An ecological and epidemiological single-season survey of Anaplasma and Ehrlichia positive ticks in Victoria Falls National Park, Zimbabwe.

There is an urgent need for continued research on the ecology of tick-borne diseases in Africa. Our objective was to provide a preliminary description of the ecology and epidemiology of tick species, tick-borne pathogens, and animal hosts in Zimbabwe, focusing efforts at Victoria Falls National Park, for a single season. We tested the hypothesis that tick surveillance and pathogen screening data can be used to model associations among ticks, hosts, and pathogens. We collected ticks from domesticated animals and wildlife in Zimbabwe and screened the ticks for the presence of Anaplasma and Ehrlichia bacteria. Nearly 30% of the screened ticks were PCR-positive; 89% of tick species were PCR-positive, and 88% of animal species carried at least one PCR-positive tick. We sequenced a subset of amplicons that were similar to three Anaplasma species and three Ehrlichia species. The odds of a tick being PCR-positive increased when many ticks were collected from the host or the tick was collected from a cow (domesticated animal). Tick species shared host species more often than expected. We demonstrate that ticks in northwestern Zimbabwe present a One Health problem for nearby wildlife and humans.

Development of a computerized information system in the Harare City Health Department.

The experience is reported with the health information system of the Health Department of Harare City, five years after its introduction. The system was evaluated in terms of the implementation procedure and improvements in the management process. It is concluded that careful management of the implementation process itself is a key to the successful realization of a health information system in developing countries. The statement that the quality of information produced during a computerization process is only as good as the original data fed into it, is emphasized.

Evaluation of a measles vaccine efficacy during a measles outbreak in Mbare, City of Harare Zimbabwe.

OBJECTIVE: To determine measles vaccine efficacy. DESIGN: Between October and November 1996, during a measles outbreak in Mbare, a retrospective study through interviews with care givers was performed. Thirty clusters were randomly selected and seven or more, nine to 35 months old children in each cluster were selected. SETTING: Mbare suburb, City of Harare SUBJECTS: 294 children aged nine to 35 months. MAIN OUTCOME MEASURES: Cases were classified in a two by two contingency table based on their vaccination status and measles status during the outbreak. Vaccine coverage, attack rates and vaccine efficacy were then calculated. RESULTS: Of the 294 children selected, 83% (95% CI 78.7, 87.3) were vaccinated and 9.5% had measles. The attack rate for the vaccinated was 6.9% while that for the unvaccinated was 22%. Vaccine efficacy was 68%. CONCLUSION: Vaccine efficacy was found to be low. There is need for serological confirmation of measles cases during outbreaks; for a comprehensive evaluation of the measles vaccination programme in Mbare and for maintenance of high measles vaccine coverage rates to reduce morbidity.

PIP: Through the Zimbabwe Expanded Program of Immunization (ZEPI) introduced in Zimbabwe in 1982, children are vaccinated with the Schwarz-strain vaccine at age 9 months. Through the ZEPI, measles immunization coverage has increased from 56% in 1981 to 82% in 1995. Nonetheless, measles remains one of Zimbabwe's most important public health problems. The number of reported measles cases has declined, but there is still an unacceptably high level of cases and outbreaks continue to be reported regularly throughout the country. The efficacy of the measles vaccine used in the ZEPI was evaluated near the end of a measles outbreak which occurred between June and November 1996 in Mbare suburb, with an estimated 1995 population of 120,000. The retrospective study was conducted through interviews with caregivers of 7 or more children aged 9-35 months from each of 30 randomly selected neighborhood clusters. A total 294 children were considered from the clusters, of whom 83% were vaccinated and 9.5% had measles during the outbreak period. The attack rates for the vaccinated and unvaccinated were, respectively, 6.9% and 22%. Vaccine efficacy was therefore determined to be 68%. Clinical measles cases identified during outbreaks should be serologically confirmed to achieve a more accurate diagnosis. Moreover, the Mbare Health Team should conduct a comprehensive evaluation of its measles vaccination program.

Immunization status of children living in Harare, Zimbabwe.

PIP: Surveys to ascertain the immunization status of children living in Harare, the capital of Zimbabwe (population 658,364 as of the 1982 census) were carried out over a period of 10 days in May/June 1982 and a period of 6 weeks in October/November 1983, using World Health Organization prescribed cluster sampling methods. 206 children were examined in 1982 and 234 in 1983. 82.5% of children were found to have record cards in the 1982 survey, 88.5% in 1983. 47.6% were considered fully immunized in 1982, 55.6% in 1983. In 1982, 74.0% of children were recorded as having BCG scars, 79.4% in 1983. 64.6% and 71.4% had measles innoculations respectively. DPT (dyptheria, pertussis, tetanus) injections had been given to 69.9% in 1982 and 76.5% in 1983. Figures for 2nd and 3rd DPT boosters were 65.5% and 58.7% for 1982 and 76.5 and 75.6% for 1983. Figures for 1st innoculations with OPV (polio) were 69.9 and 76.5% for 1982 and 1983 respectively. 2nd and 3rd polio booster figures were 66.0 and 57.8% for 1982 and 76.5 and 74.8% for 1983. The study was part of an evaluation of immunization integrated with maternal and child health services in the city, administered by nursing personnel, health visitors, and medical assistants in various clinics. Dropout rates for 1st to 2nd dose and 1st to 3rd dose for DPT and OPV improved markedly. Increased usage of immunization probably reflects publicity generated by the 1982 program launching. The extent of infection by these 6 diseases in Zimbabwe is not known, although most are frequently encountered. Survey studies will be required to ascertain reasons for nonimmunization, in order to attain total immunization by 1990.^ieng

An activity sampling study of primary care staff of two Harare polyclinics.

PIP: As part of an exercise in which clinical operations were examined, an activity sampling study was carried out at the primary care units of 2 polyclinics in Harare, Zimbabwe. 1 clinic served a population of 59,791 in a newly developed area, receiving 187,240 primary care visits, 90,830 of which were initial visits. The other clinic, situated in a more established area, served a population of 23,546, experiencing 47,705 initial primary care visits out of a totsl of 148,912 visits in 1983. The work measurement technic involved making instantaneous observations of staff member activities. 7 consecutive days were spent by the research team at each of the clinics, observing the activities of state registered nurses (SRNs), medical assistants (MAs), clinic orderlies (upgraded literate domestic workers given in-service training), and maids. 50 observation times were randomly selected daily between 7:30 a.m. and 4:00 p.m. from Monday to Friday; and 33 random times between 7:30 a.m. and 1:00 p.m. on Saturdays and Sundays. The study found that at the clinic where MAs were engaged more in consulting patients, the SRNs and sister-in-charge had more time to supervise and administer staff, and screen patients (they spent 12.4% of their time in administration, as opposed to the other clinic, where they spent 2.3%). It is suggested that increasing the delegation of duties to the MAs can improve clinic operations.^ieng

Evaluation of cervical cancer screening programme in the Harare City Health Department, Zimbabwe.

OBJECTIVES: To evaluate the Cervical Cancer Screening Programme in Harare City Health Department. DESIGN: Exploratory descriptive study. SETTING: Harare City Health Department. SUBJECTS: Twenty Head Office and District Health Executives and 18 Family Health Clinic nurses. RESULTS: There was varied opinion on women who should be screened and the age at which screening should be recommended. There is no comprehensive policy document to guide the programme. Women who were being screened were mostly new clients on Depo Provera. CONCLUSION: The was no comprehensive policy on cervical cancer screening and the number of Pap smears done were below optimum.

PIP: An evaluation of the Harare City (Zimbabwe) Health Department's Cervical Cancer Screening Program revealed a lack of a comprehensive policy to guide program activities. The evaluation was based on interviews with 20 head office and district health executives and 18 family health clinic nurses as well as a review of annual reports and policy guidelines. All those interviewed agreed that cervical cancer is an important local and national health issue and health workers were well informed about the signs and symptoms of this disease. There was confusion, however, about who should be targeted for screening and how often and at what age Pap smears should be administered. Although the majority of health workers believed that all family planning clients, all women with gynecologic symptoms suggestive of cervical cancer, and all first-time Depo-Provera acceptors should be screened, a review of the records of five clinics indicated that only new Depo-Provera users were actually receiving Pap smear testing routinely. 16 of the 20 managers characterized the resources allocated for cervical cancer screening as inadequate. A review of annual reports revealed that the number of Pap smears declined from 758 in 1987 to 177 in 1993, then increased to 1329 in 1994 when Depo-Provera was reintroduced. At four of the clinics evaluated, more than 50% of Pap smears were classified as suboptimal. Four of the clinic nurses had never had a Pap smear. Overall, these observations suggest a need for development of comprehensive policies on cervical cancer screening, formal training of health workers on taking adequate smears, and allocation of adequate resources to the cervical cancer screening program.

Knowledge and attitudes on AIDS relevant for the establishment of community care in the city of Harare.

Part I: Because of the increasing number of people with the HIV infection or AIDS, health resources and facilities are becoming over burdened. Many projects are looking towards involving communities more in caring and supporting those living with HIV/AIDS. In view of this, features of knowledge and attitudes have been drawn out of a main study on knowledge, attitudes and practices on 2 109 respondents in the City of Harare, to demonstrate areas where urgent preparation is needed to facilitate community care. The majority of respondents (96 pc) were aware that AIDS is a sexually transmitted disease. About 70 pc of the respondents thought that there were many people infected with HIV in Zimbabwe. Most of the respondents (83.3 pc) were frightened by the idea of catching AIDS. However, 82 pc would want to know if they are infected with the AIDS virus. About nine pc of the respondents said that they would commit suicide on discovering that they had HIV. Only 10 pc would have another child after becoming infected. A quarter of the respondents would not be supportive of people with AIDS. They stated that they would evict lodgers with AIDS, would avoid either neighbour, coworker or school mate with AIDS. People were generally more willing to look after their own children (76 pc) and less supportive of other relatives (68 pc) who had AIDS. Gender differences are also highlighted.

Behaviour patterns which may predispose to HIV infection or further transmission and possible intervention strategy in the City of Harare. Part II.

The proportion of people with AIDS is increasing rapidly in Zimbabwe. Several strategies have been adopted to check the further spread of the disease. This paper discusses the behaviour patterns which may predispose to HIV infection and possible intervention strategies that may be taken in the City of Harare. Over a third (33.9 pc, n = 1,526) of the married respondents reported that they were living separately from their spouses. There was a high proportion (76.6 pc, n = 564) of single respondents who admitted to engaging in premarital sex. Fifteen pc of total respondents were engaging in casual sex. The proportion of single respondents (31.2 pc) engaging in casual sex was higher than among the married (11.1 pc). More single respondents (10.9 pc) had been paid for sex than the married (4.1 pc) whilst the proportion that had been paid for sex was similar for the single (21.2 pc) and the married (22.9 pc). The median age for starting sex was 17 years (range = three to 26) for the single and 18 years (range = four to 35) for the married respondents. Sixteen pc stated that they had an STD in 1989. Condom usage was low with only 9.2 pc always using a condom. Forty eight pc of the married respondents who have engaged in casual sexual relationships never use condoms. The main source of information on AIDS/HIV was the radio (74 pc). Most parents (66 pc) had not talked about AIDS to their children.

PIP: HIV transmission is spread in sub-Saharan Africa mainly through heterosexual intercourse, with most infected people in the age group 20-39 years. Findings are reported from a 1989 knowledge, attitudes, and practice study conducted in the city of Harare, Zimbabwe, among 2109 adults undertaken to identify and document behavior patterns which may predispose individuals to HIV infection and possible intervention strategies. The median age for initiating sex was 17 years among single respondents and 18 years for those married. 33.9% of married respondents reported living away from their spouses, 76.6% of singe respondents admitted to engaging in premarital sex, and 15% of all respondents were having casual sex. Only 9.2%, however, reported always using a condom, while 48% of the married respondents who have engaged in casual sexual relationships never use condoms. 16% reported having a sexually transmitted disease in 1989. 10.9% of single respondents and 4.1% of married respondents had been paid for sex. 66% of parents had not talked about AIDS to their children and the main source of information on HIV/AIDS was the radio at 74%. All types of education/prevention campaigns should be encouraged as long as health education messages do not further stigmatize people with HIV or AIDS. The poorly educated and illiterate should be specially targeted.

Alcohol problems among patients attending five primary health care clinics in Harare city.

Modified versions of the CAGE and WHO AUDIT (Alcohol Use Disorders Identification Test) questionnaires were used to investigate drinking habits of patients attending primary care clinics in Harare in 1989. The questionnaires were administered to 483 consecutive patients of whom 63 pc were male and 37 pc female. The results showed that 41 pc of the patients were current drinkers, and over 60 pc of them were drinking to and beyond "safe limits". Thirty nine pc of the current drinkers drank at least three or more times per week. On an average drinking day 66 pc of the male drinkers consume 10 or more units of alcohol per day. On heavy drinking days 38.5 pc of the drinkers or 16 pc of the total sample consume more than 21 units per day. These sessions occurred around paydays. Thirteen (13.2 pc) of those who consume more than 10 units per heavy drinking session exceeded the recommended frequency levels i.e. not more than three times per week. Seventy five pc of drinkers stated that they drink to socialize or for recreational purposes. About 60 pc of the current drinkers had tried unsuccessfully to cut down or stop drinking. The main reason for such an attempt reported by 92 pc of them was health problems. More current drinkers presented with STD and work-related injuries compared to non-drinkers. None of the current drinkers were asked about their drinking habits by the health workers who attended to them at the clinic. No diagnosis of alcohol dependence or an alcohol problem was made by the Primary Health Care worker at the clinic.

PIP: The proportion of individuals who abuse alcohol is growing rapidly in developing countries, especially in Zimbabwe. The authors used modified versions of the CAGE and WHO AUDIT questionnaires to investigate the drinking habits of 483 consecutive patients attending primary care clinics in Harare in 1989. 63% were male and 41% were current drinkers of whom more than 60% were drinking to and beyond safe limits. 39% of current drinkers drank at least 3 or more times per week. On an average drinking day, 66% of the male drinkers consume 10 or more units of alcohol. On heavy drinking days, however, 38.5% of the drinkers or 16% of the total sample consume more than 21 units. These latter sessions occurred around payday. 13.2 of those who consume more than 10 units per heavy drinking session exceeded the recommended frequency levels of not more than 3 times per week. 75% of drinkers stated that they drank to socialize or for recreational purposes. Further, 60% of the current drinkers had tried unsuccessfully to end or reduce their levels of drinking largely due to health problems. More current drinkers than non-drinkers presented with sexually transmitted diseases and work-related injuries. It is noted that none of the current drinkers were asked about their drinking habits by the health workers who attended to them at the clinic and that no diagnosis of alcohol dependence was made.