Zambia was an early adopter of insecticide-treated nets strategy in 2001, and policy for mass distribution with long-lasting insecticidal nets (LLINs) in 2005. Since then, the country has implemented mass distribution supplemented with routine delivery through antenatal care and under five clinics in health facilities. The national targets of universal (100%) coverage and 80% utilization of LLINs have not been attained. Free mass LLIN distribution campaign in Zambia offers important lessons to inform future campaigns in the African region. This study reviewed LLIN free mass distribution campaign information derived from Zambia’s national and World Health Organization Global Malaria Programme annual reports and strategic plans published between 2001 and 2016. In 2014, a nationwide mass distribution campaign in Zambia delivered all the 6.0 million LLINs in 6 out of 10 provinces in 4 months between June and September before the onset of the rainy season. Compared with 235,800 LLINs and 2.9 million LLINs distributed on a rolling basis in 2008 and 2013, respectively, the 2014 mass campaign, which distributed 6 million LLINs represented the largest one-time-nationwide LLIN distribution in Zambia. The province (Luapula) with highest malaria transmission, mostly with rural settings recorded 98–100% sleeping spaces in homes covered with LLINs. The percentage of households owning at least 1 LLIN increased from 50.9% in 2006 to 77.7% in 2015. The 2014 mass campaign involved a coordinated response with substantial investments into macro (central) and micro (district) level planning, capacity building, tracking and logistics management supported by a new non-health sector partnership landscape. Coordination of LLIN distribution and logistics benefited from the mobile phone technology to transmit “real time” data on commodity tracking that facilitated timely delivery to districts. Free mass distribution of LLINs policy was adopted in 2005 in Zambia. Consistently implemented, has not only contributed to increased coverage of LLINs, but has also produced the added value and lessons of strengthening joint planning, strategic coordination, partnerships with non-health sector institutions and community engagement with traditional leaders at community. Furthermore, the mass distribution, through improving coverage has indirect added (spin-off) value or impact on other arthropod-borne diseases, in addition to malaria.

Malaria is among the top causes of mortality and morbidity in Zambia. Efforts to control, prevent, and eliminate it have been intensified in the past two decades which has contributed to reductions in malaria prevalence and under-five mortality. However, there was a 21% upsurge in malaria prevalence between 2010 and 2015. Zambia is one of the only 13 countries to record an increase in malaria among 91 countries monitored by the World Health Organization in 2015. This study investigated the upsurge by decomposition of drivers of malaria. The study used secondary data from three waves of nationally representative cross-sectional surveys on key malaria indicators conducted in 2010, 2012 and 2015. Using multivariable logistic regression, determinants of malaria prevalence were identified and then marginal effects of each determinant were derived. The marginal effects were then combined with changes in coverage rates of determinants between 2010 and 2015 to obtain the magnitude of how much each variable contributed to the change in the malaria prevalence. The odds ratio of malaria for those who slept under an insecticide-treated net (ITN) was 0.90 (95% CI 0.77–0.97), indoor residual spraying (IRS) was 0.66 (95% CI 0.49–0.89), urban residence was 0.23 (95% CI 0.15–0.37), standard house was 0.40 (95% CI 0.35–0.71) and age group 12–59 Months against those below 12 months was 4.04 (95% CI 2.80–5.81). Decomposition of prevalence changes by determinants showed that IRS reduced malaria prevalence by − 0.3% and ITNs by − 0.2% however, these reductions were overridden by increases in prevalence due to increases in the proportion of more at-risk children aged 12–59 months by + 2.3% and rural residents by + 2.2%. The increases in interventions, such as ITNs and IRS, were shown to have contributed to malaria reduction in 2015; however, changes in demographics such as increases in the proportion of more at risk groups among under-five children and rural residents may have overridden the impact of these interventions and resulted in an overall increase. The upsurge in malaria in 2015 compared to 2010 may not have been due to weaknesses in programme interventions but due to increases in more at-risk children and rural residents compared to 2010. The apparent increase in rural residents in the sample population may not have been a true reflection of the population structure but due to oversampling in rural areas which was not fully adjusted for. The increase in malaria prevalence may therefore have been overestimated.

Background and Aim: Listeria monocytogenes in ready-to-eat (RTE) foods remains consistently under-reported globally. Nevertheless, several independent studies conducted to investigate have elucidated the prevalence and antibiotic resistance profiles of L. monocytogenes in RTE-associated foods and their antibiotic resistance profiles. Given the rapid increase in consumption of RTE foods of both animal and plant origin, it is imperative to know the prevalence deductive data focusing on how much of L. monocytogenes is present in RTE foods, which is critical for food safety managers and retailers to assess the possible risk posed to end-users. In addition, valuable insight and another angle to the depth of the problem, we conducted a systematic review and meta-analysis to synthesize available data regarding the prevalence of L. monocytogenes in RTE foods and antibiotic resistance profiles. Materials and Methods: We conducted a meta-analysis study of L. monocytogenes and antibiotic resistance to clinically relevant antibiotics to determine the extent of L. monocytogenes contamination in RTE foods and antibiotic resistance profiles. The primary search terms, also known as keywords used, were restricted to peer-reviewed and review articles, and databases, including Google Scholars, Science-Direct, and Scopus, were searched. The inclusion of articles meeting eligibility criteria published between 2010 and 2020 after title, abstract, and full article screening. Data analysis was performed at multiple stages using quantitative meta-analysis reviews. Results: L. monocytogenes pooled proportion/prevalence was highest in chicken products determined at (22%) followed by various but uncategorized RTE foods at 21%. Regarding antibiotic resistance, profiling's highest pooled prevalence resistance was observed in penicillin at 80% resistance, followed by cephalosporin at 47%. Conclusion: Within its limitations, this study has attempted to provide insight into the pooled proportion/prevalence of L. monocytogenes in RTE foods and the antibiotic resistance profile at the global level. Determining the proportion/ prevalence of L. monocytogenes in RTE foods across the globe and antibiotic resistance profile is essential for providing quality food and reducing public health problems due to unsuccessful treatment of foodborne illness. This study provides insight into the pooled prevalence of L. monocytogenes in RTE foods and the antibiotic resistance profile. The results of this study partly endeavored to help appropriate authorities strengthen their preventive measures on specific RTE foods that are most likely to be contaminated with L. monocytogenes and antibiotic resistance profiles.

Objective Since introduction of the programme in April 2021, COVID-19 vaccine uptake has been low at less than 20%. This study explored community members’ and health workers’ perspectives on the COVID-19 vaccine uptake and its influencing factors in Zambia. Study design A qualitative study employing focus group discussions (FGDs) and in-depth interviews (IDIs). Study setting Sixteen primary healthcare facilities selected from Lusaka, Copperbelt, Central and Southern provinces. Participants A total of 32 FGDs comprising local community members and 30 IDIs including health workers, traditional, religious and civic leaders (n=272). FGDs were separated based on age (youth and adults), sex (male and female) and place of residence (urban and rural). Results Both FGD and IDI participants agreed that vaccine uptake was low. Limited knowledge, access to information, myths and misconceptions, negative attitude, low-risk perception and supply in remote areas affected vaccine uptake. Overall, FGD participants expressed limited knowledge about the COVID-19 vaccine compared with health workers. Further, FGD participants from urban sites were more aware about the vaccine than those from rural areas. Health workers perceived the vaccine to be beneficial; the benefits included prevention of infection and limiting the severity of the disease. Moreover, FGD participants from urban sites expressed a negative attitude towards the vaccine. They believed the vaccine conferred no benefits. By contrast, participants from rural communities had mixed views; they needed more information about the vaccine benefits. Participants’ attitude seems to have been influenced by personal or family experience with the COVID-19 disease or vaccination; those who had experienced the disease had a more positive attitude. In contrast, most young people believed they were not at risk of the COVID-19 disease. Misinformation from social media influenced their attitude. Conclusion These results provide starting points for future policies and interventions for increasing COVID-19 vaccine uptake.

Objective To explore the health professionals’ and community members’ perspectives on the factors influencing transmission of the novel COVID-19 in Zambia. Design An exploratory qualitative study using in-depth interviews as data collection technique. Setting Four primary healthcare facilities and local communities of Lusaka city and Chirundu international border town under Lusaka province, Zambia. Participants Purposive sampling of 60 study participants comprising health professionals (n=15) and community members (n=45). Health staff were health inspectors and surveillance officers. Community members included public market traders, civic and religious leaders, immigration officers, bus and international truck drivers. Results Both health professionals and community members were aware of the COVID-19 pandemic, the preventive and control measures. Nevertheless, stark differences were observed on the two groups’ perspectives on COVID-19 and the factors influencing its transmission. Most health staff expressed high personal risk and susceptibility to the disease and a positive attitude towards the prevention and control measures. Conversely, myths and misconceptions influenced most community members’ perspectives on the disease and their attitude towards the COVID-19 guidelines. Participants were unanimous on the low levels of adherence to the COVID-19 preventive and control measures in the community. Reasons for non-adherence included limited information on COVID-19, negative attitude towards COVID-19 guidelines, social movement and travel patterns, networks and interactions, living and work conditions, water and sanitation facilities, and observation of behaviours of important role models such as politicians and other community leaders. These factors were perceived to increase the risk of COVID-19 transmission. Conclusion These findings highlight important factors influencing transmission of COVID-19 in Zambia. Future interventions should focus on providing information to mitigate myths and misconceptions, increasing people’s risk perception to the disease, and improving attitude towards the prevention and control interventions and mitigating structural and socioeconomic barriers.

The fight against malaria is currently ongoing in many countries where the disease is still endemic. The overall target is to eliminate malaria in all nations, regardless of their malaria burden, by 2030. Currently, the disease has been eliminated mainly in low-burden and unstable malaria areas globally. However, in high-burden countries, particularly in Africa, the disease is still not eliminated; some countries are even recording increases in incidence. This paper discusses why the disease is currently being eliminated in some countries and not in others using a historical and geo-economic perspective. It identifies gaps in the primary contemporary interventions in high endemic areas, particularly in rural constituencies where incidence of the disease is even higher. The key discussion point is that poor housing and behavioral patterns predispose rural dwellers to more malaria. Other risk factors include agricultural occupations, livestock keeping, and the fact that mosquito vectors in Africa thrive more in rural than urban areas. Combating malaria in rural African areas, therefore, requires radical transformative action to address the unique situations that currently enable the persistence of malaria beyond the contemporary, mainly indoor, and health facility-based interventions. Improving housing structures in rural Africa, which are mainly mud and thatched huts, to at least insect-proof standards is the recommended transformative action. Moreover, behavioral patterns, such as cooking outdoors in the evenings, must be modified to cooking in improvised insect-proof kitchens.