The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Protocol for school-age follow-up.

Background: There is a need for follow-up of early-life stunting intervention trials into childhood to determine their long-term impact. A holistic school-age assessment of health, growth, physical and cognitive function will help to comprehensively characterise the sustained effects of early-life interventions. Methods: The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe assessed the effects of improved infant and young child feeding (IYCF) and/or improved water, sanitation and hygiene (WASH) on stunting and anaemia at 18 months. Among children enrolled to SHINE, 1,275 have been followed up at 7-8 years of age (1,000 children who have not been exposed to HIV, 268 exposed to HIV antenatally who remain HIV negative and 7 HIV positive children). Children were assessed using the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox, to measure their growth, body composition, cognitive and physical function. In parallel, a caregiver questionnaire assessed household demographics, socioeconomic status, adversity, nurturing, caregiver support, food and water insecurity. A monthly morbidity questionnaire is currently being administered by community health workers to evaluate school-age rates of infection and healthcare-seeking. The impact of the SHINE IYCF and WASH interventions, the early-life 'exposome', maternal HIV, and contemporary exposures on each school-age outcome will be assessed. We will also undertake an exploratory factor analysis to generate new, simpler metrics for assessment of cognition (COG-SAHARAN), growth (GROW-SAHARAN) and combined growth, cognitive and physical function (SUB-SAHARAN). The SUB-SAHARAN toolbox will be used to conduct annual assessments within the SHINE cohort from ages 8-12 years. Ethics and dissemination: Approval was obtained from Medical Research Council of Zimbabwe (08/02/21) and registered with Pan-African Clinical Trials Registry (PACTR202201828512110, 24/01/22). Primary caregivers provided written informed consent and children written assent. Findings will be disseminated through community sensitisation, peer-reviewed journals and stakeholders including the Zimbabwean Ministry of Health and Child Care.

District health executives in Midlands province, Zimbabwe: are they performing as expected?

BACKGROUND: The cornerstone of the health system in Zimbabwe, the district health system has been under the responsibility of the district health executive since 1984. Preliminary information obtained from some provincial health managers in Midlands Province suggested a poor performance by most district health executives. We therefore investigated the reasons for this poor performance. METHODS: A descriptive cross sectional study was conducted. Structured interviewer administered questionnaires were used to obtain information from district health managers of five randomly selected districts in the province. Checklists were used to assess resource availability, staffing levels and proxy indicators to effective district health executive function. Data were analysed using Epi Info statistical package. RESULTS: Thirty district health managers were interviewed. Almost half of the participants could not list at least five functions of district health executives. Twenty nine managers reported having inadequate management skills requiring training. District health executives failed to meet their targets on expected activities in the year 2010 such as conducting monthly district health executive meetings, conducting quarterly supervision to health centres and submitting quarterly district health reports to the provincial level. CONCLUSION: Poor knowledge on expected functions could have resulted in poor performance. Without adequate management training district health managers are likely to underperform their duties. DHE guidelines were therefore distributed to all districts. Management trainings were conducted to all district health executives throughout the country from November 2011.

An evaluation of the isoniazid preventive therapy program performance for under-fives in Kwekwe City, January 2019 - December 2020: a descriptive cross-sectional study.

Childhood tuberculosis (TB) is underserved in resource-constrained endemic areas. Zimbabwe National Tuberculosis Program recommends tuberculosis prevention treatment for children aged <5 years who are close contacts of smear-positive TB cases. The Isoniazid Preventive Therapy (IPT) program performance had never been evaluated since its inception in 2010. We therefore, assessed the IPT program's inputs, processes, outputs, and outcomes. We conducted a process evaluation using the logic model in Kwekwe City. We recruited twenty-seven health care workers from all the five municipal health facilities. Smear-positive guardians of under 5 children, health care workers, and registers were the study population. Data were collected using a questionnaire and checklists and presented as frequencies and proportions. The IPT program met requirements in provision of guidelines (10/10), screening tools (15/15) and on-the-job trainings done in all five health facilities. Isoniazid tablets supply and quarterly budgeting did not meet meeting program requirements. Fifty-nine out of 231 (25.5%) children contacts of sputum-positive TB patients were screened. Fifty-one of the 59 (86.4%) children were initiated on IPT, 42/51 (82.4%) completed the course, one developed TB, 3/51 were still on treatment and 5/51 were lost to follow up. No dropouts and deaths were recorded. Unavailability of drugs was a barrier to the IPT and negatively impacts the TB elimination program. Contact screening was the bottleneck in the successful implementation of the program. Adequate staff and provision of drugs might improve the program. We recommended the recruitment of more healthcare workers and the budget for the program.

Evaluation of the measles case-based surveillance system in Kwekwe city, 2017-2020: a descriptive cross-sectional study.

Introduction: in 2011, WHO African region set a target for elimination of measles by 2020. During period 2017-2020, Kwekwe city, with an estimated population of 117,116, detected one case of suspected measles. This was against a target of 2 cases per year. We evaluated the system to establish why it was failing to detect at least 2 cases per year. Methods: we conducted a descriptive cross-sectional study using the Centre for Disease Control (CDC) Updated Guidelines. Nineteen health facilities were selected and fifty-seven health workers were randomly recruited. An interviewer-administered questionnaire and checklists were used to collect data. We generated frequencies, proportions, and means. Results: the mean years in service was 22.8 years (SD=12.6). Thirty (52.6%) respondents had fair knowledge. Fourteen (73.7%) of the nineteen respondents who had ever completed case investigation forms took between 10-20 minutes to complete. Only two (10.5%) of the nineteen facilities had case investigation forms. The majority of the respondents 54 (93%) were willing to continue participating in the measles Community Base Surveillance System (CBSS). None of the health facilities had used the system to inform decision-making. Reasons highlighted for poor suspected measles case detection included lack of health worker training 28/57 (49.1%). Conclusion: despite the high age in service, knowledge of the surveillance system was mostly fair. The system was found to be simple, not stable and not useful. The main reason for the system failure was lack of health worker training. We recommend retraining on Integrated Disease Surveillance and Response (IDSR) and case investigation forms distribution.

Evaluation of the acute flacid paralysis (AFP) surveillance system in Bikita district Masvingo province 2010.

BACKGROUND: AFP is a rare syndrome and serves as a proxy for poliomyelitis. The main objective of AFP surveillance is to detect circulating wild polio virus and provide data for developing effective prevention and control strategies as well planning and decision making. Bikita district failed to detect a case for the past two years. FINDINGS: A total of 31 health workers from 14 health centres were interviewed. Health worker knowledge on AFP was low in Bikita. The system was acceptable, flexible, and representative but not stable and not sensitive since it missed1 AFP case. The system was not useful to the district since data collected was not locally used in anyway. The cost of running the system was high. The district had no adequate resources to run the system. Reasons for not reporting cases was that the mothers were not bringing children with AFP and ignorance of health workers on syndromes captured under AFP. CONCLUSION: Health worker's knowledge on AFP was low and all interviewed workers needed training surveillance. The system was found to be flexible but unacceptable. Reasons for failure to detect AFP cases could be, no cases reporting to the centres, lack of knowledge on health workers hence failure to recognise symptoms, high staff turnover.