1

ZAMBIA’S JOURNAL ON PUBLIC HEALTH, DISEASE SURVEILLANCE, PREVENTION AND CONTROL

Email: editor.heathpress@znphi.co.zm

Website: http://znphi.co.zm/thehealthpress/

Suggested Citation: [Author Surname, Initial].[Article title].Health Press Zambia Bull 2019; 03(3):[inclusive page numbers].

The Health Press - Zambia is published by Zambia National Public Health Institute, Ministry of Health Zambia since Jan 31, 2017.

Address: Plot 13, Reedbuck Road, Kabulonga, Lusaka.

Editor-in-Chief:Ms Mazyanga L. MazabaManaging Editor:Dr Raymond HamoongaEditorial Team:Prof Paul KellyProf Seter SiziyaProf Mudenda HangómbeDr Jeremiah BandaDr Alwyn MwingaDr Victor MukonkaDr John S MoranCopy Editor:Melanie MchinziDesktop Publisher:Sylvester Luabeya

Issue 3Vol. 03

31 March 2019

ISSN 2520-4378

VOL 03ISSUE 11NOVEMBER 2019

ZAMBIA’S JOURNAL ON PUBLIC HEALTH, DISEASESURVEILLANCE, PREVENTION AND CONTROL

The Health Press - Zambia is published by Zambia National Public Health Institute, Ministry of Health Zambia SINCE JAN 31, 2017.ADDRESS: PLOT 13, REEDBUCK ROAD, KABULONGA, LUSAKA.

Editor-in-Chief:Ms Mazyanga L. MazabaManaging Editor:Dr Raymond HamoongaEditorial Team:Prof Paul KellyProf Seter SiziyaProf Mudenda HangómbeDr Jeremiah BandaDr Alwyn MwingaDr Victor MukonkaDr John S MoranCopy Editor:CompuScriptDesktop Publisher:Omar Chanshi

Email: editor.heathpress@znphi.co.zm

Website: http://znphi.co.zm/thehealthpress/

Suggested Citation:[Author Surname, Initial].[Article title].Health PressZambia Bull 2019; 03(11):[inclusive page numbers].

ANTIBIOTICS

TABLE OF CONTENTS

EDITORIALThe Peril Of Antimicrobial Resistance A Global Public Health Emergency 1Mazaba ML

PERSPECTIVEHypertension Policy Brief : Reduced Morbidity and Mortality Due to Hypertension 3Katemba BM, Mwango C, Nkaama JM, Chunga C

RESEARCH ARTICLESAwareness And Knowledge Of Glaucoma Among Eye Patients Attending The University Teaching Hospitals Eye Hospital 7Muma KIM, Zulu G, Mumba – Malisawa T, Nyalazi JIM, Chinama – Musonda L, Syakantu G.

SURVEILLANCE REPORTSIntegrated Disease Surveillance and Response (IDSR) 12Surveillance and Disease Intelligence Unit

Influenza Sentinel Surveillance Report 20National Influenza Center – Pathology and Microbiology Department,University Teaching Hospital, Virology Laboratory

THE PERIL OF ANTIMICROBIAL RESISTANCE A GLOBAL PUBLIC HEALTH EMERGENCY

EditorialBy : Zambia National Public Health Institute

Citation Style For This Article: Mantina HM. The Peril Of Antimicrobial Resistance A Global Public Health Emergency. Health Press Zambia Bull. 2019; 3(11); pp 1-2.

” Antimicrobial resistance (AMR) threat-ens the effective prevention and treat-ment of an ever-increasing range of in-fections caused by bacteria, parasites, viruses and fungi. AMR is an increasingly serious threat to global public health that requires action across all government sec-tors and society” according to the World Health Organisation report on February 15, 2018 [1].

Antibiotics historically were the greatest discovery in modern medicine providing a wide range of medical solutions to various infections caused by microbial organisms. However, over the recent years, resistance among infection causing organisms to the different antimicrobials used to treat them has been on the rise. This worrisome rise to dangerously high levels is as a result of overuse and misuse of antimicrobials in human and animal health; although most data available focuses on antibiotic resis-tance [1, 2].

1

Five years ago, Chajer and Ali stated that “Since antibiotics were first introduced into clinical practice some 80 years ago, microbes have been evolving ways to resist these drugs, but in recent years this problem of antimicrobial resistance (AMR) has been rapidly getting worse” [3].Recognising the problem of AMR, more-so antibiotic resistance (ABR), its cause and the best approaches in mitigating it, members states at the Sixty-Eighth World Health Assembly held in 2016, endorsed the Global Action Plan on Antimicrobial Resistance. They called for a dedicated global campaign to raise public awareness and understanding of antibiotic resistance [4]. Annually in November, many gov-ernments, health facilities, schools and communities across the globe celebrate an awareness campaign dubbed World Antibiotic Awareness Week (WAAW),

The Health Press Zambia (THP-Z) align-through which best practices to stall fur- ther public, health workers and policy

The Health Press Zambia (THP-Z) align-ing to the 2019 World Antibiotic Aware-ness Week theme of “The future of an-tibiotics depends on us all” supported awareness campaign activities in Zambia including the media awards, the debates among secondary and tertiary institu-tions, an awareness walk and various me-dia engagement. THP-Z encourages all governments, public and private institu-tions and individuals to take responsibility and be a part of the drive to mitigate anti-microbial resistance.

THP-Z also invites you to read beyond this editorial published in this issue; a policy brief on Hypertension: Reduce salt intake, Save a heart! Reduced Morbidity and Mor-tality Due to Hypertension, Awareness And Knowledge Of Glaucoma Among Eye Patients Attending The University Teach-ing Hospitals Eye Hospital, the November Influenza and IDSR reports. Enjoy!

LIST OF REFERENCES1. WHO. Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. 2018

2. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health.

2015;109(7):309–318.

3. Chhajer R, Ali N. Genetically modified organisms and visceral leishmaniasis. Front Immunol 2014;5:213.

4. WHO. Global Action Plan on Antimicrobial Resistance. https://www.who.int/antimicrobial-resistance/global-action-plan/

en/

2

REDUCED MORBIDITY AND MORTALITY DUE TO HYPERTENSION

PerspectiveBy : BM Katemba, C Mwango, JM. Nkaama, C ChungaMentors: D Mwansa, D Mushinge, KM BandaNational Health Research Authority

Citation Style For This Article: Katemba BM, Mwango C, Nkaama JM, Chunga C, . Reduced Morbidity and Mortality Due to Hy-pertension. Health Press Zambia Bull. 2019; 3(11); pp 3-6

Key Messages• Circulatory diseases are the third leading

cause of death in Zambia • Hypertension is a silent killer; most peo-

ple do not know they have it• Hypertension is non-curable but can be

controlled• In Zambia, hypertension accounts for the

highest proportion of deaths due to car-diovascular diseases

• On average, 670 people die every year due to hypertension in Zambia

• Reduced sodium intake can increase someone’s life expectancy by 5-6 years

• The consumption of sodium among Zam-bians is twice as high (9.5 grams) as the World Health Organization (WHO) rec-ommended (5 grams) per day

Problem StatementHypertension, also known as high or raised blood pressure, is a global public health issue. The condition rarely causes symptoms in the early stages and a lot of people go undiagnosed. Those who are diagnosed may not have access to treat-ment and may not be able to successfully control their illness overtime . It is cur-rently estimated that 34.8% of the adult population (18-69 years) in Zambia are living with hypertension . In 2016, hypertension accounted for 3.3% of all deaths in Zambia . Risk factors in-clude unhealthy diet, harmful use of alco-hol, lack of physical activity, excess weight and stress . Diet has been identified as one of the major contributing factors to hypertension in Zambia . Research has shown that excess consumption of sodi-um is associated with increased risk of hy-pertension and cardiovascular diseases. The 2017 Steps survey shows that Zam-bians consume an average of 9.5 grams of sodium/salt per day. This is nearly double the WHO recommended limit of 5 grams per day .

Reducing sodium intake has been iden-tified as one of the most cost-effective measures countries can take to reduce hy-pertension incidence and improve health outcomes in hypertensive patients yet Zambia is one of the countries that has no strategy on regulating sodium intake.

According to different studies done by WHO, the main source of consumed so-dium is processed foods and ready-made meals . With a great availability of pro-cessed foods in Zambia, regulating the amount of sodium in processed foods can prevent 2,716 deaths annually.

Policy Options1.Maintain status quoThe current status in Zambia is that there is no strategy to reduce sodium intake despite overwhelming evidence showing the benefit of sodium reduction on reduc-ing hypertension. Sodium consumption in Zambia is currently double WHO’s recommended daily intake. With the cur-rent status, 34.8% of the adult population in Zambia are living with hypertension . As of 2016, a total of 36,400 premature deaths were recorded as a result of NCD and 3.3% were as a result of hypertension .

2.Mandatory regulation of the amount of sodium in processed foods and labelling What: Pass legislation on regulating the amount of sodium in processed foods. Manufacturers and importers are com-pelled by law to adhere to set standards. Sodium levels in food will be checked to make sure that companies are complying with the standards.

Why: The main source of food in most countries is ‘processed food’ and ready-made meals . 70% of the consumed foods in Zambia is purchased and studies have further shown that 70% of the consumed sodium/salt comes from processed foods . Zambians consume 9.5 grams of sodi-um/salt per day and currently, 34.8% of the people in Zambia are living with hy-pertension . Sodium reduction at 2.0 to 2.3 grams per day significantly decreas-es the risk of cardiovascular diseases by 20% . According to literature, 15% reduc-tion in the sodium/salt intake translates to 3/1.4mm Hg drop in the average blood pressure in the adult population between a period of 8 years . Mandatory reduc-tion of sodium/salt addition in manufac-tured foods will reduce 70% of the daily consumed sodium/salt.

3

Feasibility: High. This policy option builds on government efforts to fight NCDs in the country. It will require a legal frame-work, sensitization of food manufacturers and enforcement officers to ensure that manufacturers adhere to the set stan-dards. 3.Voluntary collaboration with food man-ufactures to regulate the amount of sodi-um in processed foods

What: Engage food associations and food manufacturers to reduce the sodium content in their product portfolio. Manu-factures will voluntarily participate in the programme and will sign an agreement with the responsible ministry to commit to gradual and progressive reduction of sodium content in manufactured foods. In the event of noncompliance, the responsi-ble line ministry will issue a written notice in order to demand regularization. There will be no penalties for not conforming to the agreement.

Why: As established, 70% of the con-sumed sodium comes from processed and commercially prepared food. With this approach, it is expected that 62% of the manufacturers will comply to set sodium reduction standards and 2,039 deaths will be averted annually.Feasibility: High. To increase the feasibil-ity of this policy option, there is need to engage food manufacturers from the ini-tial stage of developing sodium reduction guidelines.

4.Health promotion and increased aware-ness of sodium intake via mass media and health care providers

What: Conduct Mass media awareness campaigns to raise consumer awareness and education on the dangers of unregu-lated sodium/salt intake.

Why: On average, 39% of households in Zambia have access to information through television or radio . Through this strategy, 53% (3,564,894) of people liv-ing in Zambia will be reached with cam-paign messages and it is expected that 59% (2,103,288) will adhere to sodium/salt reduction messages although only 2 g/day reduction in sodium/salt is expect-ed to be achieved by compliant volunteers .

Feasibility: High. This policy option builds on the already existing health promotion strategy that the ministry has adopted in tackling non-communicable diseases. This action will require behavior change and adherence of sodium/salt reduction messages by end users.

Policy OptionsBased on these findings, we can conclude that the mandatory regulation of sodium/salt uptake in processed foods is the most cost-effective method of curtailing hyper-tension in Zambia.

The findings indicate that this interven-tion would yield the highest number of lives saved (2,716) over a 10-year period. Furthermore, the intervention yields the lowest cost to save an additional life and has the lowest annual implementation cost per death averted relative to the sta-tus quo. The relatively greater health ben-efit from mandatory reduction of sodium/salt in manufactured foods compared to voluntary interventions is consistent with previous works and is not surprising giv-en the strong scientific basis for the effec-tiveness of public health laws in general.

•Firstly: Identification of all key stake-holders to ensure that the developed guidelines incorporate all stakeholders concerns•Secondly: MoH to work with (Nation-al Food and Drugs, ZABS, Manufacturer Association of Zambia) and other stake-holders to develop the first draft of the regulations•Thirdly: Engage Zambia Law Develop-ment Commission to develop the final draft of the regulations which will be sub-mitted to Ministry of Justice for adoption•Fourthly: Launch and enforcement of the regulations

4

5

LIST OF REFERENCES1. “Global_brief_hypertension.Pdf.”

2. “Zambia-NCD-STEPS-Survey-Report-2017 (1).Pdf.”

3. “2016 VITAL Statstics Report.Pdf.”

4. Franco OH, Peeters A, Bonneux L, de Laet C: Blood pressure in adulthood and life expectancy with cardiovascular disease in

men and women. Hypertension 2005, 46:280.

5. “ZMB_B3_NCDs Strategic Plan.Pdf.”

6. “Zambia-NCD-STEPS-Survey-Report-2017 (1).Pdf.”

7. “Policybrief34.Pdf.”

8. Trieu, K., Neal, B., Hawkes, C., Dunford, E., Campbell, N. C., RodriguezFernandez, R., Legetic, B., McLaren, L., Barberio, A. &

Webster, J. (2015). Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target.

PloS One, 10(7), e0130247. doi: 10.1371/journal.pone.0130247

9. “Global_brief_hypertension.Pdf.”

10. “Zambia-NCD-STEPS-Survey-Report-2017 (1).Pdf.”

11. “Zmb_en.Pdf.”

12. “2016 VITAL Statstics Report.Pdf.”

13. “Policybrief34.Pdf.”

14. Global Panel on Agriculture and Food Systems for Nutrition. (2016). Food systems and diets: Facing the challenges of the 21st

Century. London: Global Panel

15. https://www.cdc.gov/salt/pdfs/sodium_role_processed.pdf

16. “Zambia-NCD-STEPS-Survey-Report-2017 (1).Pdf.”

17.

18. Ha S. K. (2014). Dietary salt intake and hypertension. Electrolyte & blood pressure: E & BP, 12(1), 7–18. doi:10.5049/

EBP.2014.12.1.7

19. Sadler K, Nicholson S, Steer T, Gill V, Bates B, Tipping S, et al. National Diet & Nutrition Survey— Assessment of dietary sodi-

um in adults (aged 19 to 64 years) in England, 2011. Department of Health; 2011 [cited 2014 29 October]. Available: https://

www.gov.uk/government/uploads/system/ uploads/attachment_data/file/213420/Sodium-Survey-England-2011_Text_to-

DH_FINAL1.pdf.

20. He FJ, Pombo-Rodrigues S, MacGregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure,

stroke and ischaemic heart disease mortality. BMJ Open. 2014 April 1, 2014; 4(4).

21. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303397

22. 2018 National Survey on Access and Usage of Information and Communication Technologies by Households and Individuals

23. https://www.indexmundi.com/zambia/demographics_profile.html

24. https://www.lusakatimes.com/2016/05/11/local-manufacturers-told-improve-quality-products/

25. Hyseni, L., Elliot Green, A., Lloyd-Williams, F., O’Flaherty, M., Kypridemos, C., McGill, R., Capewell, S. (2016). P48 Systematic

review of dietary salt reduction policies: evidence for an “effectiveness hierarchy”? Journal of Epidemiology and Community

Health, 70(Suppl 1), A74.2–A75.doi:10.1136/jech-2016-208064.147

26. Cobiac LJ, Vos T, Veerman JL (2010) Cost-effectiveness of interventions to reduce dietary salt intake. Heart 96: 1920–1925.

doi: 10.1136/hrt.2010.199240 PMID: 21041845

6

LIST OF REFERENCES27. Collins M, Mason H, O’Flaherty M, Guzman-Castillo M, Critchley J, Capewell S. (2014) An economic evaluation of salt re-

duction policies to reduce coronary heart disease in England: a policy modeling study. Value Health 17: 517–524. doi: 10.1016/j.

jval.2014.03.1722 PMID: 25128044

28. Collins, M., Mason, H., O’Flaherty, M., Guzman-Castillo, M., Critchley, J., & Capewell, S. (2014). An Economic Evaluation of

Salt Reduction Policies to Reduce Coronary Heart Disease in England: A Policy Modeling Study. Value in Health, 17(5), 517–524.

doi:10.1016/j.jval.2014.03.1722

29. Moulton AD, Mercer SL, Popovic T, Briss PA, Goodman RA, Thombley ML, et al. (2009) The scientific basis for law as a public

health tool. Am J Public Health 99: 17–24. doi: 10.2105/AJPH.2007.130278 PMID: 19008510

30. Goodman RA, Moulton A, Matthews G, Shaw F, Kocher P, Mensah G, et al. (2006) Law and public health at CDC. MMWR

Morb Mortal Wkly Rep 55 Suppl 2: 29–33. PMID: 17183242

ABSTRACTAim: To assess the awareness and knowl-edge levels of glaucoma among eye pa-tients attending the University Teaching Hospitals Eye Hospital.Background: Awareness and knowledge on glaucoma can be vital in the fight against blindness due to glaucoma. Spread of knowledge regarding some well-recog-nized risk factors for glaucoma may en-courage more awareness. For instance, a risk factor such as a positive family history of glaucoma, raises awareness because it encourages a search for more information regarding the disease and its assessment.Methods: This was a cross section study to assess the awareness and knowledge levels of glaucoma. A total of 1714 partic-ipants aged 18 to 98 years were recruited for the study. Respondents “having heard of glaucoma” even before they were con-tacted/recruited for the study were de-fined as “aware” and respondents having some understanding of the glaucoma dis-ease were defined as “knowledgeable”.Results: 1625 (94.8%) subjects complet-ed a questionnaire that assessed their awareness and knowledge level of glau-coma. Overall 1,162 (71.5%; 95% CI: 70.7 – 73.9) participants were aware of glauco-ma and 899 (55.3%; 95% CI: 51.3 - 72.1) had some knowledge about glaucoma. Awareness of glaucoma was not statisti-cally significant in terms of age (P =0.43) and gender (P =0.87). Literate partic-ipants were four times more likely to be aware and seven times more likely to be knowledgeable than illiterate participants (P value < 0.001). The level of education had a significant association with both awareness and knowledge (p=0.001). In addition, participants who were related or known to glaucoma patients were more likely to be aware and knowledgeable than other participants (Odds ratio: 4.11; 95% CI: 2.12 – 5.45). Determinants of glauco-ma awareness and knowledge were high-er levels of education and family history of glaucoma.Conclusion: Awareness and knowledge

about glaucoma was fairly good among the eye patients attending the clinic at the University Teaching Hospitals Eye Hospital. Participants with lower levels of education were less aware and knew less about glaucoma than their counter-parts with higher education levels. The study findings stress the need for health education and eye health promotion for effective prevention of blindness due to glaucoma.Keywords: Awareness, glaucoma, knowl-edge

INTRODUCTIONOwing to the asymptomatic nature of glaucomatous progression, glaucoma may remain undetectable in most of the cases until it reaches an advanced stage [1]. This finding highlights the high burden of dis-ease despite the existence of many effec-tive treatments [1,2]. It is estimated that approximately 90% of glaucoma-related blindness is preventable with proper early treatment [3]. One of the most important and effective actions for early detection of glaucoma and its management may be raising public awareness and knowledge levels regarding the disease. Different levels of glaucoma awareness have been reported in different populations [4-9]. Published studies from developing coun-tries indicate low levels of awareness, [4-6] while those from developed countries suggests higher levels of awareness [7-9]. Spread of knowledge regarding some well-recognized risk factors for glaucoma may encourage more awareness. These include a positive family history of glauco-ma, which is associated with higher glau-coma awareness [5,7,10]. This is because the presence of this risk factor encourages a search for more information regarding the disease and its assessment. The rela-tives have been reported as an important source of information regarding glauco-ma [11]. However, a high awareness level does not indicate that the individual has complete knowledge regarding glaucoma or enough understanding of the disease.

For example, several studies indicate that most individuals do not have an accurate understanding of this disease despite be-ing aware of this disease [6-9]. Almost 40% of the study participants had inade-quate knowledge of glaucoma [11].In describing the changing dynamics re-garding HIV infection patterns in Zambia, Michelo et al. (2006) argues that “life-styles, cultural practices and communi-cation patterns may significantly differ by educational attainment. However, whenever change happens, it does most probably begin with the higher educated groups [12]. This could therefore explain the lower risk levels of glaucoma seen among higher educated groups. On the other hand, we are aware that there is no other study that has made this observa-tion on the association of education and prevalence of POAG, thereby this study endeavouring to do that.

MATERIALS AND METHODS Study area and populationA cross sectional survey of 1,714 partic-ipants aged 18 to 98 years old was con-ducted on POAG at the UTHs Eye Hos-pital in Lusaka, Zambia. The UTHs Eye Hospital is the national referral eye hospi-tal which provides ophthalmological sur-gical and clinical services. The UTHs’ Eye Hospital is estimated to cater for more than 21,000 clients annually for both rou-tine and morbidity driven health care. The clients that attend this clinic come from across the country and include both self- and system-referrals, representing all age groups and all ethnic groups. A systematic random sampling using 50% - time sampling was employed which meant that of the 220 (on average) eye patients seen in the outpatient eye clinic every month, 110 were to be picked to participate in the study. This translat-ed to a minimum 1320 participants to be recruited into the study for a period of twelve months. To cater for attrition and assuming a response rate of 80%, the sample size of the study pegged at 1,714

7

AWARENESS AND KNOWLEDGE OF GLAUCOMA AMONG EYE PATIENTS ATTENDING THE UNIVERSITY TEACHING HOSPITALS EYE HOSPITALResearch ArticleBy : K I M Muma1,3, G Zulu1, T Mumba – Malisawa1, J I M. Nyalazi1, L Chinama – Musonda2, G Syakantu3

1 University Teaching Hospitals Eye Hospital, Lusaka, Zambia

2Eye Department, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia

3School of Medicine and Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia

E-mail Addresses: Kangwa M. I. Muma: mkmuma@yahoo.com and drichengelo@gmail.com

Citation Style For This Article: Muma KIM, Zulu G, Mumba – Malisawa T, Nyalazi JIM, Chinama – Musonda L, Syakantu G. Awareness And Knowledge Of Glaucoma Among Eye Patients Attending The University Teaching Hospitals Eye Hospital. Health Press Zambia Bull. 2019; 3(11); pp 7-11.

participants. Only 1625 (94.8%) eye pa-tients consented to study participation of which 309 had glaucoma.

General awareness regarding glaucoma among patients was assessed using the following broad questions:i.If they had previously heard of glaucomaii.If they were aware of glaucoma running in familiesiii.If they knew about the role of intra ocu-lar pressure in causing glaucomaiv.If the visual loss due to glaucoma is ir-reversible or not and that it causes blind-nessv.If they were aware of any treatment mo-dalities available for glaucoma.

We defined “awareness” as having heard about the disease. Awareness was ac-cordingly classified. Having glaucoma knowledge was classified based on the other responses provided for the ques-tions above.

Ethical statementThe University of Zambia Biomedical Re-search Ethics Committee approved the study (reference number 013-08-12). Fur-ther approval was obtained from Ministry of Health of Zambia through the UTH.

RESULTSOf the 1,714 patients, 89 (5.2%) did not accept to be in the study due to various reasons. Therefore, a total of 1,625 people were screened giving a 94.8% response rate.

Table 1: Gender distribution of partici-pants; N = 1625

Most of the participants were females 871 (53.6%) versus 754 (46.4%) male partic-ipants (p=0.789), [Table 1]. The age range of participants was 20 to 98 years with a mean age being 51 years.

Table 2: Awareness of glaucoma; glau-coma patients vs non-glaucoma patients N=1625

Awareness was statistically different (p=0.033) between the glaucoma patient and the non-glaucoma one, Table 2.

Table 3: Knowledge of glaucoma; glau-coma patients vs non-glaucoma patients n=1625

A total of 1,162 (71.5%; 95% CI: 70.7 – 73.9) participants were aware of glauco-ma and 899 (55.3%; 95% CI: 51.3 - 72.1) had some knowledge about glaucoma (Tables 2 and 3). Awareness of glaucoma was not statisti-cally significant in terms of age (P =0.43) and gender (P =0.87). Literate partici-pants were four times more likely to be

aware and seven times more likely to be knowledgeable than illiterate participants (P value < 0.001). The level of education had a significant association with both awareness and knowledge (p=0.001). In addition, participants who were related or known to glaucoma patients were more likely to be aware and knowledgeable than other participants (Odds ratio: 4.11; 95%

CI: 2.12 – 5.45). A total of 199 (12.2%; 95% CI: 10.4 - 17.5) participants under-stood the risk of familial predisposition to

glaucoma. Awareness about the irrevers-ible nature of vision loss in glaucoma was noted in 331 (20.4%; 95% CI: 17.9 - 25.8) of the respondents. Five hundred and fif-ty-one (33.9%; 95% CI: 28.1 - 38.3) re-sponded that glaucoma could be treated

and 625 (38.5%; 95% CI: 37.2 - 40.4) new that glaucomatous eyes could be-come blind. Interestingly, 826 (50.8%; 95% CI: 44.7 – 56.7) of the respondents believed that glaucoma was the same as trachoma.One hundred and fifteen respondents (7.1%; 95% CI: 3.9 - 10.4) considered that screening could prevent glaucoma, but only 517 (31.8%; 95% CI: 27.9 – 36.1%) had undergone screening/consulted an ophthalmologist in the previous year. Source of information for 343. (21.1%; 95% CI: 17.4 – 24.7) participants was ‘word of mouth’ from family or friends. Another 1,031 (63.4%; 95% CI: 59.1 - 68.3) participants had received infor-mation from visiting hospitals, medical personnel, eye camps or other healthcare recourses. Mass media was source of in-formation for 251 (15.4%; 95% CI: 11.9 – 20.2) of the participants.No associations were found between gender and awareness or knowledge of glaucoma (p = 0.765) or age (p = 0.875). 258 (76.3%; 95% CI: 72.1 – 79.3) partic-ipants were aware of glaucoma and the

8

same number (258) of participants had some knowledge about glaucoma (Tables 1 and 2). There was a positive association between glaucoma awareness and educa-tion level (p<0.0001).

DISCUSSIONThe study looked at awareness and knowledge of glaucoma in patients with glaucoma and those without glaucoma. The process of behavior changes, which culminates in action and maintenance, requires awareness and knowledge as its starting point [13]. Glaucoma is a highly prevalent ocular disease with a natural course that ultimately leads to blindness as compliance with treatment may im-prove with excellent patient knowledge and awareness. It may also lead to aware-ness among the patients’ relatives and encourage them to participate in screen-ing programmes. Low levels of aware-ness of glaucoma highlight the need for public education regarding this disease. It was discovered that knowledge regard-ing this condition was insufficient in both the glaucoma patients and those without glaucoma. Early diagnosis and institution of treatment can result in reduction of visual impairment and blindness, as the main predictor of eventual blindness is a late presentation of the disease.

Awareness was defined as having heard about the disease. Our results indicate that 89.0% of patients with glaucoma and 67.4% of those without glaucoma were aware of glaucoma. The most striking result from our study is that only 89.0% of the cases (patients with) of glaucoma were aware of the disease. The glauco-ma knowledge was high (64.5%) in our study compared to studies from Australia and India who respectively reported that 29% and 40.6% of the participants had knowledge regarding glaucoma [14,15]. This difference with our study may be at-tributed to the slightly high literacy rate in the country which stands at 63.4% [16].There are some differences in aware-ness of glaucoma in different areas and nations. For instance, a study from Mel-bourne, Australia, reported awareness of glaucoma in 76% of the general popula-tion, while a population-based study from Nepal reported a very low (2.4%) level of glaucoma awareness [4,17]. In a study in Barbados, 51% of participants with glau-coma were unaware of their diagnosis compared to our study where 53.6% were

aware of their diagnosis [18]. The 71.5% observed level of glaucoma awareness in this study is consistent with the data in published reports from the United States, which indicate that 70–93% of partici-pants attending eye clinics have heard about glaucoma [7,19,20]. In another sur-vey from Australia, 93% of 3,654 adult study participants had awareness regard-ing glaucoma [14].

Costa et al. (2006) and associates as-sessed and compared awareness re-garding glaucoma in two groups of study participants. One group consisted of high level of educated American patients with glaucoma, while the other comprised low level of educated Brazilian patients with glaucoma. The authors found significant differences between these two groups and concluded that differences in edu-cational level lead to this disparity [21]. In this study, the high number of partic-ipants with secondary and tertiary ed-ucation may have led to the high rate of glaucoma awareness. This correlates well with national literacy levels which stands at over 60%.16 The findings of a study conducted by Gogate and colleagues from India are consistent with this idea. In that study, which found lower levels of glauco-ma awareness, most study participants were less educated [22]. Our results in-dicate that level of education is the stron-gest explanatory variable for glaucoma awareness.

In describing the changing dynamics re-garding HIV infection patterns in Zambia, Michelo et al. (2006) argues that “life-styles, cultural practices and communi-cation patterns may significantly differ by educational attainment. However, when-ever change happens, it does most proba-bly begin with the higher educated groups [12]. Therefore, the lower risk levels of glaucoma seen among higher educated groups may be a stage of progression. On the other hand, we are aware that there is no other study that has made this obser-vation on the association of education and prevalence of POAG, thereby calling for additional observational studies on this factor. In addition, the glaucoma patients should also be encouraged to persuade their relatives to seek glaucoma-screen-ing examinations. Certainly, this would lead to early diagnosis of the glaucoma in the relatives.

Patients who were unaware of their diag-nosis were most probably unaware of the possibility of glaucoma being a heritable disease. In this study, only 199 of 1,625 (12.2%) participants believed that a pos-itive family history was a risk factor for glaucoma. This may indicate the necessity of urgent action regarding patient knowl-edge of glaucoma and the need to provide patients with useful information regarding inheritance of glaucoma. Lack of aware-ness regarding heritability of glaucoma has been reported to vary from 21% to 68% [11,23]. Deokule and associates found that 41% of patients with glaucoma were aware of a risk for glaucoma in their family members, even though 45% of their fami-ly members were not screened for glauco-ma [24]. Therefore, providing information to patients with glaucoma regarding the heritability of glaucoma and necessity of screening of their family members is cru-cial. This would encourage patients to in-form their family members regarding the prognosis of glaucoma and their higher chance of being affected by this blinding disease compared to the general popu-lation. To achieve this, clinicians should periodically ask their patients about the awareness of their relatives regarding their diagnosis and whether their family members have participated in glaucoma screening examinations. The slightly low level of knowledge among the patients and non-patients highlights the impor-tance of education for enhancing overall knowledge of glaucoma. This knowledge may encourage these individuals to seek glaucoma-screening examinations and help reduce the number of severe cases of this blinding condition.

In a study from Germany, participants’ rel-atives were the main sources of informa-tion regarding glaucoma [25], while mass media was found to be the main source of information in a study from India [1]. In the current study, study participants de-clared that close acquaintances were their main source of information. Our observa-tions may be due to selection bias, as all of our study participants were hospital re-cruited. This should be considered when interpreting the results of our study.There are inconsistent findings regard-ing the relationship between gender and awareness of glaucoma. In a few studies from various countries, lack of glaucoma awareness was associated with male gen-der [13,26], while the opposite has been

9

reported in other studies [4,27]. Other studies found no gender differences as-sociated with knowledge or awareness of glaucoma [14,25,28]. This study equally found the same.

CONCLUSIONSThe awareness and knowledge levels of glaucoma were fairly low. These findings suggest that there is a need for health education in this Zambia population to increase their level of awareness and knowledge of glaucoma. Education level was found to be a predictor of knowledge and awareness of glaucoma. Inadequate knowledge in the general population may be an important cause for failure to detect glaucoma early and may result in blind-ness from the disease.

RECOMMENDATIONSCommunity sensitization and education would be an effective and feasible public health strategy to enhance knowledge and awareness of glaucoma, especially among individuals with a family history of the disease. This approach may ultimately reduce loss of vision due to glaucoma.As awareness about glaucoma can lead to early detection, a very important step in preventing glaucoma-related blind-ness; [29] similarly educating masses will cardinal in improving awareness. Fur-thermore, there is a need to identify inter-ventions that reinforce people’s attitude above the perceived level of awareness about glaucoma and to devise strategies that can influence behavior to the risk of blindness from glaucoma.

10

LIST OF REFERENCES1. Dandona R, Dandona L, John RK, McCarty CA, Rao GN. Awareness of eye diseases in an urban population in southern India.

Bull World Health Organ. 2001;79(2):96–102. Epub 2003 Sep 18. PubMed PMID: 11242828. [PMC free article] [PubMed]

[Google Scholar]

2. Quigley HA, Buhrmann RR, West SK, Isseme I, Scudder M, Oliva MS. Long term results of glaucoma surgery among partic-

ipants in an east African population survey. Br J Ophthalmol. 2000 ;84(8):860–4. PubMed PMID: 10906092. [PMC free

article][PubMed] [Google Scholar]

3. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262–

267. doi: 10.1136/bjo.2005.081224. [PMC free article] [PubMed] [Cross Ref]

4. Thapa SS, Berg RV, Khanal S, Paudyal I, Pandey P, Maharjan N, Twyana SN, Paudyal G, Gurung R, Ruit S, Rens GH. Prevalence

of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: the Bhaktapur

Glaucoma Study. BMC Ophthalmol. 2011;11:2. PubMed PMID: 21255382. [PMC free article] [PubMed] [Google Scholar]

5. Sathyamangalam RV, Paul PG, George R, Baskaran M, Hemamalini A, Madan RV, Augustian J, Prema R, Lingam V. Determi-

nants of glaucoma awareness and knowledge in urban Chennai. Indian J Ophthalmol. 2009 ;57(5):355–60. PubMed PMID:

19700873. [PMC free article] [PubMed] [Google Scholar]

6. Tenkir A, Solomon B, Deribew A. Glaucoma awareness among people attending ophthalmic outreach services in Southwestern

Ethiopia. BMC Ophthalmol. 2010 ;10:17. PubMed PMID: 20509877. [PMC free article] [PubMed] [Google Scholar]

7. Gasch AT, Wang P, Pasquale LR. Determinants of glaucoma awareness in a general eye clinic. Ophthalmology. 2000

;107(2):303–8. PubMed PMID: 10690830. [PubMed] [Google Scholar]

8. Mitchell P, Smith W, Attebo K, Healey PR. Prevalence of open-angle glaucoma in Australia The Blue Mountains Eye Study.

Ophthalmology. 1996 ;103(10):1661–9. PubMed PMID: 8874440. [PubMed] [Google Scholar]

9. Altangerel U, Nallamshetty HS, Uhler T, Fontanarosa J, Steinmann WC, Almodin JM, Chen BH, Henderer JD. Knowledge about

glaucoma and barriers to follow-up care in a community glaucoma screening program. Can J Ophthalmol. 2009 ;44(1):66–9.

PubMed PMID: 19169316. [PubMed] [Google Scholar]

10. Saw SM, Gazzard G, Friedman D, Foster PJ, Devereux JG, Wong ML, Seah S. Awareness of glaucoma, and health beliefs of

patients suffering primary acute angle closure. Br J Ophthalmol. 2003 ;87(4):446–9. PubMed PMID: 12642308. [PMC free

article][PubMed] [Google Scholar]

11. Onyekwe LO, Nwosu SN. Medical students perception of undergraduate ophthalmology training in Nnamdi Azikiwe University

Nnewi Campus. Niger Postgrad Med J. 2006 ;13(4):305–8. PubMed PMID: 17203120. [PubMed] [Google Scholar] Ophthal-

mology 26: 907–909.

12. Michelo, C., Sandøy, I. F. and Fylkesnes, K. 2006. Marked HIV prevalence declines in higher educated young people: evidence

from population-based surveys (1995–2003) in Zambia. Aids, 20, 1031-1038.

13. Landers JA, Goldberg I, Graham SL. Factors affecting awareness and knowledge of glaucoma among patients presenting to an

urban emergency department. ClinExpOphthalmol. 2002;30(2):104–9. PubMed PMID: 11886413. [PubMed] [Google Scholar]

14. Attebo K, Mitchell P, Cumming R, Smith W. Knowledge and beliefs about common eye diseases. Aust N Z J Ophthalmol. 1997

;25(4):283–7. PubMed PMID: 9395831. [PubMed] [Google Scholar]

15. Celebi Ali Riza Cenk Knowledge and Awareness of Glaucoma in Participants with Glaucoma and their Normal First-Degree

Relatives; Med Hypothesis Discov Innov Ophthalmol. 2018 Spring; 7(1): 40–47

16. United Nations Data, UNESCO Institute for Statistics, 2019, Zambia population clock, https://countrymeters.info/en/Zambia

17. Livingston PM, McCarty CA, Taylor HR. Knowledge, attitudes, and self-care practices associated with age related eye disease

in Australia. Br J Ophthalmol. 1998 ;82(7):780–5. PubMed PMID: 9924371. [PMC free article] [PubMed] [Google Scholar]

18. Leske M. C., Connell A. M., Schachat A. P., and Hyman L., 1994, The Barbados Eye Study. Prevalence of open angle glaucoma.

Arch Ophthalmol 112(6): 821-829.

19. Pöhls U G, Renner SP, Fasching PA, Lux MP, Kreis H, Ackermann S, Bender HG, Beckmann MW. Awareness of breast cancer

incidence and risk factors among healthy women. Eur J Cancer Prev. 2004;13(4):249–56. PubMed PMID: 15554551. [PubMed]

[Google Scholar]

20. Michielutte R, Diseker RA, Stafford CL, Carr P. Knowledge of diabetes and glaucoma in a rural North Carolina community. J

Community Health. 1984 ;9(4):269–84. PubMed PMID: 6480891. [PubMed] [Google Scholar]

21. Costa VP, Spaeth GL, Smith M, Uddoh C, Vasconcellos JP, Kara-José N. Patient education in glaucoma: what do patients know

about glaucoma? Arq Bras Oftalmol. 2006 ;69(6):923–7. PubMed PMID: 17273690. [PubMed] [Google Scholar]

22. Gogate P, Deshpande R, Chelerkar V, Deshpande S, Deshpande M. Is glaucoma blindness a disease of deprivation and igno-

rance? A case-control study for late presentation of glaucoma in India.Indian J Ophthalmol. 2011 ;59(1):29–35. PubMed PMID:

21157069. [PMC free article] [PubMed] [Google Scholar]

23. Okeke CN, Friedman DS, Jampel HD, Congdon NG, Levin L, Lai H, et al. Targeting relatives of patients with primary open angle

glaucoma: The help the family glaucoma project. J Glaucoma. 2007;16:549–55. [PubMed] [Google Scholar]

24. Deokule S, Sadiq S, Shah S. Chronic open angle glaucoma: patient awareness of the nature of the disease, topical medication,

compliance and the prevalence of systemic symptoms. Ophthalmic Physiol Opt. 2004 ;24(1):9–15. PubMed PMID: 14687196.

[PubMed] [Google Scholar]

25. Pfeiffer N, Krieglstein GK, Wellek S. Knowledge about glaucoma in the unselected population: a German survey. J Glaucoma.

2002 ;11(5):458–63. PubMed PMID: 12362089. [PubMed] [Google Scholar]

26. Noertjojo K, Maberley D, Bassett K, Courtright P. Awareness of eye diseases and risk factors: identifying needs for health

education and promotion in Canada. Can J Ophthalmol. 2006 ;41(5):617–23. PubMed PMID: 17016537. [PubMed] [Google

Scholar]

27. Krishnaiah S, Kovai V, Srinivas M, Shamanna BR, Rao GN, Thomas R. Awareness of glaucoma in the rural population of South-

ern India. Indian J Ophthalmol. 2005 ;53(3):205–8. PubMed PMID: 16137971. [PubMed] [Google Scholar]

28. Mansouri K, Orgül S, Meier-Gibbons F, Mermoud A. Awareness about glaucoma and related eye health attitudes in Switzer-

land: a survey of the general public. Ophthalmologica. 2006;220(2):101–8. PubMed PMID: 16491032. [PubMed] [Google

Scholar]

29. Rosenstock IM. Why people use health services. Milbank Mem Fund Q. 1966;44(Suppl):94–127. [PubMed] [Google Scholar]

11

Current outbreaks• Circulating Vaccine Derived Poliovirus Type 2 (cVDPV2) Outbreak: Zero (0) AFP cases were• reported from the outbreak district of Chienge in Luapula Province• Acute Flaccid Paralysis (AFP): One (1) AFP hot case from Western Province reported in week• 47 tested positive for type 2 polioviruses. Samples are undergoing genetic sequencing• Suspected Poliovirus Type 2: Isolated type 2 polioviruses from the Ngwerere environmental• surveillance site in Lusaka Province collected in week 42 , are undergoing genetic sequencing• Anthrax: Eight (8) cases were recorded from Western Province, results are pending• Cholera: Zero (0) cases were reported Northern Province this reporting week

Other diseases

• Acute Flaccid Paralysis (AFP): Four (4) cases were reported from Copperbelt (1), North Western• (1), Southern (1) and Western (1) Provinces. Three (3) specimens were tested for poliovirus• Measles: A total of eighteen (18) cases measles were reported this week from Eastern (6),• Luapula (5), Lusaka (3), Western (2), Southern (1) and North Western (1) Provinces. Eleven (11)• specimens were tested. Two (2) samples from Luaplua from week 47 tested positive measles• Maternal Deaths: Fifteen (15) maternal deaths were registered in Lusaka (5), Copperbelt (3),• Southern (2), Northern (2), Luapula (1), North Western (1) and Central (1) Provinces

Other diseases• Typhoid: Sixteen (16) cases were notified in Eastern Province, no testing was reported

12

Weekly Summary

INTEGRATED DISEASE SURVEILLANCE AND RESPONSE (IDSR) WEEK 48 25 NOVEMBER -1 DECEMBER 2019

Surveillance ReportSurveillance and Disease Intelligence UnitZambia National Public Health Institute

Citation Style For This Article: Surveillance and Disease Intelligence Unit. Health Press Zambia Bull. 2019; 3(6); pp 12-19.

13

14

OUTBREAKS

15

16

Measles and Rubella

HIGH BURDEN DISEASES

17

18

PUBLIC HEALTH ACTIONS

General Recommendations

Circulating Vaccine Derived Poliovirus Outbreak

Ebola Virus Disease Preparedness

• Response pillars at ZNPHI to continue working with partners to strengthen surveillance, laboratory and epidemic preparedness for Polioviruses, EVD, Cholera , Measles and other public heath threats

• Provincial health and veterinary municipalities to quickly respond to suspected rabies cases, promote vac-cination of dogs and sensitize communities on rabies prevention /treatment

• Provinces to oversee that epidemic preparedness consumables (including vaccines, water testing kits and chlorine distribution) are distributed to districts at risk of outbreaks

• Provinces should ensure that epidemic preparedness committees (provincial and districts) are functional, represented by all key multisector stakeholders & hold regular meetings

• The national annualized Non Polio AFP detection rate has increased to 4 cases /100,000 of children de-tected under 15 years for provinces.

• Note all AFP cases are immediately notifiable and require immediate investigation with new case investi-gation forms

• All districts are expected to conduct health facilities integrated supervisory active searches at priority sites as per recommended schedule

• Provinces to ensure silent districts not reporting AFP/measles cases are supported for active surveillance of AFP cases

• Provinces are to ensure health workers are sensitized for improved detection, reporting and investigation of suspected measles and AFP cases

• All provinces to strengthen EVD surveillance among all health care providers and raise commu-nity aware-ness of EVD prevention

• Provide weekly reports in IDSR reports of active searches including zero reporting in at risk dis-tricts, in-cluding ports of entry

• Ensure epidemic preparedness measures for detecting cases, sample testing / transportation and manag-ing cases are effected

• All border districts to strengthen point of entry EVD screening including facilitation of cross boarder mon-itoring and reporting of suspected EVD cases

19

Heightened Surveillance in Cholera Hotspots

• Cholera hotspots to continue heightened surveillance and review of epidemiological trends to quickly de-tect and respond to changes

• Continue to provide health education to sensitize communities and health workers on cholera pre-venta-tive measures

• WASH continue water monitoring and distribution of chlorine in identified at risk populations• Provincial epidemic preparedness committee’s to engage all relevant government stakeholders and

INFLUENZA SENTINEL SURVEILLANCE REPORT PerspectiveNational Influenza Center – Pathology and Microbiology Department, University Teaching Hospital, Virology Laboratory

Citation Style For This Article: National Influenza Center – Pathology and Microbiology Department University Teaching Hospital, Virology Laboratory. Influenza Sentinal Surveillance Report. Health Press Zambia Bull. 2019; 3(6); pp 20-24.

Methodology for Establishment of Epidemic ThresholdsThresholds are calculated using Moving Epidemic Methods (MEM), a sequential analysis using R language available from: http//CRAN.R-project.org/web/package =mem) designed to calculate the duration, start and end of the annual influenza epidemic. MEM uses the 40th, 90th and 97.5th percentile established from available years of historical data to calculate threshold activities. Thresh-old activity for influenza is categorized as: below epidemic threshold, low, moderate, high or very high. Transmissibility of influenza can be inferred from ILI data while SARI data gives an indication of severity.

Summary

20

Program Influenza Sentinel Surveillance ILI and SARI

Start Year 2008

Provinces (Sites) Lusaka [UTH Pediatric, UTH Adult Hospital, Chipata Clinic]Copperbelt [Ndola Central Hospital, Arthur Davison Hospital, New Masala Clinic]

Type of site Out Patient Clinics (ILI) In Patient Hospital (SARI)

Case definition Influenza-Like Illness (ILI): Out-patient consultation AND temperature 38ºC and above or history of fever AND cough or sore throat

Severe Acute Respiratory Illness (SARI):

5 yrs. and above: Patient admitted with less than 7 days duration of illness AND tempera-ture 38ºC and above or history of fever AND cough or sore throat AND difficulty breathing. 2m-5yrs: Patient admitted with less than 7 days duration of illness AND cough or difficul-ty breathing AND one of symptoms- Tachypnoea (2m-1yr RR >50; 1-5yrs RR >40- Unable to drink or breastfeed- Lethargic or unconscious- Vomits everything (not only occa-sional)- Convulsions- Chest in-drawing (retractions under ribcage/ stridor in a calm child)

Specimen collected Nasal-pharyngeal/ Oral-Pharyngeal Swab

Main pathogen tested Influenza

There was increased influenza activity at the beginning of the 4th quarter of 2019 between epi-weeks 40 and 48. Rates of Influen-za-Like Illness (ILI) and Severe Acute Respiratory Infection (SARI) attributable to influenza virus infection were in the high to mod-erate threshold and remained within the moderate seasonal threshold in week 48. This second cycle of activity was of a moderate transmissibility and low severity.

ILI Surveillance: Specimens from 1070 outpatients were received from two ILI surveillance sites. 1035 (97%) were adequately sampled and tested. Influenza virus was detected in 232 (22%) of these samples. 86 (37%) were identified as Influenza B, 52 (22%) Influenza A H3N2, 46 (20%) Influenza A H1N1 (pandemic), 38 (16%) influenza A Untyped and 10(4%) as Influenza A unsubtypeable.

SARI Surveillance: During this same period, specimens were received from 1681 patients admitted to four SARI surveillance sites. 1251 (74%) were adequately sampled and tested. Influenza was detected in 206 (16%) specimens; 119 (58%) of which were identified as Influenza B, 23(11%) as Influenza A H3N2, 20 (10%) as Influenza A H1N1 (pandemic), 33(16%) influenza A Untyped and 11(5%) as Influenza A unsubtypeable.

Influenza TransmissibilityFig 1: Percentage of Influenza Positive ILI Cases1 (Out-Patient Visit Surveillance) per Epi-Week against Epidemic Thresholds Set Using 2013 – 2018 Data

1ILI Case / Total ILI Sampled *100

In November of 2019, ILI outpatient visits attributable to influenza virus infection were above low epidemic threshold between weeks 44 and 47. Weeks 40 – 43 had a steady raise to High Epidemic threshold which was

associated with an increase in influenza detection.

21

30th June 2019: Influenza Severity (Impact) Fig 2: Percentage of Influenza Positive SARI Cases1 (Hospital Admission Surveillance) per Epi-Week against Epidemic Thresh-

SARI Influenza Positive Cases / Total Admissions Sampled *100 In November 2019, SARI admission attributable to influenza virus infection declined to below epidemic threshold in week 40 and has remained below epidemic threshold from week 40 to week 43

22

Fig 3: Positives samples* by influenza type and detection rate** by epi-week in 2019.

Influenza viruses circulating are predominantly influenza B and there was also an increased detection of influenza A. Among the influenza A viruses subtyped, H1N1 (Pandemic) and H3N2 were mostly seen in weeks 40 45. Most viruses were detected between weeks 40 and 43.

23

Fig 4: Number of Influenza Positive Cases by Age Group

The virus circulation was greater at the beginning of the age spectrum but the most affected age groups have remained to be the under-fives, aged 3 years.

The total number of samples collected as at 30th November 2019, is 2751. 95% (2702/2751) of the received samples were tested and 16.2% (438/2702) were positive for influenza virus while 83% (2268/2702) were negative. Half of the total patients investi-gated were aged 10 years.

Fig: 6: Reported Influenza Cases among ILI patients Visits at two (2) sentinel sites in 2019

Fig: 7: Reported Influenza Cases among SARI patients’ admissions from sentinel sites in 2019.

24