Zambia: Country Profile
Zambia is a land-linked country situated in the south-central part of Africa with a population of 19.6 million people. This unique location – surrounded by 8 economically interdependent countries – places the country at a high risk of being a hotspot for emerging and re-emerging infectious disease threats in the region. Addressing these threats requires a collaborative, multi-disciplinary and multisectoral approach. Zambia responds to public health events and emergencies in line with the International Health regulations (IHR) 2005. The Zambia National Public Health Institute (ZNPHI) is mandated to coordinate One Health in the country. In February 2023, ZNPHI in collaboration with other Ministries, Department and Agencies launched the National One Health Strategic Plan 2022-2026 to build a strategic, functional and sustainable platform that advances One Health. The strategic plan is divided into five thematic areas:
- Governance and Coordination
- Surveillance
- Preparedness and Response
- Advocacy, Communication and Training
- Research
Zambia Map
Priority Zoonotic Diseases
Africa Centre for Disease Control and Prevention (CDC), ZNPHI, World Health Organization, and other partners held a zoonotic disease prioritization workshop in July 2023 and identified a list of 10 priority diseases: African Trypanosomiasis, anthrax, enteric diseases (salmonellosis), viral hemorrhagic fevers (Ebola virus disease), rabies, plague, influenza-like illnesses (zoonotic avian influenza), zoonotic tuberculosis, cysticercosis, and brucellosis.
African trypanosomiasis is caused by parasites and is spread through tsetse flies. Depending on the form, it may cause a chronic or acute infection leading to consequences on the central nervous system.
Anthrax is a bacterial infection that typically affects animals and can be transmitted from animals and animal products to humans, with limited human-to-human transmission. In endemic settings, anthrax affects primarily cattle, goats, and sheep, and the bacterial spores can remain in soil for years. The bacteria that causes anthrax can spread to humans through open wounds on the skin, ingestion, or inhalation of the spores. Anthrax outbreaks have occurred occasionally in Zambia, typically related to interactions with hippos or consumption of hippopotamus meat.
Avian influenza is an infection by an influenza virus that can affect almost all species of birds, wild or domestic. It can be highly contagious, especially in chickens and turkeys, and can lead to extremely high mortality, especially in factory farms. The avian influenza virus sometimes infects other animal species, including pigs.
Brucellosis is a bacterial infection with a global incidence of about 500,000 cases per year worldwide and a prevalence of more than 10 cases per 100,000 population in some countries. Humans become infected through contact with sick animals, ingestion of fresh unpasteurized or unboiled milk, or fresh cheese. Brucellosis has a significant impact on the health and productivity of livestock, thus greatly reducing their economic value and work performance.
Cysticercosis is caused by a parasite and typically spreads to humans via the fecal-oral route after consuming undercooked pork or contaminated food or water.
Ebola virus disease (EVD) is an infection caused by a virus of the filovirus family. Humans are infected either by direct contact with infected bats (a rare event), or by handling infected animals found dead or sick in forests (a more frequent event). Human-to-human transmission is also possible and occurs through direct contact with the blood, secretions, organs or biological fluids of infected individuals.
Plague is a bacterial infection that typically passes to humans from rodents or rodent fleas. It can be passed between humans through infectious droplets. While a serious or deadly disease if left untreated, antibiotics can manage the illness particularly if caught early. The best forms of prevention are rodent and flea control, and using protective equipment when handling rodents or potentially infected animals.
Rabies remains a widespread disease across the globe, responsible for tens of thousands of deaths worldwide each year. It is a viral infection transmitted by contact with saliva of infected mammals, mainly through bites and scratches and in most places, commonly through dogs. Children are particularly vulnerable to rabies. According to the Zambia National Public Health Institute, there are approximately 15,000 reported dog bites and 50 deaths from rabies annually (2018 data).
Salmonellosis is an infection caused by the bacteria salmonella which typically spreads through contaminated food or contact with infected animals such as poultry, swine, cattle, rodents, or reptiles. Salmonellosis causes diarrhea, fever, and vomiting and is typically more severe in children or the elderly.
Zoonotic tuberculosis is caused by the bacterial species Mycobacterium bovis and causes bovine tuberculosis in cattle (and tuberculosis in other wild animals). In 2016, according to WHO estimates, 147,000 new cases of zoonotic TB were reported in humans, including 12,500 deaths.
One Health Landscape
In Zambia, multi-sectoral technical working groups (TWG) form part of the One Health landscape. There are five TWG in line with the five thematic areas: Governance and coordination, Research, Surveillance, Preparedness and Response and Advocacy, Communication and Training. Permanent Secretaries from the key line ministries provide oversight to the TWGs. These are the key line ministries, organizations and departments that play a role:
- ZNPHI
- Ministry of Health
- Ministry of Green Economy and Environment
- Ministry of Fisheries and Livestock
- Ministry of Information and Media
- Ministry of Agriculture
- Ministry of Local Government and Rural Development
- Ministry of Tourism and Arts
- Ministry of Water Development and Sanitation
- Disaster Management and Mitigation Unit (DMMU)
- Ministry of Home Affairs and Internal Security (Police)
- Academia
- Media houses (commercial and community)
- Various cooperating partners
Summary of Breakthrough ACTION research
The Breakthrough ACTION Zambia team conducted a desk review in early 2023 to identify existing reports and journal articles related to rabies or anthrax in Zambia. The results reflected known risk behaviors and the beliefs, attitudes, sociocultural factors, and structural factors that drive those behaviors. The findings also included previous campaigns to prevent anthrax or rabies including vaccination campaigns as well as mass media campaigns or community engagement. One Health and RCCE strategies were also reviewed. Based on the existing literature, barriers to desired behaviors exist at the individual, cultural, environmental, and structural levels. Economic factors play a major role in people’s willingness to vaccinate their animals or perform other desired behaviors. Cultural practices create risk when animals are transferred between families or carcasses are disposed of in an unsafe manner. Trust between communities, health workers, veterinary workers, and other health authorities is a potential leverage point for future interventions.
In light of limited research exploring drivers of risk and prevention behaviors related to zoonotic diseases, Breakthrough ACTION followed the desk review with a qualitative study on prevention and risk behaviors related to One Health topics with a specific focus on anthrax. Data were collected in September and October 2023 in three Breakthrough ACTION implementation districts through 15 focus group discussions with members of the general population and cattle herders, and 18 in-depth interviews with health workers, veterinary workers, and community leaders. Generally, people were aware of zoonotic diseases but other health and social issues were more concerning. Participants expressed a variety of factors that influenced their willingness and ability to adopt prevention behaviors. These factors included how relevant the behavior was, participants’ knowledge of the concrete steps needed to perform the behavior, actual costs or fee transparency of services, government initiatives or policies, and misconceptions or rumors. Factors such as perceived norms and community influencers also played a role. For example, animal vaccination and avoiding the consumption of potentially infected meat were well understood but economic factors, community norms, and sociocultural factors tended to undermine the adoption of these behaviors. Other behaviors were not well known or were perceived to be very uncommon, such as covering open wounds when handling live or dead animals, keeping new animals temporarily separate from the herd, wearing protective gear during animal slaughter, and properly cleaning instruments used during slaughter or hide preparation. Prevention of zoonotic diseases in general and anthrax specifically occurred in a context of mixed access to the health system and veterinary staff, proximity to animals, and recency of outbreaks. Gender influenced access to information as well as behaviors such as thoroughly cooking meat. Care-seeking varied considerably based on trust in veterinary staff and health workers. Some participants felt the veterinary workers were accessible and trustworthy. Others felt that veterinary care was expensive or that staff were stretched too thin. Several barriers to care-seeking for human health concerns were expressed, such as the expense of medications, competing options from traditional or religious healers, and potential loss of decision-making power at the health center.
Read more in the full report and the research brief.
Following the qualitative research, Breakthrough ACTION further explored perceptions and behaviors related to anthrax and rabies via interactive voice response (IVR) surveys. The surveys explored awareness of the diseases and risk perception as well as attitudes toward and uptake of desired behaviors.
Read the rabies brief and the anthrax brief
The Breakthrough ACTION team routinely conducts social listening exercises, beginning in January 2023. The team extracts social media and other web-based posts and analyzes them for sentiment, content, and other metrics. The purpose of the social listening is to identify newly emerging misinformation related to anthrax or rabies topics (including animal-human interactions) as well as to summarize online conversations generally related to the diseases of interest.
An example social listening report can be viewed here.
In early 2024, Breakthrough ACTION conducted a community mapping exercise in four provinces to identify structures and partners who already work with communities on preventing zoonotic diseases, or that could be engaged to support risk communication and community engagement in the event of an outbreak. The mapping exercise revealed a network of government departments and non-governmental groups working at both national and subnational levels using a variety of strategies to address One Health topics. However, the mapping also exposed gaps, including limited capacity and resources to implement activities and build coordination. The full report is available for more information.
In addition to mapping community structures and partners, Breakthrough ACTION Zambia carried an infodemic management landscaping exercise to assess existing infodemic management activities, strengths, and challenges at both the national and subnational levels. Its objective was also to develop recommendations to improve the efficacy of current strategies and provide a better coordinated response to mis- and disinformation during health crises in Zambia.
Read the infodemic management landscaping report
