Strategy
How We Work
The centre has three scientific departments namely Public Health, Clinical Sciences and Biomedical Sciences. An administrative department exists to offer support to scientific activities.
MALARIA
Situation Analysis
Malaria is endemic in Zambia and is the leading public health problem. It accounts for more than 40% of out patient care and 30% of admissions in health facilities. Over the years, the work of the Centre in this area was concentrated on clinical trails of new drugs (e.g. Halofantrine, Mefloquine, Fansimef, Malarone and Arteether), epidemiology of disease (behavioral studies, cost-effectiveness of management practices, severe disease risk factors etc) and drug sensitivity studies (Chloroquine and Sulfadoxine- Pyrimethanmine). The Centre also supports the National Malaria Control Programme (NMCP) in undertaking in-service training of different categories of personnel in malaria case management, laboratory diagnosis, insecticide treated nets impregnation and re-impregnation and malaria epidemic preparedness and forecasting.
The evolution and spread of resistance to commonly used anti-malarial drugs and vector resistance to insecticides are major threats to malaria control today. The challenge, therefore, lies in refining existing tools and strategies, development and evaluation of new tools, technologies, herbal remedies and strategies for rolling back malaria in Zambia.
HIV/AIDS and STIs
Situation Analysis
The socio-economic impact of human immunodeficiency virus infections in Zambia is enormous because most affected individuals are the production base for the nation. Overall prevalence of infection is estimated at 20%, although it varies between urban and rural environment as well as general populations and high-risk groups. This high prevalence also seriously overburdens the health care system at all levels.
There is limited data on STI in Zambia. STIs account for 10% of all outpatient attendances in public health facilities. Some evidence has been generated that suggests an interaction between HIV and some STIs such as syphilis, chancroid, trichomoniasis and chlamydial infections. It is logical to conclude, therefore, that control of STIs will influence the incidence of HIV infection.
The TDRC has been involved in HIV/AIDS/STI projects since the beginning of the early 1980’s. The immunology laboratory has been instrumental in the development and evaluation of diagnostic tests and test kits in collaboration with industry. The rapid agglutination of diagnostic essay (Cappilus) for HIV 1 & 2 is the case in point. The Centre has also contributed to the establishment, functionality and supervision of a sentinel surveillance system for HIV infection in the country. These activities have resulted in the Centre being designated the status of a National Reference Laboratory for Quality Control and Quality Assurance by the Ministry of Health. Major research activities accomplished include studies on natural history of HIV infection, HIV Malaria interaction, population based survey to determine risk factors for spread of HIV and Phase 1 & 11 clinical trails of anti-retroviral drugs such as Zidovudine (AZT) and alpha-interferon immunotherapy.
TUBERCULOSIS
Situation Analysis
The evolution and spread of the HIV epidemic has exacerbated the incidence of tuberculosis worldwide. In Zambia, the incidence has increased from 100 cases per 100,000 population in 1984 to about 500 cases per100, 000 population in 1996. Local studies have shown that 70% of tuberculosis cases are also concurrently infected with HIV. In this area of work, the Centre has contributed in community based DOTs studies in collaboration with the Ndola DHMT; and supported the National Chest Diseases Laboratory in microscopic diagnosis and evaluation of sensitivity of anti-tuberculosis drugs. Although research capacity remains limited in this area, the recent establishment of PCR based molecular technology for detection of drug resistant Mycobacterium, has led to identification of new research areas. The major thrust, therefore, will be validation of molecular techniques for detection and surveillance of drug resistant strains for Mycobacterium tuberculosis. This will require capacity for TB culture.
DIARRHOEAL DISEASES
Situation Analysis
The estimated attack rate for diarrhoeal disease in the country is 1.74% per adult per year with relatively high incidence of 5.6 episodes per child per year. In Zambia, recurrent seasonal epidemics of waterborne diarrhoeal diseases especially cholera and dysentery have been occurring since 1991. To date, the work of the Centre has focused on prevalence studies, monitoring anti-microbial susceptibility, and intervention studies through evaluation of safe water technologies. The TDRC also supports the national diarrhoeal diseases control programme through training of laboratory personnel in diagnosis of diarrhoeal agents and epidemic preparedness and response.
The major challenge is the emerging persistence of diarrhoeal disease epidemics and appearance of drug resistant strains of cholera and dysentery. The new focus, therefore, will be to find ways of reducing morbidity and to strengthen laboratory capacity to carry out effective surveillance of existing and new diarrhoeal agents.
MICRONUTRIENT DEFICIENCY DISODERS
Situation Analysis
Micronutrient Deficiency Disoders (MDD) are a public health problem in Zambia. Malnutrition and infections are often associated with micronutrient deficiency. The prevalent deficiencies are vitamin A, iron and iodine. Other micronutrient deficiencies still need to be identified and defined. The most vulnerable groups are children under 5 years of age, women of childbearing age and more recently persons with HIV/AIDS.
Based on previous studies, it is estimated that 25-50% of children aged 0-59 months are vitamin A deficient (below 20ug/dl) and 15-20% of women are deficient (below 30ug/dl). There is very little information on vitamin A for persons infected with HIV particularly women of childbearing age. Further, prevalence of anaemia is as high as 50% and 30% in children and women of childbearing age, respectively. Iodine deficiency is estimated to affect 46-80% of school children but this tends to be focal and patchy in distribution.
Some measures have been instituted to control micronutrient deficiency disorders particularly for children in Zambia. These include vitamin A supplementation through capsule distribution during Expanded Programme on Immunization activities of the Ministry of Health and sugar fortification by industry. However, there is need to monitor and evaluate the impact such public health interventions have on urban and rural populations. There is also a felt need to identify most suitable local foods rich in iron, folate and vitamin A so that they can be promoted in a targeted manner. These challenges, therefore, calls for continuous assessment of foods, best ways of preparing them and development of ways of monitoring and evaluating the impact of large scale interventions.
SCHISTOSOMIASIS
Situation Analysis
Schistosomiasis distribution in Zambia tends to be patchy and focal in nature. Both S.mansoni and S.haematobium exist but the later seems to be the most wide-spread. Most work done by the Centre in this area aimed at determining distribution and morbidity associated with schistosomes have been carried out both in hospital and community settings. Use of questionnaires to identify high-risk groups for both infections has recently been completed. Results indicate that use of simple questionnaires administered to school children and teachers is of comparable sensitivity to urine dipsticks for determining blood and protein.
Major challenges include determining national distribution and morbidity associated with schistosomiasis, development of innovative tools/ways of identifying high-risk groups and delivery systems for targeted interventions. The data generated should be used to justify the place schistosomiasis on the national health agenda and lead to the formulation, development and implementation of a national programme for control of schistosomiasis.
TRYPANOSOMIASIS
Situation Analysis
African trypanosomiasis is one of the orphan diseases that could be socially and economically devastating where and when it occurs. In Zambia, some areas are denied of rapid and sustainable development because they are endemic of Trypanosome rhodesiense. However, over the years, the work of the Centre has defined and identified areas of endemicity, risk factors to human disease and development tools for rapid diagnosis, prevention and control of trypanosomiasis. In the process, the annual incidence of human disease has remained below 5 cases per 100,000 population in the northern Luangwa valley, which was epidemic, prone in the past.
In view of the above, the challenge now is to strengthen and sustain surveillance systems, and deployment of cost-effective tools in communities at risk. This will involve working closely with DHMTs