UNIVERSITY OF LUSAKA

SCHOOL: SCHOOL OF MEDICICINE AND HEALTH SCIENCES

DEGREE: DIPLOMA IN REGISTERED NURSING

COURSE NAME: PUBLIC HEALTH NURSING ONE

COURSE CODE: DNPH111

GROUP NUMBER: ONE

STUDENT NUMBERS: DRN24125623, DRN241123411, DRN24123233,

DRN24124846, DRN24124841, DRN24125391, DRN24125481, DRN24124748,
DRN24122839, DRN24125273, DRN24124507, DRN24124233

MODE OF STUDY : FULL TIME

LECTURERS NAME : Mrs. SHULA MWELWA

DUE DATE : 30TH JANUARY 2024

ASSIGNMENT NO. 1: MAJOR PUBLIC HEALTH PROBLEMS IN ZAMBIA

QUESTIONS
DISCUSS THE TOP 10 COMMUNICABLE DISEASES UNDER THE FOLLOWING
HEADINGS:

I. DEFINITION OF THE COMMUNICABLE DISEASE

II. CAUSES/ PREDISPOSING FACTORS
III. PREVENTION AND CONTROL AT COMMUNITY LEVEL
INTRODUCTION

A disease refers to any deviation from normal or an interruption of the normal structure or
function of any body part, organ, or system that is manifested by a characteristic set of
symptoms and signs, whose aetiology, pathology, and prognosis may be known or unknown,
(Dorland’s medical dictionary 2007). Any condition where the body or any part of the body
does not function properly and there is usually a pathological reason behind the condition.
Diseases can be grouped into two categories, that is communicable diseases and non-
communicable diseases. The following piece of writing put much emphases on types of
communicable disease that are a major health problem in Zambia, focusing on the causes or
predisposing factors and prevention methods at both national and community level.
Communicable diseases, also referred to as infectious or contagious diseases is an illness
caused by pathogenic microorganisms such as viruses, bacteria, parasites and fungi, directly
or indirectly from person to person or animal to person or through environmental sources. A
few examples of communicable diseases include HIV and AIDS, malaria, Covid 19,
influenza, pneumonia, schistosomiasis, diarrheal diseases and tuberculosis. Transmission can
be through blood, body fluids, contaminated surfaces, contact and respiratory droplets. Health
public measures and hygiene helps prevent the spread of communicable diseases.
Research from Human Development Network shows that communicable diseases cause more
than 50% deaths and more than 60% of DALY (disability adjusted life year) loss among the
20% of the global population living in countries with the lowest per capita incomes (Zambia
is, a low income country according to the world bank report as of 2024), compared with 34%
of deaths and 44% of DALY loss among the entire global population.
Cholera, a highly infectious disease primarily transmitted through contaminated water and
food, manifests due to several predisposing factors. Firstly, drinking from contaminated water
sources constitutes a significant risk factor. This is particularly prevalent in areas where
maintaining a sanitary environment, including access to safe water, is challenging.

Poor sanitary practices, such as consuming food without adequate hand washing, contribute
to the spread of cholera. Contaminated hands can easily transfer the cholera bacteria to food,
perpetuating the transmission cycle.

Additionally, the consumption of raw or undercooked seafood, especially from coastal waters
where the bacteria thrive, poses a heightened risk of cholera infection. Seafood sourced from
contaminated environments can serve as a vehicle for the transmission of the pathogen.

Fruits and vegetables, if not properly washed or rinsed with contaminated water, can also
harbor cholera bacteria. Ingesting these contaminated foods increases the likelihood of
infection.

An intriguing correlation exists between blood type and susceptibility to cholera. Individuals
with type O blood are twice as likely to develop cholera compared to those with other blood
types, although the precise reasons for this association remain unclear.

Moreover, individuals with reduced or absent stomach acid face an increased risk of cholera
infection. Normally, stomach acid creates an acidic environment hostile to cholera bacteria.
However, individuals with low stomach acid levels, such as children, older adults, and those
who use antacids or proton pump inhibitors, lack this protective mechanism, rendering them
more susceptible to cholera.

In conclusion, a combination of environmental, behavioral, and physiological factors

contributes to the occurrence and spread of cholera, highlighting the importance of
comprehensive preventive measures and public health interventions.

National Prevention and Control Measures

Water and Sanitation Intervention: Ensuring a safe and clean water supply is paramount in
preventing cholera outbreaks. Implementing methods to regularly test and monitor
environmental water sources for the presence of Vibrio cholerae is crucial. Distributing
chlorine tablets to households, along with clear instructions for their proper use, can also be
effective in water disinfection.

Surveillance and Reporting Strengthening: Enhancing surveillance systems by improving

reporting mechanisms, ensuring timeliness, and enhancing data quality through the
deployment of electronic systems can aid in early detection and response to cholera
outbreaks.

Oral Cholera Vaccines: The use of oral cholera vaccines is instrumental in preventing cholera
outbreaks. Currently, the World Health Organization (WHO) has pre-qualified three vaccines
– Dukoral, Shanchol, and Eurichol Plus – which can be deployed to at-risk populations.

Reinforcement of Food Safety Laws and Inspection: Strengthening food safety laws and
implementing rigorous inspection protocols can help ensure safe food preparation practices,
thereby reducing the risk of cholera transmission through contaminated food.
Prohibition of Large Funeral Gatherings: Implementing regulations to prohibit large funeral
gatherings, particularly for individuals who have died from cholera, can prevent the spread of
the disease within communities.

Mass Media Communication: Utilizing mass media platforms such as television broadcasts to
disseminate information about cholera, its prevention, and control measures can help educate
the population and raise awareness about the disease.

Prevention and Control at the Community Level

Boiling Water: Encouraging community members to boil water before drinking it can
effectively kill cholera bacteria and reduce the risk of infection.

Hand Hygiene: Promoting regular handwashing with soap and water, or the use of sanitizers,
can prevent the transmission of cholera bacteria through contaminated hands.

Avoiding Handshakes: Advising individuals to refrain from handshakes can minimize direct
contact and reduce the likelihood of cholera transmission.

Safe Dishwashing Practices: Emphasizing the importance of washing dishes and utensils with
warm water and soap can prevent contamination of food and water sources.

Sanitation Facilities: Encouraging the use of toilets or safely managed sanitation facilities for
proper disposal of feces can prevent environmental contamination and the spread of cholera.
Safe Food Handling: Promoting the thorough cooking of food, keeping it covered, consuming
it while hot, and peeling fruits and vegetables before consumption can reduce the risk of
ingesting cholera-contaminated food.

Oral Hydration: Implementing oral rehydration therapy at the community level, with the
assistance of trained community healthcare workers, can help manage dehydration associated
with cholera and prevent complications.

WHO states that malaria is a sudden feverish illness caused by plasmodium parasites, which
are transmitted to humans by bites from anopheles mosquitoes that are infected. Once
infected, individuals experience recurring "attacks" characterized by shivers and chills, high
fever, and subsequent sweating and return to normal body temperature. Typically, signs and
symptoms of malaria manifest within a few weeks after being bitten by a mosquito carrying
the infection.
Nevertheless, certain strains of malaria parasites have the capability to remain inactive within
your body for a period of up to one year. Failure to eliminate stagnant water or neglecting to
trim tall grass and bushes within the community will consequently facilitate the breeding of
mosquitoes, thereby exposing people to a heightened risk of being bitten and consequently
increasing the prevalence of malaria cases.

The World Health Organization has reported that malaria constitutes a substantial public
health concern in Zambia, with an approximate 3.7 million cases. In 2021, Zambia recorded
one million cases of malaria with an incidence rate of 189.7 cases per 1,000 people, leading
to 8,806 deaths. Despite initially meeting the goals outlined in the Global Technical Strategy
for Malaria, Zambia has been unable to reduce the incidence rate according to the targets set
since 2019. As a result, the country is no longer on track to achieve its objectives.
Specifically, in 2021, the incidence rate was 188 cases per 1,000 population.

However, there are measures that can be implemented to address this issue. Services in the
Solomo islands specifically found that pregnant women and children face an increased
likelihood of falling ill and perishing from malaria. Consequently, pregnant women are
provided with a weekly medication during their antenatal care to prevent infection and
safeguard their unborn child.
The infection of schoolchildren consequently leads to elevated levels of absenteeism,
resulting in a temporary halt to education. As a result, schools receive encouragement to
implement hygienic practices. Therefore schools are encouraged to start up clean up
campaigns that will help clean the schools and community and this will eliminate all breeding
places of mosquitoes.Environmental cleanup schemes put in place by the government such
as clearing bushes and cutting of tall grasses will help prevent the disease .Use of insecticide
that will help in termination of mosquitoes.The government can also donate treated mosquito
nets to communities that will protect people from the biting of mosquitoes .The ministry of
health on the 2nd of November 2023 distributed treated mosquito nets in Chongwe district in
Lusaka.
The Ministry of Health through the National Malaria Elimination Centre (NMEC) supported
by partners will be distributing over 11.5 million Long – Lasting Insecticide Treated Nets
countrywide protecting over 19 million people against malaria. They also intend to spray a
total number of 895, 266 eligible and targeted structures, protecting over 3,863,229 million
people.Toyota Zambia also handed over 5,400 Mosquito nets as a contribution towards the
Malaria Elimination program by 2021. Other measures include indoor residual
spraying,presumptive treatment which is killing of the malaria parasite in the blood before
they cause malaria .Mosquito repellents and local remedies are also other measures that can
be used to prevent malaria cases from rising.Lastly individual protection whic is wearing long
sleeve and trousers .

Human Immunodeficiency Virus (HIV) is an infection that targets the body's immune system,
leading to acquired immunodeficiency syndrome (AIDS), the disease's most advanced stage.
HIV primarily attacks white blood cells, compromising the immune system's ability to defend
against diseases such as Tuberculosis, infections, and certain cancers. Transmission occurs
through infected bodily fluids like blood, breast milk, semen, and vaginal fluids, including
from mother to child during childbirth or breastfeeding. Notably, HIV/AIDS cannot be
transmitted through casual contact like hugging or sharing food.

The signs and symptoms of HIV vary depending on the infection's stage. Early symptoms
may include fever, sore throat, rash, and headache, while untreated HIV can progress to
weight loss, diarrhoea, cough, and swollen lymph nodes. The virus spreads more easily
during the initial months after infection, and without treatment, individuals may develop
severe illnesses such as Tuberculosis.

Transmission of HIV primarily occurs through the exchange of various bodily fluids,
emphasizing the importance of preventive measures. However, individuals with HIV who
receive Anti-Retroviral Therapy (ART) and maintain an undetectable viral load do not
transmit the virus to their sexual partners. Timely access to ART and consistent treatment
adherence are crucial not only for improving the health of those with HIV but also for
preventing transmission.

Certain behaviors and conditions increase the risk of contracting HIV, including receiving
unsafe injections or blood transfusions and engaging in unprotected anal or vaginal sex.
Prevention strategies include consistent condom use, regular HIV and sexually transmitted
infection testing, and access to harm reduction services for individuals who inject drugs.

Furthermore, Anti-Retroviral Virus (ARV) treatment can prevent mother-to-child

transmission of HIV. Pregnant women living with HIV should promptly receive ARV
medication, safeguarding their health and preventing transmission to the fetus during
pregnancy or through breastfeeding. Effective prevention, testing, and treatment efforts are
essential in combating the HIV/AIDS epidemic and reducing its impact on individuals and
communities.

Chickenpox is a highly contagious viral infection characterized by an itchy blister-like rash

on the skin. Common symptoms include sore throat, blisters, fever, loss of appetite, and
itching, among others. The virus spreads through airborne respiratory droplets when someone
coughs or sneezes. Additionally, it can be transmitted through saliva, such as when sharing
food or drinks, and through skin-to-skin contact like hugs or handshakes. Contaminated
surfaces can also habour the virus, facilitating its spread.
Prevention of chickenpox is essential at both the community and national levels. Community
education on practicing good hygiene can help reduce transmission. Infected individuals
should stay home to prevent further spread, and quarantining at the national level can also be
effective. Vaccination is another crucial measure for preventing chickenpox and reducing its
impact on public health. By implementing these strategies, the incidence of chickenpox can
be significantly reduced, protecting individuals and communities from this contagious
disease.

Influenza is a contagious respiratory disease caused by influenza viruses. It is also referred to

as an acute communicable viral disease of the respiratory tract. Influenza is usually seasonal
in nature but can also exist throughout the year. There are different types of influenza viruses
and this includes Influenza A, influenza B and influenza C. The most common is influenza A
which mostly affect humans and animals. Influenza B primarily effect humans while
influenza C causes milder respiratory symptoms. Influenza viruses are also referred to as
orthomyxoviruses. It manifests with symptoms such as fever, cough, sore throat, body aches,
prostration, coryza and fatigue. Influenza can lead to severe complications, particularly in
vulnerable populations, and it poses a significant public health concern due to its ability to
cause seasonal outbreaks and occasional pandemics. A great example is the Spanish Flue of
1918 to 1919 which was one of the deadliest affecting one third of the world global
population. This pandemic affected mostly young adults.

The most common cause of influenza is influenza A and B, with influenza A having various
subtypes (H1N1, H3N2) potential for pandemics. These viruses go through genetic changes
through antigenic shift and drift. Transmission occurs through respiratory droplets when an
infected person talks, coughs or sneezes. Transmission can also be indirect because these
viruses can survive on environmental surfaces for certain periods hence more spread of the
seasonal influenza when people come in contact with contaminated surfaces and then touch
their faces.

There are a various number of factors which can make the population susceptible to seasonal
influenza. Young children below the age of five and elderly individuals are more prone to
influenza. Children have a developing immune system which is not fully established to fight
against such infections and may be more susceptible to the disease and in elderly individuals,
immune function may decline with age, increasing the risk of severe complications. Pre-
existing health complications like cardiovascular diseases and chronic respiratory diseases
increases the chances of individuals getting an infection. Conditions like cancer and other
communicable diseases like HIV and AIDS or other medications may weaken the immune
system, causing vulnerability to infections. A huge population in public places such as
schools, or market places increases person to person contact and facilitating virus
transmission. Visiting areas with an ongoing influenza activity increases the probability of an
individual getting an infection. Hospitals are environments where patients, -healthcare
workers, and visitors are in close contact, facilitating the transmission of infections therefore
Individuals with weakened immune systems are more susceptible to infections, and hospitals
often have a higher concentration of such patients.

Influenza is a disease which has potential to kill millions of people within a population
worldwide and health organizations have recognized the need to fight against communicable
diseases such as influenza which can be a threat to the world population. This has sparkled
international collaboration between states and institutions to manage such infections. From a
period of 2008 to 2017 in Zambia most populated cities like Lusaka and Copperbelt, a
surveillance system was put in place aiming to collect and analysing data, as well as
providing the information which leads to action being taken to prevent and control seasonal
influenza. To a greater extent, the measure worked in studying the contribution of influenza
viruses to the respiratory diseases in Zambia. Implementing and promoting routine
vaccination programs, especially for high-risk populations, to protect against vaccine-
preventable diseases, including influenza. The nation also conducting public awareness
campaigns to educate the population on preventive measures, symptoms, and the importance
of seeking medical care promptly. The Zambian government has also been improving health
care facilities, ensuring adequate resources, and enhancing the capacity to handle infectious
diseases effectively as shown by key national healthy indicators such as infant mortality rate,
under five mortality and maternal mortality, however improved over the review period.
Implementing strict measures in healthcare settings by the health organization in Zambia to
minimize the spread of infections, including proper hand hygiene, isolation precautions, and
use of personal protective equipment such as mask. The nation also enhanced the capacity of
healthcare professionals through training programs to effectively manage infectious diseases
and this was evidenced by the improvement in population to doctor ratio, which was 5900 in
2019 as compared to 10886 in 2016 and the population to nurse ratio also improved by 955
per nurse from 1366 per nurse. Influenza is seasonal in Zambia and other sub Saharan
countries, and annual influenza vaccination campaigns target high-risk groups, such as
elderly individuals, healthcare workers, pregnant women, and individuals with underlying
health conditions. This helps reduce the impact of seasonal influenza outbreaks.

Communities also work with health workers to fight against influenza. Public health nurses
conduct awareness campaigns to educate the community about infectious diseases, their
modes of transmission, and preventive measures. This includes, encouraging and teaching
proper hand hygiene, sanitation, and safe water practices within the community to reduce the
risk of infections. Communities also establishes systems for community based surveillance to
detect and report early signs of infectious diseases, facilitating prompt intervention and
organizing vaccination campaigns in collaboration with local health authorities to ensure that
community members receive necessary vaccines, especially for preventable diseases like
influenza. They also organize vaccination campaigns in collaboration with local health
authorities to ensure that community members receive necessary vaccines, especially for
preventing influenza and identifying or addressing social factors that contribute to disease
transmission, such as poverty, overcrowded living conditions, and limited access to
healthcare.

Leprosy is a chronic, curable infectious disease mainly causing skin lesions and nerve
damage. Also known as Hansen's disease, it has been around since ancient times and still
exists today, though it can be cured when detected and treated early. In 2019, leprosy cases in
Zambia numbered 206, showing fluctuations over recent years but tending to decrease from
2005 to 2019.

Signs and symptoms include numbness of affected areas of the skin, muscle weakness or
paralysis (especially in the hands and feet), loss of eyebrows and eyelashes, thick, stiff, or dry
skin, enlarged nerves (especially those around the elbow, knee, and in the sides of the neck),
and eye problems that may lead to blindness when facial nerves are affected.

The disease predominantly affects the peripheral nerves and affects the sense of sensitivity.
Prevention involves early diagnosis and treatment of infected individuals, with Rifampicin
antibiotic shared with those at most risk of developing the disease. Additionally, avoiding
contact with airborne droplets from the nose or mouth is recommended. In conclusion,
leprosy remains a major public health concern worldwide. All healthcare workers must have
a basic understanding of this disease to diagnose it effectively.

Tuberculosis (TB) is a disease caused by germs that are spread from person to person through
the air. These germs are mostly known as mycobacterium. There are two TB-related
conditions: latent (inactive) and active TB. The main difference between these two is that
active TB has a large amount of germs in the body, while inactive TB only has a small
amount. Active TB is characterized by abnormal chest x-rays or positive sputum smear or
culture, whereas inactive TB shows a normal chest x-ray and negative sputum smear.

TB bacteria spread through the air similar to colds and flu. One can get TB when they come
in contact with those who carry the germs. When someone with TB coughs, laughs, sneezes,
or sings, they release tiny droplets that contain the germs. If another person breathes in these
germs, they can contract the disease.

Symptoms of tuberculosis vary depending on the type. Inactive TB typically does not exhibit
any symptoms. However, active TB in the lungs may include a cough that lasts for three or
more weeks, chest pains, coughing up blood, feeling tired all the time, night sweats, chills,
fever, loss of appetite, and weight loss. Symptoms may differ across age groups, with
children aged 1-12 exhibiting symptoms such as weight loss, fever, sluggishness, a bulge in
the soft spot on their heads, fussiness, and feeding difficulties.

Prevention of tuberculosis involves limiting the spread of its germs by successfully finding
and treating people with the illness to prevent them from passing it on to others. This can be
achieved through raising awareness of TB so people with symptoms seek help immediately
and contact tracing, which involves screening close contacts of diagnosed individuals for the
illness. Simple precautions can also reduce the risk of infection, such as ensuring good
ventilation, practicing good hygiene by covering the mouth and nose when coughing and
sneezing, using protective face masks, or keeping potentially infectious patients separated
from others.

Treatment for tuberculosis typically lasts up to six months and may have side effects. TB
treatment usually consists of a combination of four antibiotics: Isoniazid, Rifampicin,
Pyrazinamide, and Ethambutal. Isoniazid, Rifampicin, and Pyrazinamide can be combined
into a single tablet called Rifater. After two months of this treatment, patients may switch to a
course of two antibiotics for four months, with Rifampicin and Isoniazid combined into a
tablet called Rifinah. Side effects of tuberculosis medicine may include nausea, dizziness,
skin rashes, pins and needles sensation, and flu-like symptoms.

Bilharzia, also known as schistosomiasis, is a parasitic disease caused by worms. In Zambia,

its distribution spans across the country, with Mufumbwe district and areas around Lake
Kariba in the southern province being the most heavily affected, particularly among school-
going children.

The causes of schistosomiasis are often linked to activities involving water. Crossing streams
on the way to school, playing in water, and women washing kitchen utensils in ponds
contribute to the spread of the disease.

To address the national prevalence of schistosomiasis, Zambia has implemented a control

program focusing on mass drug administration (MDA), provision of safe water, sanitation,
hygiene, and preventive chemotherapy. These measures aim to reduce the transmission of the
disease and improve overall public health.

At the community level, preventive measures include sanitation and education initiatives to
raise awareness about the disease. People are encouraged to avoid urinating or defecating in
still water, refrain from washing in stagnant water, and boil and treat drinking water to
prevent infection.

Referencing

Gwatkin, D.R and Guillot, M. (1999). Human Development Network, Health, Nutrition,
Population: Current Situation, future trends and Implications.
Rector. C, Stanley. M. J. (2020) Community and Public Health Nursing, Promoting Public
Health nursing. 1oth edition
Nies. M. A. and Mcewen. M. (2018). Community Public Health Nursing, 7th edition
Barry J. M. (2004), The Great Influenza, The story of the deadliest pandemic in history,
Viking Press