competing interests. The 2021 Lancet Countdown gives a code red for health, as people's health worldwide is increasingly affected by climate change.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google Scholar Trends of environmental degradation and existing health and social inequalities are continuously worsening. The African continent is highly vulnerable to climate change and its related risks. For example, although 2020 marked an alarmingly warm year globally, ranking between the third and eighth warmest year on record,2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar Africa is heating up more and at a faster rate than the global mean. One reason that Africa is particularly vulnerable to climate variability and change is because of the substantial contribution of agriculture to most African economies. For example, almost half of the sub-Saharan African population lives below the poverty line and depends on weather-sensitive activities, such as rain-fed agriculture, herding, and fishing, for their livelihoods.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar These activities are threatened as climate change continues to increase the frequency, intensity, and duration of extreme weather events that affect food productivity and water security.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google Scholar Undermined food security poses risks to millions of lives in Africa. Compared with the previous year, food insecurity increased by 40% in 2020 and increases by 5–20 percentage points with each flood or drought.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar The Horn of Africa is particularly affected by recurrent extreme droughts.1Romanello M McGushin A Di Napoli et al.The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.Lancet. 2021; 398: 1619-1662Google Scholar Extreme weather events, such as floods, droughts, and storms, not only affect food security but also contribute to internal and cross-border displacement. In 2020, around 12% of all new population displace­ments happened in east Africa and the Horn of Africa, with more than 1·2 million displacements related to disasters.2World Meteorological OrganizationState of the climate in Africa 2020.https://library.wmo.int/doc_num.php?explnum_id=10929Date: Nov 22, 2021Date accessed: November 22, 2021Google Scholar These regions are already struggling with conflict and food insecurity, and displacement related to climate change functions as a multiplier of these issues. In addition to climate vulnerability, Africa's adaptive capacity to climate change is considered to be low. Initiatives are largely isolated, autonomous, and reactive to short-term motivation, such as the promotion of drought-resistant crop varieties, solar-powered irrigation schemes, and environmentally friendly heating mechanisms.3Niang I Ruppel OC Abdrabo MA et al.Africa.https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap22_FINAL.pdfDate: 2014Date accessed: September 22, 2022Google Scholar Incomplete, under-resourced, and fragmented institutional frame­works further inhibit the progress of policy implementation.3Niang I Ruppel OC Abdrabo MA et al.Africa.https://www.ipcc.ch/site/assets/uploads/2018/02/WGIIAR5-Chap22_FINAL.pdfDate: 2014Date accessed: September 22, 2022Google Scholar Although this narrative of Africa's vulnerability to and low adaptive capacity for climate change has a degree of truth, it is only part of the story. The dominant global narratives tend to overlook the solutions and innovations coming from Africa. As part of our activities with the Planetary Health Eastern Africa Hub, we encounter many such solutions. For example communities in the urban townships of Lusaka, Zambia, are supporting the use of environmentally friendly and renewable sources of energy for cooking and heating. Their initiative aims to provide a sustainable source of energy through the production and use of improved cook stoves based on saw dust pellets. The use of saw dust pellets reduces pressure on wood fuel (ie, charcoal), which has greatly contributed to unsustainable forest harvesting. The communities are motivated to drive the project forwards through local solutions in an effort to contribute to the reduction of greenhouse gas emissions. At the national level, the Zambian Government has committed to combat the climate crisis through the development of the National Policy on Climate Change, pledging to reduce greenhouse gas emissions by 25% by 2030, relative to 2010 levels.4Lee S Paavola J Dessai S Towards a deeper understanding of barriers to national climate change adaptation policy: a systematic review.Clim Risk Manag. 2022; 35100414Google Scholar In Kenya, the indigenous communities of Lake Bogoria have shown autonomous adaptive measures to severe flooding.5Puzyreva M Roy D Adaptive and inclusive watershed management: assessing policy and institutional support in Kenya.https://www.iisd.org/system/files/publications/adaptive-inclusive-watershed-management-kenya.pdfDate: August, 2018Date accessed: September 21, 2022Google Scholar Their efforts include awareness and educational programmes on vector-borne diseases, the initiation of natural mosquito and tsetse fly control mechanisms, and the protection of endangered medicinal plants. Community members have further shifted to increased income diversification and resilient food production techniques to counter increasing food insecurity. Formulation, publishing, and implementation of the Kenya National Adaptation Plan 2015–2030 and the Kenya Climate Change Act 2016 and the development of Kenya's second climate change action plan, the National Climate Change Action Plan 2018–2022, together with other strategies and plans related to climate change, continue to guide Kenya's response in adapting to the impact of climate change and reducing greenhouse gas emissions.6Ministry of Environment and ForestryNational climate change adaptation plan 2018–2022.https://www.environment.go.ke/wp-content/uploads/2020/03/NCCAP_2018-2022_ExecutiveSummary-Compressed-1.pdfDate: Aug 17, 2018Date accessed: August 17, 2018Google Scholar In 2020, Kenya revised its commitment on the contribution to abate greenhouse gas emissions by 30% by 2030 by setting out priority actions to reduce greenhouse gas emissions. These actions included policies, programmes, and technologies that would help to drive the country to low carbon emissions.7Asokan SM Obando J Kwena BF Luwesi CN Climate change adaptation through sustainable water resources management in Kenya: challenges and opportunities.https://link.springer.com/referenceworkentry/10.1007/978-3-030-45106-6_148Date: May 21, 2021Date accessed: September 21, 2022Google Scholar Although the east African region has made substantial progress in its commitments to address the climate crisis, particularly among local and indigenous communities, moving to implementation is a crucial step.8Jegede AO Human rights implications of the climate change regulatory framework on indigenous peoples' lands in Africa. University of Pretoria, 2014: 3-11Google Scholar Policies at the sector level are needed to meet these commitments. However, insufficient technical capacity to develop multisectoral transformative policy frameworks is a challenge. East Africa continues to face many climatic threats. Communities, policy makers, and government figures are starting to address the climate crisis.9Boyle AD Leggat G Morikawa L Pappas Y Stephens JC Green new deal proposals: comparing emerging transformational climate policies at multiple scales.Energy Res Soc Sci. 2021; 81102259Google Scholar As a result, there is an opportunity to enact policies and laws that increase local communities' adaptive capacity, promote sustainable development, and implement a long-term climate strategy.10Foxon TJ Reed MS Stringer LC Governing long-term social–ecological change: what can the adaptive management and transition management approaches learn from each other?.Environ Policy Gov. 2009; 19: 3-20Google Scholar We declare no competing interests.

Many people in the world lack safe basic drinking water sources and rely on untreated water source. Packaged water can be considered as an alternative to other water sources if measures are put in place to ensure its safety for consumption. This study aimed to assess the bacteriological quality and heavy metal analysis of packaged water produced in Lusaka, Zambia and associated quality control measures. A cross-sectional study was conducted in May 2019 where 18 brands of packaged water were analyzed for total and fecal coliforms as well as concentrations of Lead, Chromium, and Cadmium. The study found that 33.5% of the packaged water produced in Lusaka did not comply with the standard for drinking water on bacteriological quality. We also found that the concentrations for Lead were <0.01 mg/l in all the 17 samples, thus compliant to WHO/ZABS standards. Concentrations of Chromium were between 0.002 and 0.62 mg/l and compliance to the standard was 11.8%. Concentrations for Cadmium were between 0.009 and 0.2 mg/l against the acceptable concentration of <0.003 mg/l. Most brands of the packaged water did not conform to the standards for drinking water.

Background The burden of child under-nutrition still remains a global challenge, with greater severity being faced by low- and middle-income countries, despite the strategies in the Sustainable Development Goals (SDGs). Globally, malnutrition is the one of the most important risk factors associated with illness and death, affecting hundreds of millions of pregnant women and young children. Sub-Saharan Africa is one of the regions in the world struggling with the burden of chronic malnutrition. The 2018 Zambia Demographic and Health Survey (ZDHS) report estimated that 35% of the children under five years of age are stunted. The objective of this study was to analyse the distribution, and associated factors of stunting in Zambia. Methods We analysed the relationships between socio-economic, and remote sensed characteristics and anthropometric outcomes in under five children, using Bayesian distributional regression. Georeferenced data was available for 25,852 children from two waves of the ZDHS, 31% observation were from the 2007 and 69% were from the 2013/14. We assessed the linear, non-linear and spatial effects of covariates on the height-for-age z-score. Results Stunting decreased between 2007 and 2013/14 from a mean z-score of 1.59 (credible interval (CI): -1.63; -1.55) to -1.47 (CI: -1.49; -1.44). We found a strong non-linear relationship for the education of the mother and the wealth of the household on the height-for-age z-score. Moreover, increasing levels of maternal education above the eighth grade were associated with a reduced variation of stunting. Our study finds that remote sensed covariates alone explain little of the variation of the height-for-age z-score, which highlights the importance to collect socio-economic characteristics, and to control for socio-economic characteristics of the individual and the household. Conclusions While stunting still remains unacceptably high in Zambia with remarkable regional inequalities, the decline is lagging behind goal two of the SDGs. This emphasises the need for policies that help to reduce the share of chronic malnourished children within Zambia.

Introduction: the focus of antiretroviral therapy (ART) in Zambia has been on HIV-1. However, some patients are infected with HIV-2 or both. HIV-2 is resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs), drugs used for HIV-1. Therefore, this study sought to determine the seroprevalence of HIV-2 or dual infection in HIV infected individuals and compare the treatment outcomes associated with HIV subtype in patients taking NNRTI-based first line cART at the University Teaching Hospitals (UTH). Methods: this was a cross- sectional study, we collected data from the Virological Impact of Switching from Efavirenz and Nevirapine based first-line cART regimens to Dolutegravir (VISEND) study being conducted at UTH. Ninety six individuals were included in the study. Descriptive and inferential statistics were performed. Logistic regression was used to assess the relationship between treatment outcomes and HIV type. Results: the proportion of HIV 1 and 2 co-infected patients was 5.2% (95% CI 2%-12%). The mean age was 46 years ± 2 years with 60 (62.5%) being females. The median viral load was 1.3 log 10 copies/ml, IQR 0-1.7 log 10 copies/ml and the median absolute CD4+ T cell count increased from 231 to 463 cells/mm3 (p < 0.001) after being on cART for one year or more. The study did not report any associations between treatment outcomes and HIV type (p > 0.05). Conclusion: there is a small proportion of patients that are HIV 1 and 2 co-infected but are on an NNRTI-based cART regimen, drugs that are not active against HIV-2. This, however, does not seem to significantly affect the patient´s virological or immunological treatment outcome.

Background: People living and working in ASGM areas are exposed to toxic metals such as arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb). Whereas Hg is purposely used to extract the gold from the ore, the other toxic metals can be liberated from the ore during the mining process. These metals can contaminate drinking water and food and are thus, a source of exposure for people living in these mining areas. However, there is limited to no data about the exposure to toxic metals of people living in ASGM areas. Therefore, the purpose of this study was to conduct biomonitoring of people identifying themselves as artisanal gold miners. Methods: Blood and urine were collected from 207 people living and working in two ASGM areas in Zimbabwe. Hg in whole blood and urine was analyzed by direct mercury analysis, Pb in blood as well as As and Cd in urine were analyzed by GF-AAS. The results were evaluated by descriptive analysis and correlated with the location, age, fish consumption, years living and working in the area. Results: Median As level in urine was 10.0 µg/l (range from below limit of detection to 460 µg/l). Median Cd level in urine was 0.3 µg/l (range from below limit of detection to 11.4 µg/l). Median Hg levels in blood / urine were 2.7 / 5.2 µg/l (range from 0.2 to 167 µg/l / 0.1 to 612 µg/l). Median Pb level in blood was 19.9 µg/l (range from 6.6 to 276 µg/l). As expected, the Hg levels were frequently above international reference values (e. g. NHANES, blood: 34%, urine: 69%). For Pb and Cd, a considerable number of participants (32% and 22% respectively) were above the reference values (NHANES / National Health and Nutrition Examination Survey) and for As 33% of the participants were above the reference value (UBA/ German Environment Agency). Conclusions: Hg levels were, as expected in ASGM areas, mainly above reference and threshold values. A high proportion of As, Cd and Pb levels were also above reference levels. Therefore, the exposure to toxic metals in the two ASGM areas in Zimbabwe is relevant for public health.

Abstract Malnutrition contributes to more than one third of all child deaths, although hardly listed as the direct cause. In sub-Saharan Africa, malnutrition accounts for about 2% of deaths and 3% of Disability adjusted life years (DALYs) among under-5 children. In Zambia, 35% of under-5 children are stunted, 4% wasted, 12% underweight and 5% overweight. Malnutrition and HIV interact in complex ways that increase vulnerability to and worsen each condition therefore we sought to determine factors associated with malnutrition among under 5 children in Zambia. Using Stata version 14.2, we extracted and analysed sample data of 159 children aged 0-59 months from the 2016 ZAMPHIA population-based survey, that used a two-stage cluster sampling design. We used Generalised Linear Models to measure socio-economic factors associated with malnutrition. P-value of less than 0.05 was set as level of statistical significance. Factors associated with malnutrition included gender, child's HIV status and wealth index which showed an association with stunting, wasting and being underweight. The 16 (10%) under-5 children living with HIV were significantly more affected by stunting (38% vs 33%), wasting (19% vs 11%) and underweight prevalence (38% vs 10%) than the remaining 143 who were HIV negative. Our sample prevalence was similar to national stunting (33% vs 35%) and underweight prevalence (13% vs 12%) but had three times higher wasting prevalence (12% vs 4%). A high prevalence of malnutrition was found in HIV positive compared to negative under 5 children, wealth index showing an association with malnutrition. Eliminating malnutrition is key to attaining SDG 3 which is to end preventable deaths of newborns and children under 5 years of age. Key messages All types of malnutrition had a higher prevalence in HIV infected than uninfected under five children in Zambia. Wealth index is a socio-economic factor that is associated to all types of malnutrition in under-five children in Zambia.

Introduction Focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors. Methods We defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1st January to 31st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results We included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19). Conclusion Unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.