Global Leadership Training Programme in Africa 2014
RESEARCH REPORT

Studies for enhancement of strategies for the control of rabies in Zambia
Chiho KANKEO1

1

Hokkaido University, Graduate School of Veterinary Medicine, Research Center for Zoonosis Control, Unit of Risk Analysis
and Management, Doctoral course 2nd grade
The University of Zambia, 2nd December, 2014 – 30th April, 20151

Summary (English)
The purpose of this study is to perform risk assessment of rabies infection in the Republic of Zambia(Zambia). Risk assessment of rabies virus infection will lead to cost-effective control measures for rabies,
and the control measures will be implemented as risk management cooperating with the University ofZambia and the relevant authorities. As the first step of the research, in order to grasp the current situation on
the occurrence of rabies and its control programmes in Zambia, a survey on the vaccination status andantibody retention ratio against rabies virus in domestic dog population, and a KAP survey against dog rabies
and its control among dog owners were conducted. Furthermore, information on the rabies situation in
Zambia was collected from the relevant authorities regarding the rabies control measures. The survey was
conducted in two different areas which were Mazabuka and Monze districts in Southern Province, andLusaka district in Lusaka Province. A total of 736 dogs were vaccinated and 265 canine sera were collected
through mass vaccination in Mazabuka and Monze districts. In Lusaka district, a total of 278 canine sera
were collected visiting households with dog(s) and 224 KAP survey questionnaires were collected at thesame time. The results of the survey conducted by GLTP in Africa 2014 are now in the progress of analysis.
The canine sera samples are going to be measured the antibody titre against rabies virus then the data ofantibody titre will be collated with the vaccination record of each dog. Moreover, all of the data obtained in
the survey may be analysed by multivariate analysis, then epidemiological factors correlating withvaccination status in dog population in Zambia may be identified. Finally risk analysis for the control ofrabies will be conducted using all of the data which obtained in the survey and the data from the previous
literatures to determine the factors associated with the risk of rabies occurrences in Zambia. It will contributeto risk management to carry out the cost-effective control measures for human rabies in the future. All of theoutcomes of this research are going to be published as a doctoral dissertation in around 2017.

2

Summary (日本語)本研究の目的はザンビア共和国(以下ザンビア)において狂犬病のリスクアナリシスを実施し、リスクアセスメントを通して費用対効果の高い狂犬病対策方法を検討し、大学および関連機関と協力してそれらの対策法をリスクマネジメントとして実施することである。その第一段階として、現在のザンビアにおける狂犬病発生の実態や狂犬病制御対策(主に飼い犬におけるワクチン接種)の実施状
況について把握するために、Global Leadership Training Programme in Africa 2014 において、ザンビアの飼い犬におけるワクチン接種状況と狂犬病抗体保有についての調査、そして犬の飼い主を対象とした狂犬病についての Knowledge, Attitudes and Practices (KAP) 調査を実施した。また、ザンビアにおいて狂犬病制御対策を実施している関連機関においてザンビア国内の狂犬病の発生に関する情報を収集した。南部州に位置するマザブカ郡・モンゼ郡および首都であるルサカ郡が対象とされた。
マザブカ・モンゼの両郡では、集団狂犬病ワクチン接種が実施され、合計 736 頭の飼い犬がワクチンを接種され同時に 265 頭の飼い犬が血液を採取された。ルサカ郡においては犬を飼育する家庭を訪問し、合計 278 頭の飼い犬が採血された。また、224 人の飼い主から KAP 調査の回答を得た。
GLTP in Africa 2014 で得られた調査結果は現在解析中であり、採取された犬血清中の狂犬病ウイルスに対する中和抗体価とワクチン接種時期や使用されたワクチンの種類等の関連について結果を照合する予定である。そして、犬の個体情報や飼い主情報、KAP の回答を合わせた多変量解析を実施し、ザンビアにおける犬集団のワクチン接種状況に関連する疫学的要因を検討する。また、調査結果や関連機関、過去文献から得られたデータをもとに、ザンビアの狂犬病制御対策のためのリス
クアナリシスを実施し、狂犬病発生のリスクと関連する要因を探し出し、今後の費用対効果の高い
狂犬病制御対策法を実施するためのリスクマネジメントにつなげる。本研究は調査者の博士号論文として発表されるため、最終的な調査結果の発表は 2017 年ごろになる見込みである。

3

Background
Rabies has been known since antiquity as one of the most feared zoonotic diseases. Today, it still causes
approximately 55,000 deaths per annum, predominantly among children in Asia and Africa (Knobel et al.,2005). Rabies is a viral disease caused by rabies virus belonging to a neurotropic species of Lyssavirus, amember of the family Rhabdoviridae, that has tropism for the central nervous system and the salivary glands(Stedman’s Medical Dictionary, 2006). Transmitted by saliva from the bite of an infected animal, thesymptoms are characteristic of a profound disturbance of the nervous system, e.g., excitement,
aggressiveness, and madness, followed by paralysis and death, in the absence of timely post-exposure
prophylaxis (PEP). In animals, clinical signs are variable, and sometimes salivation and tongue paralysis are
the only signs. Although rabies may affect all species of warm-blooded animals, the majority of humanrabies cases are intermediated by domestic dogs (Lembo et al., 2010).
Though rabies is fatal once clinical signs appear, it is fully preventable in the presence of appropriate
vaccine programme and PEP. Nevertheless, rabies cases in human and animal have still been prevalent inmost of the countries in the world. The main reason of this situation is considered that costly pre-exposure
vaccine and post-exposure vaccine is enormous burden for both of the health sector of the government andindividuals and its resultant incomplete distribution of pre or post-exposure vaccine against rabies (Knobel etal., 2005). Now dog vaccination is regarded as the most effective control strategy against animal as well as
human rabies with the combination of dog population control, registration system for owned dogs,
movement regulations and elimination of stray dogs, however, covering the entire dog population in thenation as the target for control is always accompanied by difficulties concerning about economic andadministrative argument (Durr et al., 2009). Additionally some other reasons such as presence of wildlife or
cross-border of rabid animals hamper the control of rabies in the world. Involving these various factors,
execution of control strategy against rabies becomes complicated therefore, rabies is also considered one of
the Neglected Tropical Diseases particularly in the developing countries.
In this study, rabies situation in Zambia was focused on. For collecting the fundamental information toconsider the overall situation of rabies in Zambia, the basic data of dog population was researched and thefeatures of the population were cleared. Besides, the vaccination status of the dog population was studied.
The vaccination status in domestic dog population was commonly considered to be crucial for the control ofrabies outbreak. Furthermore, the Knowledge, Attitudes and Practices (KAP) survey in human against rabies
infection and its control was also conducted. The official information on rabies from the relevant authorities
was also collected as much as possible.

Purpose of the study
The study was designed to understand the features of dog population and its vaccination status againstrabies in target areas and to summarize KAP against rabies and its control in humans as the fundamental
study to develop an advanced risk analysis of human rabies in Zambia in the future.

4

Strategies
For achieving the purposes, the following strategies were built up.
i)

To understand the features of dog population and its vaccination status against rabies in target areas inZambiaFor achieving this, canine blood sampling and collection of information from dog owners were planned.
It is to obtain the information of particulars of domestic dogs and vaccination status and to confirm thatdogs have enough immunity to protect rabies virus infection conferred by vaccination.

ii) To summarize KAP against rabies and its control in humans
It is to evaluate KAP in humans against dog rabies. It will contribute to promote the control measures,
particularly in education and sensitization against rabies.
iii) To collect the information about rabies from relevant authorities
It is important to grasp the situation in Zambia and to utilize for developing the risk analysis model todetermine the high risk factors to be controlled and managed in the society.

Study areas
Two types of target areas were selected from local area and urban area in Zambia. The selected areas were
Mazabuka and Monze districts in Southern province as the local area, and Lusaka district in Lusaka province
as the urban area. In Mazabuka district, the area of the district is 6,242 km2, human population is 261,268(2010) and the dog population registered is 12,916 (2012). In Monze district, the area is 4,854 km2, humanpopulation is 195,921 (2010) and 16,136 dogs are estimated to be kept (2014). These two areas areneighboured each other. Several times of outbreaks of rabies in humans and dogs have been reported in
Mazabuka district recent years and the outbreaks also have been reported in Monze districts. However, little
data was available about immunization coverage in dog population nevertheless the adequate level of
immunization coverage in dog population highly contributes to prevention from outbreak in not only dog
population but also human population. The area of Lusaka district is 360 km2 and the population is 1,742,979(2010), the dog population in Lusaka district is 26,000 (The National Livestock Epidemiology andInformation Centre, 2009/Central Statistical Office, 2011). The high density area of humans like Lusaka is
an important area for the control and containment of the disease not to spread the outbreak to the other areasin the nation.

Materials and Methods
1. Canine blood sampling in the target areas
The mass vaccine campaign was conducted to gather the domestic dogs in Mazabuka district (14th to 15th
February, 2015) and Monze district (28th February 2015) under the cooperation of Mazabuka and Monze
District Veterinary Office (DVO), respectively. Simultaneously with the mass vaccination against rabies,
blood sample collections were carried out from cephalic vein on the foreleg of the dogs with the consensus
of the owners. The information about particular of owners and dogs, vaccination history was collected fordata analysis.
5

In Lusaka district, sampling was conducted from 23rd March 2015 to 17th April 2015 following WHO
Immunization Coverage Cluster Survey (World Health Organization. Dept. of Immunization, Vaccines andBiologicals, 2005/World Health Organization. Expanded Programme on Immunization, 2008). The goal ofthis two - stage cluster sampling design is to estimate immunization coverage to within ± 10% points of thetrue population, with 95% confidence. In the first stage, 20 of clusters, which are wards of constituencies in
Lusaka district, are selected with probability proportionate to the size (PPS) of the population in the cluster.
Sampling with PPS allows the larger clusters to have a greater chance of being selected. In the second stageof sampling, 10 subjects are selected within each cluster. Although the sampling unit is the individual subject,
the sampling is conducted on the household level. To identify the clusters, the number of households in
Lusaka district is extrapolated for the population to be surveyed representing the dog population. In thisstudy, 20 wards out of 33 wards in 7 constituencies in Lusaka district are selected to be surveyed as theclusters based on the PPS (details in appendix).
The minimum sample size is calculated by the following formula.

 p  1  p n  DE  z 
2

1 / 2d2

α: the desired confidence levelp: expected coveraged: the desired width of the confidence interval
DE: the ratio between the variance from the cluster design to the variance that would be obtained from a
simple random samplen  2

1.962  0.5  1  0.5 192.08
0.12
192.08
 9.60420clusters 

Ten subjects are sampled in each cluster, that is to say, 1 dog is sampled from each household which hasdog(s) and 10 households are visited in one cluster in total. In the target households with dog(s), vaccinationand simultaneous blood sampling were carried out and the information about particular of owners and dogs,
vaccination history was collected for data analysis. It was also done with the consensus of the owners.
2. KAP survey in human
The KAP survey through questionnaires was implemented in Lusaka district at the same time the canine
blood sampling in the same period. The dog owners in the district were interviewed about the knowledge on
rabies and the control of rabies and attitudes and practices for the control of rabies using questionnaire sheet.
The questions in the KAP survey were e.g. the numbers of dogs kept in the household, how to keep the dogs
in the household, knowledge about the rabies clinical signs or transmission, etc. If the actual dog’s owner6was absent when interviewers visited the household, a representative from the household was interviewed forquestionnaire. In both cases, the interviewees were 16 years old and more based on the official age forsuffrage in Zambia.
3. Collection of the information regarding rabies cases in Zambia from relevant authorities
The information regarding rabies in animals and humans in Zambia were collected from the relevant
authorities. The information about rabies cases and its control in animals was obtained through the Directorof Veterinary Public Health Sub-unit, Veterinary Services Unit, Department of Veterinary Services, Ministryof Agriculture and Livestock on 17th February 2015. The information about rabies cases and bite cases inhuman and the control of rabies from medical side was obtained from the Director of Disease Control andSurveillance, Ministry of Health on 7th April 2015. Furthermore, the any other information about rabies wascollected through the activity period by contacting the relevant officers in the DVO or professors andlecturers in the university.

Results
1. Canine blood sampling in the target areas
A total of 736 dogs were vaccinated and 265 canine blood samples were collected through mass vaccinationin Mazabuka and Monze districts in Southern province. In Lusaka district, a total of 278 canine blood
samples were collected. These samples are going to be measured the level of immunity against rabies virus
which is considered to have been induced by previous rabies vaccine by the golden standard defined by theWorld Organization for Animal Health. The antibody titre in each canine serum will be collated with theinformation of the particulars of the dog and its owner including the information of vaccine history. Then, thelatest time when the dog was vaccinated will be compared with the actual level of antibody titre. The statusof vaccine coverage in the dog population and the antibody retention ratio will useful to consider theeffectiveness of the vaccination programme and the effectiveness of the vaccines in the field. It may
contribute to reconsideration of the vaccination programme to reach further high immunization coverage andit will finally attain the control of rabies outbreaks in domestic dogs. Achievement of the control of rabies
outbreaks in domestic dogs will lead to the reduction of human rabies.

Picture 1. Mass vaccination

Picture 2. Blood sampling7

2. KAP survey in human
A total of 224 questionnaire responses for KAP were obtained from dog owners in Lusaka district. Throughthe collection of the information of dogs and owners and the result of KAP survey, the features of dog
population and dog owners were observed. The dogs were mainly kept without using collars and they wereusually free-range except for the cases that the owner’s house had complete fence to surround the house or
the cases using the chains to hold the dogs. It was the first time for 34% of the dog population sampled blood
to be vaccinated in their life at the time of sampling in Lusaka district. In Mazabuka and Monze district, 45%of dogs have never been vaccinated before at the time of the sampling. Besides, the situations for
safekeeping of the vaccination records by the owners were different between in urban area and rural areas.
The dog owners in the urban area were more likely to keep the previous vaccine certificate for their dogs
properly compared with the dog owners in the local areas. The further analysis of these data is now inprogress.

Picture 3. KAP survey in Lusaka district

3. Collection of the information regarding rabies cases in Zambia from relevant authorities
Various types of information about e.g. the annual number of bite case in humans, the annual number ofrabies cases in animals and humans, respectively, the annual use of vaccine against rabies in animal, etc.,
were collected through the relevant authorities. The data is going to be utilised to develop the risk analysis
model and to consider overall situation in rabies in Zambia. The risk analysis will show the risk factors(areas, behaviour or phenomena etc.) for rabies occurrences and it will be also useful to estimate the real
number of cases of rabies. The outcomes of the risk analysis will make the cost-effective control measuresagainst rabies possible to be carried out with limited resources for obtaining the maximum effectiveness. The
outcomes may be able to be proposed to the Ministry of Agriculture and Livestock and the University ofZambia. The control measures found to be effective and necessary will be implemented collaborating with
the DVO which has the jurisdiction including the high risk areas of rabies.

Discussion
The samples and data from the field activities in Zambia have still been in the process of experiment in the8laboratory and in the analysis. They are unfortunately unable to be shown in this report so that it is
impossible to discuss the study outcomes, however, only the current situation of dog population and on
rabies in Zambia is able to be mentioned here.
Firstly, through the collection of the information on dogs and owners and the results of KAP survey, thefeatures of dog population and dog owners were observed. According to the primary analysis of the result, it
implied that the features of dog population and dog owners would be different between in the local areas andthe urban area. It means that the fully effective approaches to enhance the control of rabies might not be
entirely same between these areas. The results of the analysis for the features of the dog population and theowners between in the local areas and the urban area will be completely disclosed in the doctoral dissertationin 2017 with the result of the assay of canine blood samples detecting antibody titre level against rabies virus
in the dog population.
Secondly, through the information from the relevant authorities, the features of rabies control and rabies
cases in Zambia were cleared step by step. Rabies cases in humans and animals have been occurred regularly
in Zambia. Munang’andu et al. reported a total of 98 cases in humans, 747 cases in dogs, 139 cases in cattle,
49 cases in the other domestic animals and 37 cases in wildlife were confirmed as rabies from 1985 to 2004
in Zambia. Rabid dogs constituted 69.9% (747 samples) of the total rabies positive cases from humans,
domestic animals and wildlife during the period. The monthly distribution of dog rabies reflects an averageof 2.93 (95% CI: 2.59-3.29) positive cases per month for the period 1985-2004 (Munang’andu et al. 2011).
Furthermore, an association was found between the provincial human population density and dog rabies
cases (Munang'andu et al., 2011). In another report, a total of 46, 36, and 24 cases were confirmed as dog
rabies cases in 2010, 2011, and 2012, respectively. The total fatal numbers of human rabies diagnosed onclinical grounds were 2 cases in 2010, 3 cases in 2011 and 5 cases in 2012. The numbers of people bitten bydogs were 620 in 2010, 732 in 2011 and 595 in 2012 in Zambia (Kayesa, 2012). Considering theseinformation from the previous literature, rabies infection occurrences have been maintained with the regularnumber of cases in humans and animals since several decades before, particularly cases in dogs haveoccupied the big numbers of rabies infection in Zambia, it implies that the control of rabies infection in dog
population will highly contribute to the control of rabies infection in the nation. Regarding the human cases,
they have been reported mainly according to the clinical signs-based diagnosis because the family of
deceased are likely to decline the laboratory diagnosis. Considering the several hundreds of bite cases inhumans per annum and inconvenient access to hospitals in rural areas, the number of rabies cases in humanmight be underreported. For controlling the situation of rabies in Zambia, the Ministry of Agriculture andLivestock, the Ministry of Health, the Zambia Wildlife Authority, the Central Veterinary Research Instituteand the District Councils are mainly involved in the control of rabies in the country. They have regularmeeting to share the epidemiological information in the different levels such as district level, provincial levelor national level. However they also have other various public health problems like control of HIV/AIDS andTuberculosis, diagnosis and treatment of Malaria or shoreline operation to prevent invasion of Ebola virus
infection so that sometimes the prioritisation in infectious diseases field under public health issues may bedifficult in the limited sources. Furthermore, as the previous literature reported, wildlife has been considered9to be important to maintain rabies virus in the ecosystem of Zambia(Röttcher and Sawchuk, 1978,

Berentsen et al., 2013,). As Röttcher and Sawchuk observed that outbreaks of bovine rabies coincided bothseasonally and geographically with outbreaks in Jackals on the Kafue flats where geographically overlapped
between the national parks, game management areas and the wetlands which allows for the co-existence ofdomestic animals and wildlife (Röttcher and Sawchuk, 1978), rabies occurrences in Zambia are said that theymostly begin where the National Park locates near. However, the observation conducted by Munang'andu etal. indicated that the domestic dog was a more likely candidate to transmit rabies to cattle than the jackal(Munang'andu et al., 2011). More investigations are expected to be performed about rabies situation andcirculation in the ecosystem in Zambia. Moreover, the control of rabies in wild animals is more complicatedthan domestic animals. It has been attempted mainly in Europe and North America and the attempts havegiven the consistent results in those areas. However the trials mostly needed organized strategies beyond theadministrative jurisdictions. Cooperation and big driving force among the relevant agencies may be required
to conduct the projects in wild animals. As the conclusion, vaccination of dogs is much easier and primarymeasure to prevent the outbreak of rabies compared with the control of rabies in wildlife, so promotion of
vaccination in domestic dogs and education about rabies is highly important.

Future plan
The experiment and analysis are still in progress. The primary outcomes of the field activities in thisprogramme are now under the next step of analysis for developing an advanced risk analysis study. The
information on the dog and its owner which collected at the same time with the blood sampling have been
added and statistically analysed. Now the experiment to measure the antibody titre against rabies virus in thecanine sera is under progress. The results of all the data of antibody titre level in the canine sera will becollated with the basic information. It will take approximately 1 year to complete all of step of this study as
the doctoral dissertation.
Unfortunately the detailed outcome data is not able to be shown here, however, the outcomes whichobtained in the field activities will contribute to build up the risk analysis model of rabies in Zambia. The
risk analysis will reveal the burden of rabies in the society as visualised and the high risk factors or control
points to prevent the outbreak based on cost benefit. The outcome of the risk analysis should be utilized topromote risk management of rabies in Zambia. It will be introduced to the University of Zambia and theMinistry of Agriculture and Livestock, Zambia. The outcomes of the study will be utilized to take the risk
based cost effective control measures for particularly in the high risk areas for rabies occurrencescollaborating with each DVO under the Ministry of Agriculture and Livestock.

Reflection on the GLTP in Africa
The five months period of the activities in Zambia were seriously challenging, however, it were also heavily
valuable as the precious opportunity to develop the capability on how to plan and how to conduct the
research and how to affect the supporters to make the united team to conduct the research. The experiences
earned in this programme will contribute to my future as the researcher to be involved the activities for10

promoting humans and animals’ health and well-being in the African countries. I also hope that the outcomeof the study will contribute to promotion of the activities for the public health on-site in the future.

Acknowledgement
I would like to deeply thank the Global Leadership Training Programme in Africa 2014, the Institute for the
Advanced Study of Sustainability, the United Nations University for the funding and kind support.
I am also grateful to my host institute, namely the School of Veterinary Medicine, the University of Zambia,
the Research Center for Zoonosis Control, Hokkaido University and the Hokudai Center for Zoonosis
Control in Zambia.

References
2006. Stedman’s Medical Dictionary.
Berentsen, A.R., Dunbar, M.R., Becker, M.S., M'soka, J., Droge, E., Sakuya, N.M., Matandiko, W., McRobb,
R., Hanlon, C.A., 2013. Rabies, canine distemper, and canine parvovirus exposure in large carnivore
communities from two Zambian ecosystems. Vector Borne Zoonotic Dis 13, 643-649.
Durr, S., Mindekem, R., Kaninga, Y., Doumagoum Moto, D., Meltzer, M.I., Vounatsou, P., Zinsstag, J., 2009.
Effectiveness of dog rabies vaccination programmes: comparison of owner-charged and freevaccination campaigns. Epidemiol Infect 137, 1558-1567.
Cenral Statstial Offce, the Republic of Zambia, 2011.2010 CENSUS OF POPULATION AND HOUSING.
LusakaKayesa, E., 2012. ZAMBIA COUNTRY REPORT. In: Group, S.a.E.A.R. (Ed.), Southern and Eastern
African Rabies Group: rabies diagnosis and surveillance 2010-2012.
Knobel, D.L., Cleaveland, S., Coleman, P.G., Fèvre, E.M., Meltzer, M.I., Miranda, M.E., Shaw, A., Zinsstag,J., Meslin, F.X., 2005. Re-evaluating the burden of rabies in Africa and Asia. Bull World HealthOrgan 83, 360-368.
Lembo, T., Hampson, K., Kaare, M.T., Ernest, E., Knobel, D., Kazwala, R.R., Haydon, D.T., Cleaveland, S.,
2010. The feasibility of canine rabies elimination in Africa: dispelling doubts with data. PLoS Negl
Trop Dis 4, e626.
Munang'andu, H.M., Mweene, A.S., Siamudaala, V., Muma, J.B., Matandiko, W., 2011. Rabies status in
Zambia for the period 1985-2004. Zoonoses Public Health 58, 21-27.
The National Livestock Epidemiology and Information Centre, Department of Veterinary Services, Ministryof Agriculture and Livestock, Lusaka, Zambia
Röttcher, D., Sawchuk, A.M., 1978. Wildlife rabies in Zambia. J Wildl Dis 14, 513-517.
World Health Organization. Dept. of Immunization, Vaccines and Biologicals, 2005. Immunization
Coverage Cluster Survey: reference manual. Geneva: World Health Organization
World Health Organization. Expanded Programme on Immunization, 2008. Training for mid-level managers(MLM) 7. Geneva: World Health Organization
11Annex: Identification of the clusters to be surveyed
Cluster Survey in LUSAKA district
Data: 2010 CENSUS OF POPULATION AND HOUSING PRELIMINARY REPORT (Cenral Statstial Offce, 2011)
Boldface and red：selected area as cluster to be surveyed
Constituency

No.

Chawama Constituency

Kabwata Constituency

Kanyama Constituency

Mandevu Constituency

Matero Constituency

Munali Contituency

Number ofhousehold

Cumulative number ofhousehold

ClusterNumber1

1

Nkoloma

16,501

16,501

2

Chawama

15,264

31,765

3

John Howard

6,093

37,858

4

Lilayi

3,050

40,9085

Kamwala10,04950,957

6

Kabwata

4,835

55,7927

Libala4,487

60,2798

Chilenje

10,52170,8009

Kamulanga

5,185

75,985

10

36,834

112,819

5,6

35,989148,808

7,8

12

Kanyama
Harry
Nkumbula
Munkolo

6,172

154,980

13

Silwizya

1,595

156,575

14

Independence

3,638

160,213

15

Lubwa

7,635

167,848

16

Kabulonga

12,704

180,552

17

Roma

14,120

194,672

18

Mulungushi

2,950

197,62219

Ngwerere

14,164

211,78620

Chaisa4,566

216,352

21

Justine Kabwe

8,560

224,912

12

22

Raphael Chota

18,999243,911

13

23

Mpulungu

11,490255,401

14

24

Muchinga

8,202

263,603

25

Kapwepwe

10,952

274,55526

Lima

13,195

287,750

27

Mwembeshi

13,016

300,766

16

28

Matero11,688

312,454

17

29

Chainda

8,485

320,939

30

Mutendere

22,729343,668

18

31

Kalingalinga

8,714

352,382

19

32

Chakunkula

6,647

359,029

33

Munali

9,335

368,364

11
Lusaka Central Constituency

Ward

Mwaanga

Sampling Interval

18418

Random Number

15120

12

2

3
4

9
10
11

15

20