BACKGROUND & AIMS: BACKGROUND:Zambia is still experiencing a severe shortage of health workers, which is impacting the national health care system. Very few people are trained, educational infrastructure is inadequate, and senior human resources for training are not yet sufficient to produce the number of health care workers needed, especially for currently underserved rural areas. Therefore, to strengthen the medical education program of medical licentiates, we implemented a tablet-based electronic learning platform (e-platform) with a medical decision-support component. OBJECTIVE:As the primary objective, this study aimed to explore the acceptance and information system (IS) success of an e-platform focused on offline-based tablet usage for nonphysician clinical students in a low-resource context in Zambia, Africa. Furthermore, we aimed to evaluate student demographic factors and prior technological experience, as well as medical lecturers' acceptance of technology of the e-platform. METHODS:We collected data for the study before and after the intervention. Before the intervention, we collected student demographic data and prior technological experience using a questionnaire. After the intervention, we collected results of the questionnaire on technology acceptance of students and IS success of the e-platform, as well as technology acceptance of medical lecturers. We calculated statistical measures such as means, standard deviations, and correlations of investigated variables. The study report was compiled using the Consolidated Standards of Reporting Trials-Electronic Health checklist. RESULTS:Overall, questionnaire results of students and medical lecturers indicated acceptance of the e-platform and showed higher ratings for overall net benefits and information quality (students) and perceived ease of use and perceived usefulness (medical lecturers) as compared with ratings of other categories. The lowest scores were conveyed for system use and service quality (students) and attitude and behavioral intention (medical lecturers). CONCLUSIONS:Acceptance of the e-platform as a learning technology for strengthening medical education in a low-resource context in Zambia was generally high for students and medical lecturers, but shortcomings were also identified. Results indicated low overall usage of the e-platform as a learning and teaching tool. One hindering factor was the tablets' overall weak reliability with regard to its service life and battery life span, and another was the teachers' low engagement with the e-platform. Next steps may include other hardware and more technology-based training for medical lecturers. The evaluation results indicated that the e-platform may open new promise for further strengthening and expanding medical education in this context, especially with more affordable and viable technologies that are available.

背景与目标： 背景：赞比亚仍然面临着卫生工作者的严重短缺，这正在影响国家卫生保健系统。受过培训的人很少，教育基础设施不足，用于培训的高级人力资源还不足以产生所需的医护人员数量，尤其是对于目前服务不足的农村地区。因此，为加强医疗机构的医学教育计划，我们实施了带有医疗决策支持组件的基于平板电脑的电子学习平台（e-platform）。
目的：作为主要目标，本研究旨在探索在非洲赞比亚资源匮乏的情况下，针对非医师临床学生的基于离线的平板电脑使用情况的电子平台的接受和信息系统（IS）的成功。此外，我们旨在评估学生的人口统计学因素和先前的技术经验，以及医学讲师对电子平台技术的接受程度。
方法：我们收集了干预前后的研究数据。在进行干预之前，我们使用问卷调查收集了学生的人口统计数据和先前的技术经验。干预后，我们收集了有关学生对技术的接受程度和电子平台的IS成功率以及医学讲师的技术接受程度的问卷调查结果。我们计算了统计量度，例如均值，标准差和所研究变量的相关性。该研究报告是使用《报告试验综合标准-电子健康》核对表编制的。
结果：总体而言，学生和医学讲师的问卷调查结果表明，他们接受了电子平台，并且与其他专家相比，他们对整体净收益和信息质量（学生）以及对易用性和感知有用性（医学讲师）的评价更高。类别。得分最低的是系统使用和服务质量（学生），态度和行为意向（医学讲师）。
结论：在赞比亚资源匮乏的情况下，电子平台作为一种用于加强医学教育的学习技术的接受程度普遍对学生和医学讲师而言很高，但也存在不足之处。结果表明，将电子平台作为一种学习和教学工具的总体使用率较低。阻碍因素是平板电脑在使用寿命和电池寿命方面总体上较差的可靠性，另一个是教师对电子平台的参与度低。下一步可能包括其他硬件以及针对医学讲师的更多基于技术的培训。评估结果表明，在这种情况下，电子平台可能会为进一步加强和扩展医学教育开辟新的希望，尤其是借助更实惠和可行的技术。

BACKGROUND & AIMS: :The genomes of African swine fever virus isolates collected from soft ticks (Ornithodoros moubata) inhabiting warthog burrows in four areas of Zambia were compared by restriction enzyme site mapping. Isolates from different areas showed considerable diversity. The regions of genomes that differed between isolates were distributed throughout the virus genome, although some more conserved regions were identified, such as the right-hand third of the genome. The genomes of seven isolates from neighbouring warthog burrows within Livingstone Game Park in southern Zambia were more similar to each other than those from different areas. However, a number of differences were observed even between the genomes of isolates from the same warthog burrow. The variation between these latter isolates probably resulted from point mutations located at various positions along the genome, in addition to small additions or deletions at both terminal regions. Restriction enzyme site mapping indicated that one isolate may have originated by earlier recombination between two distinguishable viruses.

背景与目标： ：通过限制性内切酶位点图谱比较了从赞比亚四个地区疣猪洞穴中的软壁虱（Ornithodoros moubata）收集的非洲猪瘟病毒分离株的基因组。来自不同地区的分离株显示出相当大的多样性。尽管鉴定出一些更保守的区域，例如基因组的右手三分之一，但分离株之间的基因组区域却分布在整个病毒基因组中。赞比亚南部利文斯通野生动物园内邻近疣猪洞穴的七个分离株的基因组彼此之间的相似性高于不同地区。然而，甚至在来自相同疣猪洞穴的分离株的基因组之间也观察到许多差异。后两个分离物之间的变异可能是由于位于两个基因组各个位置的点突变，以及两个末端区域的少量添加或缺失所致。限制性酶切位点作图表明，一种分离物可能是由两种可区分的病毒之间的早期重组引起的。

BACKGROUND & AIMS: :Traditional fermented foods and beverages are common in many countries, including Zambia. While the general (nutritional) benefits of fermented foods are widely recognised, the nutritional composition of most traditional fermented foods is unknown. Furthermore, fermentation is known to add nutritional value to raw materials, mainly by adding B-vitamins and removing anti-nutritional factors. In the case of traditional fermentation, the composition of microbial communities responsible for fermentation varies from producer to producer and this may also be true for the nutritional composition. Here, we characterized the nutrient profile and microbial community composition of two traditional fermented foods: milk-based Mabisi and cereal-based Munkoyo. We found that the two products are different with respect to their nutritional parameters and their microbial compositions. Mabisi was found to have higher nutritional values for crude protein, fat, and carbohydrates than Munkoyo. The microbial community composition was also different for the two products, while both communities were dominated by lactic acid bacteria. Our analyses showed that variations in nutritional composition, defined as the amount of consumption that would contribute to the estimated average requirement (EAR), might be explained by variations in microbial community composition. Consumption of Mabisi appeared to contribute more than Munkoyo to the EAR and its inclusion in food-based recommendations is warranted. Our results show the potential of traditional fermented foods such as Mabisi and Munkoyo to add value to current diets and suggests that variations in microbial composition between specific product samples can result in variations in nutritional composition.

背景与目标： 传统发酵食品和饮料在包括赞比亚在内的许多国家都很普遍。尽管人们普遍认识到发酵食品的一般（营养）益处，但大多数传统发酵食品的营养成分尚不清楚。此外，已知发酵主要通过添加B-维生素和消除抗营养因子来增加原材料的营养价值。在传统发酵的情况下，负责发酵的微生物群落组成因生产者而异，营养成分也可能如此。在这里，我们表征了两种传统发酵食品的营养成分和微生物群落组成：基于牛奶的马比西和基于谷物的Munkoyo。我们发现这两种产品的营养参数和微生物组成有所不同。发现Mabisi的粗蛋白，脂肪和碳水化合物的营养价值比Munkoyo高。两种产品的微生物群落组成也不同，而两个群落均以乳酸菌为主。我们的分析表明，营养成分的变化（定义为有助于估计的平均需求量（EAR）的消费量）可以用微生物群落组成的变化来解释。马比斯的消费对EAR的贡献似乎超过了Munkoyo，因此有必要将其包含在以食物为基础的建议中。我们的结果表明，传统的发酵食品（例如Mabisi和Munkoyo）可能会增加当前饮食的价值，并表明特定产品样品之间微生物组成的变化会导致营养成分的变化。

BACKGROUND & AIMS: :An anthrax outbreak occurred in November 2010 in five villages of Sesheke district in Western Zambia. Control measures and data collection was carried out immediately the outbreak was reported. The prevalence of the disease in cattle was estimated at 7.4% (45/609) while the average herd size of infected cattle in affected villages was estimated at 121.8 (95% CI 48.8-194.8). Individual mortality per herd varied between 1.70% (3/179) and 20.25% (6/79). The relative risk of infection of cattle in the five affected villages varied between 0.18 (95% CI 0.4-5.7) and 3.7 (95% CI 1.99-6.68). In humans, the disease only affected three people and was characterized by cutaneous carbuncles. The ratio of infected persons per number of infected carcasses varied between 1:37 and 1:49 in affected villages while the overall ratio of people at risk to the number of carcasses was 42:1 indicating that despite availability of a large number of carcasses, human contact with infected carcasses was low. The findings of this study underline the importance of timely disease control measures in reducing the risk of human infections to anthrax in the face of an outbreak.

背景与目标： ：2010年11月，赞比亚西部Sesheke区的五个村庄发生了炭疽热暴发。报告爆发后立即进行了控制措施和数据收集。据估计，该病在牛中的流行率为7.4％（45/609），而在受影响村庄中，被感染牛的平均牛群规模估计为121.8（95％CI 48.8-194.8）。每群的个体死亡率在1.70％（3/179）和20.25％（6/79）之间变化。在五个受影响的村庄中，牛感染的相对风险在0.18（95％CI 0.4-5.7）和3.7（95％CI 1.99-6.68）之间变化。在人类中，该疾病仅影响了三个人，并且以皮肤carb肿为特征。在受影响的村庄中，感染人数/屠体总数的比例在1:37和1:49之间，而处于危险之中的人数与屠体总数的总比例为42：1，这表明尽管有大量屠体，人与受感染屠体的接触率很低。这项研究的结果强调了及时的疾病控制措施对于降低人间暴发时人类感染炭疽的风险的重要性。

BACKGROUND & AIMS: OBJECTIVES:We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. METHODS:We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003-2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan-Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. RESULTS:From 17 facilities, 4147 patients were included. Retention ranged from 52.0% to 96.2% at 1 year to 25.8%-90.4% at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) = 1.30 (1.14-1.47)], WHO stage 4 ([aHR (95% CI): 1.56 (1.29-1.88)], >10% bodyweight loss [aHR (95%CI) = 1.17 (1.00-1.38)], poor functional status [ambulatory aHR (95%CI) = 1.29 (1.09-1.54); bedridden aHR1.54 (1.15-2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95%CI) = 1.17 (1.10-1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95%CI) = 0.88 (0.78-1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95%CI) = 0.55 (0.30-1.01) for women; 0.40 (0.21-0.75) for men] had significantly less attrition. CONCLUSIONS:Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.

背景与目标： 目的：我们评估了坦桑尼亚，乌干达和赞比亚的抗逆转录病毒治疗（ART）诊所的保留率和流失率（记录的死亡或随访损失）的预测因素。
方法：我们对2003-2010年开始接受ART的成年人（≥18岁）进行了一项回顾性队列研究。我们在每个国家有目的地选择了六个医疗机构，并从每个机构中随机选择了250名患者。在数据提取之前的90天内至少访问过一次诊所的患者被定义为保留。通过图表审查和诊所经理访谈获得了有关个人和计划级人员流失风险因素的数据。创建了跨站点保留的Kaplan-Meier曲线。使用多变量Cox比例风险模型评估损耗的预测因素，并针对站点级别的聚类进行了调整。
结果：来自17家机构的4147例患者被纳入研究。保留率从1年的52.0％至96.2％到4年的25.8％-90.4％不等。对ART起始特征的多变量分析发现以下几种导致流失的独立危险因素：年龄较小[调整后的危险比（aHR）和95％置信区间（95％CI）= 1.30（1.14-1.47）]，WHO第4阶段（[aHR（ 95％CI）：1.56（1.29-1.88），> 10％体重减轻[aHR（95％CI）= 1.17（1.00-1.38）]，功能状态不佳[动态aHR（95％CI）= 1.29（1.09- 1.54）；卧床不起的aHR1.54（1.15-2.07）]，以及在政府机构开始抗逆转录病毒治疗之前临床工作的年限增加[aHR（95％CI）= 1.17（1.10-1.23）]。妇女提供社区抗逆转录病毒配药[aHR（95％CI）= 0.55（0.30-1.01）]的几率（增长10倍）减少[aHR（95％CI）= 0.88（0.78-1.00）]。男性则为0.40（0.21-0.75）]。
结论：随着时间的流逝，患者对单个程序的保留率随着时间的推移而恶化，尤其是在男性，年轻人和临床指标较差的人群中。社区抗逆转录病毒药物配药计划可以提高保留率。

BACKGROUND & AIMS: :Overlap syndromes, where otherwise distinct autoimmune processes of the central and peripheral nervous systems are present in the same patient, are uncommon and have not been previously reported in sub-Saharan Africa. We present a case of a 32-year-old man who was found to have both clinically isolated syndrome and chronic inflammatory demyelinating polyneuropathy, highlighting the importance of continued efforts to establish the prevalence of demyelinating disease in the region given the limited treatment options currently available for autoimmune disease.

背景与目标： 重叠综合征是同一患者中中枢神经系统和外周神经系统明显不同的自身免疫过程，但在撒哈拉以南非洲以前尚无报道。我们介绍了一例32岁的男子，他被发现患有临床孤立综合征和慢性炎症性脱髓鞘性多发性神经病，突出强调了继续努力建立该地区脱髓鞘性疾病患病率的重要性，因为目前可用的治疗方法有限用于自身免疫性疾病。

BACKGROUND & AIMS: BACKGROUND:The Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets require that, by 2020, 90% of those living with HIV know their status, 90% of known HIV-positive individuals receive sustained antiretroviral therapy (ART), and 90% of individuals on ART have durable viral suppression. The HPTN 071 (PopART) trial is measuring the impact of a universal testing and treatment intervention on population-level HIV incidence in 21 urban communities in Zambia and South Africa. We report observational data from four communities in Zambia to assess progress towards the UNAIDS targets after 1 y of the PopART intervention. METHODS AND FINDINGS:The PopART intervention comprises annual rounds of home-based HIV testing delivered by community HIV-care providers (CHiPs) who also support linkage to care, ART retention, and other services. Data from four communities in Zambia receiving the full intervention (including immediate ART for all individuals with HIV) were used to determine proportions of participants who knew their HIV status after the CHiP visit; proportions linking to care and initiating ART following referral; and overall proportions of HIV-infected individuals who knew their status (first 90 target) and the proportion of these on ART (second 90 target), pre- and post-intervention. We are not able to assess progress towards the third 90 target at this stage of the study. Overall, 121,130 adults (59,283 men and 61,847 women) were enumerated in 46,714 households during the first annual round (December 2013 to June 2015). Of the 45,399 (77%) men and 55,703 (90%) women consenting to the intervention, 80% of men and 85% of women knew their HIV status after the CHiP visit. Of 6,197 HIV-positive adults referred by CHiPs, 42% (95% CI: 40%-43%) initiated ART within 6 mo and 53% (95% CI: 52%-55%) within 12 mo. In the entire population, the estimated proportion of HIV-positive adults who knew their status increased from 52% to 78% for men and from 56% to 87% for women. The estimated proportion of known HIV-positive individuals on ART increased overall from 54% after the CHiP visit to 74% by the end of the round for men and from 53% to 73% for women. The estimated overall proportion of HIV-positive adults on ART, irrespective of whether they knew their status, increased from 44% to 61%, compared with the 81% target (the product of the first two 90 targets). Coverage was lower among young men and women than in older age groups. The main limitation of the study was the need for assumptions concerning knowledge of HIV status and ART coverage among adults not consenting to the intervention or HIV testing, although our conclusions were robust in sensitivity analyses. CONCLUSIONS:In this analysis, acceptance of HIV testing among those consenting to the intervention was high, although linkage to care and ART initiation took longer than expected. Knowledge of HIV-positive status increased steeply after 1 y, almost attaining the first 90 target in women and approaching it in men. The second 90 target was more challenging, with approximately three-quarters of known HIV-positive individuals on ART by the end of the annual round. Achieving higher test uptake in men and more rapid linkage to care will be key objectives during the second annual round of the intervention. TRIAL REGISTRATION:ClinicalTrials.gov NCT01900977.

背景与目标： 背景：联合国艾滋病毒/艾滋病联合规划署（UNAIDS）90-90-90目标要求到2020年，90％的HIV感染者知道其状况，90％的已知HIV阳性患者接受持续的抗逆转录病毒疗法（ ART），并且90％的ART患者具有持久的病毒抑制作用。 HPTN 071（PopART）试验正在评估普遍测试和治疗干预措施对赞比亚和南非的21个城市社区中艾滋病毒感染率的影响。我们报告了来自赞比亚四个社区的观测数据，以评估PopART干预1年后实现联合国艾滋病规划署目标的进展。
方法和调查结果：PopART干预包括社区艾滋病护理提供者（CHiP）每年进行的基于家庭的HIV测试，他们也支持与护理，ART保留和其他服务的联系。来自赞比亚四个社区的接受了全面干预的数据（包括对所有艾滋病病毒感染者进行的即时抗病毒治疗）被用来确定在CHiP访问后知道其艾滋病毒状况的参与者的比例。转诊后与护理和启动抗逆转录病毒疗法有关的比例；以及在干预前和干预后知道自己状况的HIV感染者的总体比例（前90个目标）以及接受抗逆转录病毒治疗的人群中的比例（后90个目标）。在此研究阶段，我们无法评估实现第90个目标的进度。在第一轮年度调查（2013年12月至2015年6月）中，总计46,714户家庭中有121,130名成年人（59,283名男性和61,847名女性）被列举。在同意接受干预的45,399名男性（77％）和55,703名女性（90％）中，有80％的男性和85％的女性在CHiP访问后知道了他们的艾滋病毒状况。在CHiPs推荐的6,197名HIV阳性成年人中，有42％（95％CI：40％-43％）在6个月内发起抗逆转录病毒疗法，有​​53％（95％CI：52％-55％）在12个月内引发抗逆转录病毒疗法。在整个人口中，知道自己的状况的艾滋病毒呈阳性的成年人的估计比例从男人的52％增至78％，从女人的56％增至87％。据估计，接受抗逆转录病毒治疗的已知HIV阳性个体的比例总体上从CHiP访问后的54％上升到该轮结束时的男性的74％，女性的53％增至73％。不论他们是否知道自己的状况，估计艾滋病毒呈阳性的成年人的总体比例，从81％的目标（前两个90个目标的乘积）相比，从44％增加到61％。青年男子和妇女的覆盖率低于老年组。这项研究的主要局限性是需要对成人的艾滋病毒状况和抗逆转录病毒疗法的知识进行假设，尽管我们的结论在敏感性分析中是可靠的，但他们不同意干预措施或艾滋病毒检测。
结论：在这项分析中，尽管与护理和抗病毒治疗的联系花费的时间比预期的长，但接受干预措施的人对艾滋病毒检测的接受程度很高。对艾滋病毒阳性状态的了解在1年后急剧增加，几乎达到了女性的前90个目标，而男性则接近了这一目标。第二个90目标更具挑战性，到年度回合结束时，大约四分之三的已知HIV阳性个体接受抗逆转录病毒治疗。在第二年的年度干预中，实现男性更高的测试摄入量和与护理之间更快的联系将是主要目标。
试用注册：ClinicalTrials.gov NCT01900977。

BACKGROUND & AIMS: BACKGROUND:A recurring discussion in the literature relates to the possible contradictions among the Sustainable Development Goals (SDGs). The focus has been on economic goals, such as economic growth and goals related to climate change. We explore the possible contradictions that may arise between economic goals and health goals, specifically, the goal on Non-Communicable Diseases (NCDs) - SDG3.4. As a way to achieve SDG3.4, countries have been urged to introduce sin taxes, such as those on sugar. Yet others have argued that such taxes may affect employment (SDG 8.5), economic growth (SDG 8.1), and increase poverty (SDG1). However, there is limited or no reliable evidence, using actual experience, on the effect of sugar tax on health and economic outcomes. This makes it hard to assess the possible contradictions in SDGs that sugar taxes may generate. MAIN BODY:Using a conceptual framework on SDGs that views relationships among SDGs as either contradictory, reinforcing, or neutral, we carefully consider whether there are contradictions between SDG 3.4 on one hand and SDG 1, SDG 8.1, and SDG 8.5 on the other hand. We illustrate this using Zambia which recently introduced an equivalent 3% tax on non-alcoholic beverages, implicitly targeted at sugar-sweetened beverages (SSBs), given the stated goal of reducing NCDs. Concerns are that such a tax would be detrimental to the Zambia sugar value chain which contributes about 6% to GDP, in which case the achievement of SDG 3.4 (health) would be at odds with, or contradict, SDG 1, SDG 8.1, and SDG 8.5 (poverty eradication, economic growth, and creation of employment). We discuss that the existence of contradictions depend on a number of contextual factors, which allows us to make two conclusions about sugar taxation in Zambia. First, the current tax rate of 3% is likely neutral (no contradictions or reinforcing relationships) because it is too low to have any health or employment effects. However, the revenue raised can be reinvested to improve livelihoods. Secondly, the tax rate should be increased but care has to be exercised to ensure that the rate is not too high to generate contradictions. There will be need to carefully assess important parameters such as elasticities and explore alternative economic livelihoods. CONCLUSION:Without paying due consideration to important contextual factors, Zambia and many LMIC risk experiencing contradictions among SDGs.

背景与目标： 背景：文献中的反复讨论涉及可持续发展目标（SDG）之间可能存在的矛盾。重点一直放在经济目标上，例如经济增长和与气候变化有关的目标。我们探讨了经济目标与健康目标之间可能出现的矛盾，特别是关于非传染性疾病（NCD）目标-SDG3.4。作为实现SDG3.4的一种方式，已敦促各国开征罪恶税，例如食糖税。还有一些人认为，此类税收可能会影响就业（可持续发展目标8.5），经济增长（可持续发展目标8.1）和加剧贫困（可持续发展目标1）。但是，根据实际经验，关于糖税对健康和经济成果的影响的可靠证据有限或没有可靠证据。这使得很难评估糖税可能产生的可持续发展目标中可能存在的矛盾。
主要主体：使用关于SDG的概念框架，将SDG之间的关系视为矛盾，加强或中立，我们仔细考虑一方面SDG 3.4与SDG 1，SDG 8.1和SDG 8.5之间是否存在矛盾。 。我们使用赞比亚来说明这一点，赞比亚最近提出了对非酒精饮料征收相当于3％的税，隐含地针对含糖饮料（SSB），因为既定的目标是减少非传染性疾病。令人担忧的是，这种税收将不利于赞比亚糖价值链，赞比亚的糖价值链对GDP的贡献约为6％，在这种情况下，实现SDG 3.4（健康）将与SDG 1，SDG 8.1和SDG 1不一致或相矛盾。可持续发展目标8.5（消除贫困，经济增长和创造就业机会）。我们讨论了矛盾的存在取决于许多上下文因素，这使我们可以对赞比亚的食糖税作出两个结论。首先，目前的3％税率可能是中性的（无矛盾或无巩固关系），因为它太低了，不会对健康或就业产生任何影响。但是，筹集的收入可以用于改善生计。其次，应提高税率，但必须谨慎行事，以确保税率不会太高而不会引起矛盾。有必要仔细评估诸如弹性之类的重要参数，并探索替代性的经济生计。
结论：在没有适当考虑重要的背景因素的情况下，赞比亚和许多中低收入国家在可持续发展目标之间存在矛盾。

BACKGROUND & AIMS: BACKGROUND:One important ethical issue in randomised controlled trials (RCTs) is randomisation. Relatively little is known about how participating individuals and communities understand and perceive central aspects of randomisation such as equality, fairness, transparency and accountability in community-based trials. The aim of this study was to understand and explore study communities' perspectives of the randomisation process in a cluster RCT in rural Zambia studying the effectiveness of different support packages for adolescent girls on early childbearing. METHODS:In this explorative study, in-depth semi-structured interviews were carried out in 2018 with 14 individuals who took part in the randomisation process of the Research Initiative to Support the Empowerment of Girls (RISE) project in 2016 and two traditional leaders. Two of the districts where the trial is implemented were purposively selected. Interviews were audio recorded and fully transcribed. Data were analysed by coding and describing emergent themes. RESULTS:The understanding of the randomisation process varied. Some respondents understood that randomisation was conducted for research purposes, but most of them did not. They had trouble distinguishing research and aid. Generally, respondents perceived the randomisation process as transparent and fair. However, people thought that there should not have been a "lottery" because they wanted all schools to receive equal or balanced benefits of the interventions. CONCLUSIONS:Randomisation was misunderstood by most respondents. Perceived procedural fairness was easier to realize than substantive fairness. Researchers working on Cluster Randomised Controlled Trials (CRCTs) should consider carefully how to explain randomisation.

背景与目标： 背景：随机对照试验（RCT）中的一个重要的伦理问题是随机化。对于参与的个人和社区如何理解和感知随机化的中心方面（例如基于社区的试验中的平等，公平，透明和问责制）知之甚少。这项研究的目的是了解和探索研究社区对赞比亚农村地区RCT集群研究中随机化过程的观点，研究针对青春期女孩的不同支持计划对早期生育的有效性。
方法：在这项探索性研究中，2018年对14位参与了2016年支持女孩赋权研究倡议（RISE）项目的随机过程的人员进行了深入的半结构化访谈，其中包括两名传统领导者。目的是选择执行审判的两个地区。采访被录音并被完全转录。通过编码和描述紧急主题来分析数据。
结果：对随机过程的理解各不相同。一些受访者理解，随机化是出于研究目的而进行的，但大多数人没有这样做。他们在区分研究和援助方面遇到困难。通常，受访者认为随机化过程是透明且公平的。但是，人们认为不应有“抽奖”，因为他们希望所有学校都能从干预中获得同等或平衡的收益。
结论：大多数受访者误解了随机化。感觉到的程序公正比实质公正更容易实现。进行集群随机对照试验（CRCT）的研究人员应仔细考虑如何解释随机化。

BACKGROUND & AIMS: BACKGROUND:Improved primary health care is needed in developing countries to effectively manage the growing burden of hypertension. Our objective was to evaluate hypertension management in Zambian rural primary care clinics using process and outcome indicators to assess the screening, monitoring, treatment and control of high blood pressure. METHODS:Better Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge trial of improved clinical service delivery underway in 46 rural Zambian clinics. Clinical data were collected as part of routine patient care from an electronic medical record system, and reviewed for site performance over time according to hypertension related indicators: screening (blood pressure measurement), management (recorded diagnosis, physical exam or urinalysis), treatment (on medication), and control. Quantitative data was used to develop guides for qualitative in-depth interviews, conducted with health care providers at a proportional sample of half (20) of clinics. Qualitative data was iteratively analyzed for thematic content. RESULTS:From January 2011 to December 2014, 318,380 visits to 46 primary care clinics by adults aged ≥ 25 years with blood pressure measurements were included. Blood pressure measurement at vital sign screening was initially high at 89.1% overall (range: 70.1-100%), but decreased to 62.1% (range: 0-100%) by 48 months after intervention start. The majority of hypertensive patients made only one visit to the clinics (57.8%). Out of 9022 patients with at least two visits with an elevated blood pressure, only 49.3% had a chart recorded hypertension diagnosis. Process indicators for monitoring hypertension were <10% and did not improve with time. In in-depth interviews, antihypertensive medication shortages were common, with 15/20 clinics reporting hydrochlorothiazide-amiloride stockouts. Principal challenges in hypertension management included 1) equipment and personnel shortages, 2) provider belief that multiple visits were needed before official management, 3) medication stock-outs, leading to improper prescriptions and 4) poor patient visit attendance. CONCLUSIONS:Our findings suggest that numerous barriers stand in the way of hypertension diagnosis and management in Zambian primary health facilities. Future work should focus on performance indicator development and validation in low resource contexts, to facilitate regular and systematic data review to improve patient outcomes. TRIAL REGISTRATION:ClinicalTrials.gov, Identifier NCT01942278 . Date of Registration: September 2013.

背景与目标： 背景：发展中国家需要改善初级卫生保健，以有效管理日益增长的高血压负担。我们的目标是使用过程和结果指标评估高血压的筛查，监测，治疗和控制，以评估赞比亚农村基层医疗诊所的高血压管理。
方法：通过指导和评估（BHOMA）获得更好的健康结果是一项为期5年的随机渐进式临床试验，旨在改善赞比亚46个农村诊所的临床服务质量。从电子病历系统中收集临床数据，作为日常患者护理的一部分，并根据高血压相关指标随时间检查其部位表现：筛查（血压测量），管理（记录的诊断，体检或尿液分析），治疗（药物），并加以控制。定量数据被用于制定定性深入访谈的指南，该访谈与医疗保健提供者按一半（20个）诊所的比例样本进行。定量分析定性数据的主题内容。
结果：自2011年1月至2014年12月，年龄≥25岁的成年人对血压测量进行了318,380次就诊，共有46家初级保健诊所就诊。生命体征筛查时的血压测量最初总体较高，为89.1％（范围：70.1-100％），但在干预开始后48个月下降至62.1％（范围：0-100％）。大多数高血压患者仅去过诊所一次（57.8％）。在至少两次访视且血压升高的9022名患者中，只有49.3％的患者有图表记录的高血压诊断。监测高血压的过程指标<10％，并且没有随时间改善。在深度访谈中，降压药物短缺是普遍现象，有15/20的诊所报告了氢氯噻嗪-阿米洛利缺货。高血压管理方面的主要挑战包括：1）设备和人员短缺； 2）提供者认为在正式管理之前需要多次就诊； 3）药品缺货，导致处方不正确； 4）患者就诊率低。
结论：我们的研究结果表明，在赞比亚主要卫生机构中，高血压的诊断和管理存在许多障碍。未来的工作应侧重于在资源匮乏的情况下开发和验证绩效指标，以促进定期和系统的数据审查以改善患者的预后。
试用注册：ClinicalTrials.gov，标识符NCT01942278。注册日期：2013年9月。

BACKGROUND & AIMS: :Mosquito net ownership is rising in sub-Saharan Africa but will substantially reduce malaria only if nets are used and the most vulnerable household members sleep under them. We used data from 9 large-scale household surveys conducted in 6 African countries from 2000 to 2004 that enumerated all household members and nets owned, analyzing only net-owning households. Across countries, women of reproductive age and children under 5 (without gender bias) were most likely to use the net; least likely were children of age 5-14 and adult males. Nets commonly covered 2-3 people. If a baby net was used, fewer people used the family net. Pregnant women were more likely to use a net in 2004 than in 2000. In several countries, a sizable minority of nets owned were not used. Understanding intra-household net-use patterns helps malaria control programs more effectively direct their efforts to increase their public health impact.

背景与目标： ：在撒哈拉以南非洲，蚊帐的所有权正在增加，但只有使用蚊帐并且最脆弱的家庭成员在蚊帐下面睡觉，才能大大减少疟疾。我们使用了2000年至2004年在6个非洲国家/地区进行的9项大规模家庭调查的数据，其中列举了所有家庭成员和所拥有的网，仅分析了拥有网的家庭。在各个国家/地区，育龄妇女和5岁以下儿童（无性别偏见）最有可能使用该网络；最不可能的是5-14岁的儿童和成年男性。蚊帐通常覆盖2-3人。如果使用婴儿网，则使用家庭网的人数会减少。与2000年相比，2004年孕妇使用网的可能性更高。在一些国家中，未使用相当数量的网。了解家庭内部的网络使用方式有助于疟疾控制计划更有效地指导其努力，以增加其对公共卫生的影响。

BACKGROUND & AIMS: :A molecular survey was conducted for several hemoparasites of domestic dogs and three species of wild carnivores from two sites in Zambia. Three Babesia spp. were detected including Babesia felis and Babesia leo in lions (Panthera leo) and a Babesia sp. (similar to Babesia lengau) in spotted hyenas (Crocuta crocuta) and a single lion. All wild dogs (Lycaon pictus) and domestic dogs were negative for Babesia. High prevalences for Hepatozoon were noted in all three wild carnivores (38-61%) and in domestic dogs (13%). Significantly higher prevalences were noted in hyenas and wild dogs compared with domestic dogs and lions. All carnivores were PCR negative for Ehrlichia canis, Ehrlichia ewingii, and Bartonella spp. Overall, high prevalences and diversity of Babesia and Hepatozoon were noted in wild carnivores from Zambia. This study is the first molecular characterization of Babesia from any hyena species and is the first report of a Babesia sp. closely related to B. lengau, a parasite previously only reported from cheetahs (Acinonyx jubatus), in lions and hyenas. Although usually benign in wild carnivores, these hemoparasites can be pathogenic under certain circumstances. Importantly, data on vectors for these parasites are lacking, so studies are needed to identify vectors as well as determine transmission routes, infection dynamics, and host specificity of these hemoparasites in wildlife in Africa and also the risk of transmission between domestic animals and wildlife.

背景与目标： ：对赞比亚两个地方的家犬的几种血液寄生虫和三种野生食肉动物进行了分子调查。三个巴贝亚菌属。被检出的包括狮中的巴贝斯猫和巴贝斯狮子（Panthera leo）和巴贝斯虫。 （类似于巴贝斯狮eng）斑点鬣狗（Crocuta crocuta）和一头狮子。所有的野狗（Lycaon pictus）和家养犬的巴贝虫病均为阴性。在所有三种野生食肉动物（38-61％）和家犬（13％）中均发现肝癌的高患病率。与家养犬和狮子相比，鬣狗和野狗的患病率明显更高。所有食肉动物的犬埃里希氏菌，尤文埃里希氏菌和Bartonella spp均为PCR阴性。总体而言，在赞比亚的野生食肉动物中发现了巴贝虫和肝虫的高患病率和多样性。这项研究是来自任何鬣狗物种的巴贝斯虫的第一个分子特征，也是巴贝斯虫的第一个报道。与以前仅从猎豹（Acinonyx jubatus）报道过的狮子和鬣狗中的一种寄生虫B. lengau密切相关。尽管通常在野生食肉动物中是良性的，但这些血液寄生虫在某些情况下可能是致病的。重要的是，缺乏用于这些寄生虫的载体的数据，因此需要进行研究以鉴定载体以及确定这些血寄生虫在非洲野生生物中的传播途径，感染动态和宿主特异性，以及家畜与野生生物之间传播的风险。

BACKGROUND & AIMS: BACKGROUND:: We describe promotional strategies for couples' voluntary HIV counseling and testing (CVCT) and demographic risk factors for couples in Lusaka, Zambia, where an estimated two thirds of new infections occur in cohabiting couples. PRINCIPAL FINDINGS:: CVCT attendance as a function of promotional strategies is described over a 6-year period. Cross-sectional analyses of risk factors associated with HIV in men, women, and couples are presented. Community workers (CWs) recruited from couples seeking CVCT promoted testing in their communities. Attendance dropped when CW outreach ended, despite continued mass media advertisements. In Lusaka, 51% of 8500 cohabiting couples who sought HIV testing were concordant negative for HIV (MF) and 26% concordant positive (MF); 23% had 1 HIV-positive partner and one HIV-negative partner, with 11% HIV-positive man/HIV-negative woman (MF) and 12% HIV-negative man/HIV-positive woman (FM). HIV infection was associated with men's age 30 to 39, women's age 25 to 34, duration of union <3 years, and number of children <2. Even among couples with either 1 or 2 or no risk factors, HIV prevalence was 45% and 29%, respectively. CONCLUSIONS:: Many married African adults do not have high-risk profiles, nor realize that only 1 may be HIV positive. Active and sustained promotion is needed to encourage all couples to be jointly tested and counseled.

背景与目标： 背景：：我们描述了赞比亚卢萨卡夫妇的自愿性HIV咨询和检测自愿咨询（CVCT）促销策略以及夫妇的人口统计学危险因素，据估计，三分之二的新感染发生在同居夫妇中。
主要调查结果：在6年的时间内描述了CVCT出席率与促销策略的关系。提出了与男性，女性和夫妇中与HIV相关的危险因素的横断面分析。从寻求CVCT的夫妇中招募的社区工作者（CW）在他们的社区中促进了测试。尽管继续进行大众媒体广告宣传，但CW外展活动结束后，出席人数下降了。在卢萨卡，寻求艾滋病毒检测的8500名同居夫妇中，有51％的艾滋病毒（MF）为一致阴性，而26％的艾滋病毒为阳性（MF）。 23％的人有1个HIV阳性伴侣和1个HIV阴性伴侣，其中11％的HIV阳性男性/ HIV阴性女性（MF）和12％的HIV阴性男性/ HIV阳性女性（FM）。艾滋病毒感染与男性30至39岁，女性25至34岁，合并时间<3年和儿童人数<2有关。即使是有1个或2个或没有危险因素的夫妇，艾滋病毒的患病率也分别为45％和29％。
结论：许多已婚非洲成年人没有高危特征，也没有意识到只有1人可能是HIV阳性。需要积极和持续的晋升，以鼓励所有夫妇共同接受测试和咨询。

BACKGROUND & AIMS: BACKGROUND:Early infant diagnosis is important for timely identification of HIV-infected infants and linkage to care. Testing at birth has been implemented to facilitate earlier diagnosis of HIV infection but may present new challenges. This study was conducted to understand the acceptability and feasibility of birth testing in urban and rural settings in southern Zambia. METHODS:This cross-sectional study was conducted at 11 hospitals and clinics in Livingstone, Choma, and Macha in Southern Province, Zambia from 2016 to 2018. Infants born to pregnant women living with HIV at the sites were eligible for enrollment. After enrollment, a questionnaire was administered to the mother and a dried blood spot card was collected from infants for testing at a central laboratory. When results were available, mothers were notified to return to the clinic. Acceptability of birth testing was evaluated based on the proportion of women who agreed to participate and the reasons for non-participation among women who declined. Feasibility of testing at birth was evaluated using turnaround times for returning results, the proportion of women receiving results, and linkage to care for infants testing positive. RESULTS:One thousand four hundred three women were approached for the study. A small proportion declined due to refusal of birth testing (0 to 8.2% across sites). One thousand two hundred ninety women agreed to have their infants tested. The proportion of mothers receiving results ranged from 51.6 to 92.1%, and was significantly lower at the hospital than clinics in Livingstone (51.6% vs. 69.8%; p < 0.0001) and Macha (69.5% vs. 85.7%; p < 0.0001) but not Choma (85.7% vs. 92.1%; p = 0.34). For mothers who received test results, the median turnaround time from sample collection was 67 days in Livingstone and 53 days in Macha and Choma. Overall, 23 (1.8%) infants tested positive for HIV but only 8 (34.8%) were linked to care a median of 68 days (range: 29, 784) after sample collection. CONCLUSIONS:While testing at birth was acceptable, this study highlights the operational challenges under a centralized laboratory testing system. Point-of-care platforms are needed for rapid testing and return of results so HIV-infected children can be identified, linked to care, and treated as early as possible.

背景与目标： 背景：早期婴儿诊断对于及时识别感染了艾滋病毒的婴儿以及与护理的联系非常重要。已经进行了出生时检测，以促进早期诊断HIV感染，但可能带来新的挑战。进行这项研究是为了了解赞比亚南部城市和农村地区出生测试的可接受性和可行性。
方法：这项横断面研究于2016年至2018年在赞比亚南部省利文斯通，乔马和马查的11家医院和诊所进行。在这些地点感染艾滋病毒的孕妇所生的婴儿符合入组条件。入选后，向母亲进行了问卷调查，并从婴儿那里收集了一张干血点卡以在中央实验室进行测试。当结果可用时，通知母亲返回诊所。根据同意参加试验的妇女比例和拒绝参加试验的妇女拒绝参加试验的原因，对出生测试的可接受性进行了评估。使用返回结果的周转时间，接受结果的妇女比例以及对测试呈阳性的婴儿的护理联系来评估出生时进行测试的可行性。
结果：有143位女性被纳入研究。一小部分由于拒绝出生测试而下降（在各个站点中为0到8.2％）。 129名妇女同意对婴儿进行检查。接受检查的母亲所占比例在51.6％至92.1％之间，并且在医院中显着低于利文斯通（51.6％对69.8％； p <0.0001）和Macha（69.5％对85.7％； p <0.0001）的诊所。但不是Choma（85.7％对92.1％； p = 0.34）。对于收到测试结果的母亲，在利文斯通（Livingstone）收集样本的中位周转时间为67天，在玛莎（Macha）和乔马（Choma）为53天。总体上，有23名（1.8％）婴儿的HIV检测呈阳性，但只有8名（34.8％）的婴儿在收集样本后的中位护理时间为68天（29、784天）。
结论：虽然出生时的测试是可以接受的，但这项研究强调了集中实验室测试系统下的操作挑战。快速检测和返回结果需要现场护理平台，以便可以识别，感染艾滋病毒的儿童，并与他们建立联系，并尽早对其进行治疗。

BACKGROUND & AIMS: BACKGROUND:Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). METHODS:Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13-17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. RESULTS:Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68-0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. CONCLUSIONS:ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

背景与目标： 背景：滥用药物和酒精是一个全球性问题，增加了HIV感染的风险。这是撒哈拉以南非洲的孤儿和弱势儿童（OVC）的关注点，他们的吸毒率可能较高。酒精，吸烟和物质参与筛查测试（ASSIST）是在初级保健高收入环境中成年人中使用药物的可靠有效工具。这项研究使用音频计算机辅助自我访谈（ACASI）检查了赞比亚OVC中ASSIST的心理测量特性。
方法：分析了一项正在进行的随机试验以减少艾滋病毒风险行为的基线数据。分析包括502名年龄在13-17岁的OVC，他们生活在赞比亚卢萨卡的低收入，高密度社区中。评估ASSIST的内部一致性，并使用“青年自我报告”中的项目作为标准变量来衡量判别效度。
结果：对于每种特定物质量表和总物质参与量，Cronbach's alpha≥0.80的内部可靠性均很强。对于除烟草和镇静剂以外的所有物质，在区分低风险使用和中度使用之间都具有判别效度。敏感性和特异性分析表明，不同物质类型之间曲线下的面积足够大（AUC范围：0.68-0.80）。酒精和全部物质参与证明了中高风险之间的区别。
结论：通过ACASI进行管理的ASIST是一种可靠的工具，也是在撒哈拉以南非洲青少年OVC人群中区分低毒和有害物质使用的合适工具。有必要进行额外的检查以确定其测量危险使用中严重性等级的能力。