Factors associated with a malaria outbreak at Tongogara refugee camp in Chipinge District, Zimbabwe, 2021: a case-control study.

BACKGROUND: Malaria is a leading cause of morbidity and mortality among forcibly displaced populations, including refugees, approximately two-thirds of whom reside in malaria endemic regions. Data from the rapid disease notification system (RDNS) reports for Manicaland Province in Zimbabwe showed that despite implementation of malaria control initiatives, there was an increase in number of malaria cases above action thresholds at Tongogara refugee camp in Chipinge district during weeks 12-14 of 2021. An investigation that described the outbreak by person, place and time was conducted. Malaria emergency preparedness, response, and appropriateness of case management were assessed. The factors associated with contracting malaria were determined to enable the formulation of appropriate interventions, establish control, and prevent future malaria outbreaks among this vulnerable population. METHODS: A 1:1 unmatched case-control study involving 80 cases and 80 controls was conducted using interviewer-administered questionnaires at household level. Data was entered into Epi Data version 3.1 and quantitative analysis was done using Epi Info™ version 7.2.2.6 to generate medians, proportions, odds ratios and their 95% confidence intervals. RESULTS: Malaria cases were distributed throughout the 10 residential sections within Tongogara refugee camp, the majority being from section 7, 28 (35%). Despite constituting 11% of the total population, Mozambican nationals accounted for 36 (45%) cases. Males constituted 47 (59%) among cases which was comparable to controls 43 (54%), p = 0.524. The median age for cases was 15 years [Interquartile range (IQR), 9-26] comparable to controls, which was 17 years (IQR, 10-30) (p = 0.755). Several natural and man-made potential vector breeding sites were observed around the camp. Risk factors associated with contracting malaria were engaging in outdoor activities at night [AOR = 2.74 (95% CI 1.04-7.22), wearing clothes that do not cover the whole body during outdoor activities [AOR 4.26 (95% CI, 1.43-12.68)], while residing in a refugee housing unit reduced the risk of contracting malaria [AOR = 0.18 (CI, 0.06-0.55)]. CONCLUSIONS: The malaria outbreak at Tongogara refugee camp reemphasizes the role of behavioural factors in malaria transmission. Intensified health education to address human behaviours that expose residents to malaria, habitat modification, and larviciding to eliminate mosquito breeding sites were recommended.

An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study.

BACKGROUND: Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. METHODS: We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. RESULTS: The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW's negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. CONCLUSION: The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

Investigation of an anthrax outbreak in Makoni District, Zimbabwe.

BACKGROUND: Anthrax continues to be a disease of public health importance in Zimbabwe, with sporadic outbreaks reported annually in many parts of the country. A human anthrax outbreak occurred in wards 22 and 23 of Makoni District from mid-June 2013 to end of January 2014, following cattle deaths in the wards. Laboratory tests confirmed anthrax as the cause for the cattle deaths. This study investigated the clinical characteristics, distribution of cases (places, person and time) and risk factors for contracting the anthrax disease. We also assessed the environment, district preparedness and response, and outbreak prevention and control measures. METHODS: We conducted an outbreak investigation using a mixed-methods design. A 1:1 case-control study was used to assess risk factors for contracting anthrax. The controls were frequency matched to cases by sex. Data were collected using a structured interviewer-administered questionnaire. Environmental assessment, district preparedness and response, and outbreak prevention and control measures were assessed using a checklist, observations, and key informant interviews. Multivariable unconditional logic regression analysis was performed to identify independent risk factors associated with contracting anthrax. RESULTS: We interviewed 37 of the 64 cases, along with 37 controls. All the cases had cutaneous anthrax, with the hand being the most common site of the eschar (43%). Most of the cases (89%) were managed according to the national guidelines. Multivariable analysis demonstrated that meat sourced from other villages [vs butchery, OR = 15.21, 95% CI (2.32-99.81)], skinning [OR = 4.32, 95% CI (1.25-14.94)], and belonging to religions that permit eating meat from cattle killed due to unknown causes or butchered after unobserved death [OR = 6.12, 95% CI (1.28-29.37)] were associated with contracting anthrax. The poor availability of resources in the district caused a delayed response to the outbreak. CONCLUSION: The described anthrax outbreak was caused due to contact with infected cattle meat. Although the outbreak was eventually controlled through cattle vaccination and health education and awareness campaigns, the response of the district office was initially delayed and insufficient. The district should strengthen its emergency preparedness and response capacity, revive zoonotic committees, conduct awareness campaigns and improve surveillance, especially during outbreak seasons.

Trends in antimicrobial resistance of bacterial pathogens in Harare, Zimbabwe, 2012-2017: a secondary dataset analysis.

BACKGROUND: Antimicrobial resistance is one of the most serious public health threats of the twenty-first century. The implementation of AMR surveillance in Zimbabwe is limited. However, data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (i.e., from 73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that Zimbabwe is affected by AMR. This study was done to determine the magnitude of AMR in Harare and determine the trends of AMR to first-line and to last-resort antibiotics and make recommendations to mitigate the problem. METHODS: A retrospective record review of data collected from the microbiology department at a private laboratory between January 2012 and December 2017 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates. Microsoft Excel 2016 was used to plot trends from 2012 to 2017 and Epi Info™7 was used for statistical analysis. RESULTS: A total of 23,432 isolates, of 12 medically important bacteria were analysed. Forty-three percent of the isolates were from urines, 36.7% were from pus swabs and 7% were from blood. The most common pathogen was Escherichia coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoea (0.2%). Resistance was highest to ampicillin followed by penicillin, both ranging between 70 and 100% over the six years. Statistically significant increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant E. coli and Streptococcus pneumonia and third generation cephalosporin-resistant E. coli. There was an increase in resistance to last-line antibiotics i.e., fluoroquinolone-resistant Salmonella spp. and carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, methicillin-resistant S. aureus showed a decreasing trend. CONCLUSIONS: There is a high burden of drug resistance to common antibiotics in Harare and an emergence of resistance to last-line antibiotics.

Utilization and outcomes of cervical cancer screening services in Harare City, 2012-2016: a secondary data analysis.

BACKGROUND: Visual inspection with acetic acid and cervicography (VIAC) is a method used to screen for cervical cancer. VIAC can be used as part of a "see and treat" strategy. Nine Harare city council health facilities offer VIAC free of charge with the aim of reducing morbidity and mortality from cervical cancer. Between 2014 and 2016, the number of women utilising VIAC dropped by 35%. We analysed records of clients who utilise VIAC at Harare city health facilities to characterise women accessing VIAC and their outcomes to make recommendations for improving the services. METHODS: We conducted a descriptive cross-sectional study using data collected for the Harare city VIAC program. We analysed all records of clients who utilised VIAC services at nine Harare city health facilities from 1 May 2012 to 31 December 2016. RESULTS: We analysed 46,217 records, the median age of the clients was 34 years [Q1 = 27: Q3 = 42]. Of the 46,217 clients screened, 3001 (6.5%) were VIAC positive, and 512 (1.1%) had suspicious of cancer lesions. The prevalence of VIAC positive ranged from 58 to 74 per 1000-screened clients over the 5 years. The prevalence of suspected cancer ranged from 9 to 14 per 1000-screened clients, and there was a general decrease in the prevalence between 2012 and 2016. Of the 3513 clients with VIAC positive or had suspicious of cancer lesions, 2090 (74.1%) did not receive treatment at the site where the screening took place. CONCLUSION: The majority of women who are accessing VIAC services in Harare are middle-aged, multiparous and married women. There is a treatment gap at most of the VIAC centres such that clients are referred to other centres for management. The objective of "see and treat" is not being realised.

Utilisation of Medical Services and Outcomes at Adult Rape Clinic at Parirenyatwa Group of Hospitals, Zimbabwe.

Sexual violence is a major public health problem due to the associated risk of acquiring sexually transmitted infections, behavioural disorders and risk of committing suicide. The Adult Rape Clinic (ARC) was established at Parirenyatwa Hospital, Harare in 2009 with the objective of providing medical and support services for survivors of sexual violence in a safe and private environment. The data collected had never been analysed since the establishment of the clinic. We described the clients' profile and the services offered at the clinic to identify gaps in service provision and areas of improvement. A retrospective record review of data was carried out from the ARC collected from February 2009 to December 2017. We analyzed 2343 affidavits that were available. Out of 2343 records analysed, (2190) 93.5% were female and 6.5 % (153) were male. The median age was 23years (Q1=21; Q3= 29) for males and 19 years (Q1= 17; Q2=25) for females. Among the clients, 2164 (92.4%) received a baseline HIV test, and 263 females and 6 males tested positive. From 2010 to 2017, six clients' seroconversion was recorded. Only 863(36.8%) clients presented within 3 days after the sexual assault. About 40% of male victims were assaulted by someone they knew and 27% were married. The study recommends further research on the determinants of late presentation after sexual assault.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study.

BACKGROUND: Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10-19 years) on antiretroviral therapy (ART) in Harare city. METHODS: We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI. RESULTS: We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80-11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22-22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20-9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01-0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23-0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21-0.80)] were protective. CONCLUSION: Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.

Clinical care given to victims of sexual assault at Kadoma General Hospital, Zimbabwe: a secondary data analysis, 2016.

BACKGROUND: Despite the guidelines for managing sexual assault being in place, victims of sexual assault attended to at Kadoma General Hospital consistently raised complaints related to the quality of care offered. Medicolegal data for sexual assault has been collected at the hospital since 2012. However, no analysis had been done regardless of complaints having been raised. We analysed the dataset to determine the quality of clinical care offered to sexual assault victims. METHODS: A retrospective cross-sectional study based on secondary data was conducted. Epi. Info 7 software was used to analyse data and generate frequencies, measures of central tendency and proportions. RESULTS: We analysed 474 medical affidavits completed between January 2014 and July 2016. Thirty percent of the victims sought care within 72 h of the sexual assault. Baseline HIV testing was done in 23 (22%) and follow-up HIV test done in 2 (2%) of the victims. Post Exposure Prophylaxis for HIV was administered to 18 (51%), emergency contraception 9 (69%) and forensic evidence gathered in six (5%) of victims presenting within the prescribed 72 h of the sexual assault. Prophylactic antibiotics were given to 156 (33%). There were no documented counselling sessions for all victims whilst follow up care was given to 47 (10%) victims. CONCLUSION: Suboptimal clinical care was given to victims of sexual assault during the period 2014-2016. These findings suggest possible delayed presentation by victims of sexual assault as well as suboptimal administration of prophylaxis by health care workers. We recommend adherence to guidelines in managing sexual assault. Further research to determine factors for delayed presentation among sexual assault victims and quality of care provided to them is recommended.

Factors associated with late presentation for HIV/AIDS care in Harare City, Zimbabwe, 2015.

BACKGROUND: Despite widespread awareness and publicity concerning Human Immunodeficiency Virus (HIV) care and advances in treatment, many patients still present late in their HIV disease. Preliminary review of the Antiretroviral Therapy (ART) registers at Wilkins and Beatrice Road Hospitals, both located in Harare, indicated that 67 and 71 % of patients enrolled into HIV/AIDS care presented late with baseline CD4 of <200 cells/uL and/or WHO stage 3 and 4 respectively. We therefore sought to explore factors associated with late presentation in Harare City. METHODS: We conducted a 1:1 unmatched case control study where a case was an HIV positive individual (>18 years) with a baseline CD4 of <200/uL or who had WHO clinical stage 3 or 4 at first presentation to OI/ART centres in 2014 and; a control was HIV positive individual (>18 years) who had a baseline CD4 of >200/uL or WHO clinical stage 1 or 2 at first presentation in 2014. Written informed consent was obtained from all study participants. RESULTS: A total of 268 participants were recruited (134 cases and 134 controls). Independent risk factors for late presentation for HIV/AIDS care were illness being reason for test (Adjusted Odds Ratio [aOR] =7.68, 95 % CI = 4.08, 14.75); Being male (aOR = 2.84, 95 % CI = 1.50, 5.40) and; experienced HIV stigma (aOR = 2.99, 95 % CI = 1.54, 5.79). Independent protective factors were receiving information on HIV (aOR = 0.37, 95 % CI = 0.18, 0.78) and earning more than US$250 per month (aOR = 0.32, 95 % CI = 0.76, 0.67). Median duration between first reported HIV positive test result and enrolment into pre-ART care was 2 days (Q1 = 1 day; Q3 = 30 days) among cases and 30 days (Q1 = 3 days; Q3 = 75 days) among controls. CONCLUSION: Late presentation for HIV/AIDS care in Harare City was a result of factors that relate to the patient's sex, reason for getting a test, receiving HIV related information, experiencing stigma and monthly income. Based on this evidence we recommended targeted interventions to optimize early access to testing and enrolment into care.

Maternal death surveillance and response system evaluation in Makonde District, Zimbabwe, 2021.

BACKGROUND: Maternal mortality is of global concern, almost 800 women die every day due to maternal complications. The maternal death surveillance and response (MDSR) system is one strategy designed to reduce maternal mortality. In 2021 Makonde District reported a maternal mortality ratio of 275 per 100 000 and only sixty-two percent of deaths recorded were audited. We evaluated the MDSR system in Makonde to assess its performance. METHODS: A descriptive cross-sectional study was conducted using the CDC guidelines for evaluating public health surveillance systems. An Interviewer-administered questionnaire was used to collect data from 79 health workers involved in MDSR and healthcare facilities. All maternal death notification forms, weekly disease surveillance forms, and facility monthly summary forms were reviewed. We assessed health workers' knowledge, usefulness and system attributes. RESULTS: We interviewed 79 health workers out of 211 workers involved in MDSR and 71 (89.9%) were nurses. The median years in service was 8 (IQR: 4-12). Overall health worker knowledge (77.2%) was good. Ninety-three percent of the deaths audited were of avoidable causes. Twelve out of the thirty-eight (31.6%) facilities were using electronic health records system. Feedback and documented shared information were evident at four facilities (21%) including the referral hospital. Nineteen (67.9%) out of 28 maternal death notification forms were completed within seven days and none were submitted to the PMD on time. CONCLUSION: The MDSR system was acceptable and simple but not timely, stable and complete. Underutilization of the electronic health system, work load, poor documentation and data management impeded performance of the system. We recommended appointment of an MDSR focal person, sharing audit minutes and improved data management.

Factors associated with COVID-19 fatality among patients admitted in Mashonaland West Province, Zimbabwe 2020-2022: a secondary data analysis.

Introduction: approximately 15% of COVID-19 patients develop symptoms necessitating admission. From 2020 to 2022, Mashonaland West Province had an institutional case fatality rate of 23% against a national rate of 7%. Therefore, we evaluated the COVID-19 admissions in the province to determine the factors associated with COVID-19 mortality. Methods: we conducted an analytical cross-sectional study based on secondary data from isolation centers across the province using all 672 death audit forms and patient records. We obtained data on patient demographics, signs and symptoms, clinical management and oxygen therapy administered, among other things. Data were entered into an electronic form and imported into Epi-info 7 for analysis bivariate and multivariate conducted. Results: we found that being an older man, aOR 1.04 (1.03-1.05), who had diabetes aOR 6.0 (95% CI: 3.8-9.2) and hypertension aOR 4.5 (95% CI: 2.8-6.5) were independent risk factors. Patients put on dexamethasone aOR 2.4 (95% CI: 1.6-3.4) and heparin/clexane aOR 1.6 (95% CI: 1.1-2.2) had a higher mortality risk. However, vitamin C aOR 0.48 (95% CI: 0.31-0.71) and oxygen therapy aOR 0.14 (95% CI: 0.10-0.19) and being pregnant aOR 0.06 (95% CI: 0.02-0.14) were protective. Conclusion: mortality risk increased in older male patients with comorbidities and with those on dexamethasone and heparin therapy. Oxygen therapy and vitamin C were protective. There is a need to conduct further study of the source of these variations in risk across patients to establish the true impact of differences in individuals' mortality.

Tuberculosis cohort analysis in Zimbabwe: The need to strengthen patient follow-up throughout the tuberculosis care cascade.

INTRODUCTION: Globally people with tuberculosis (TB) continue to be missed each year. They are either not diagnosed or not reported which indicates possible leakages in the TB care cascade. Zimbabwe is not spared with over 12000 missed cases in 2020. A preliminary review of TB treatment outcomes indicated patient leakages throughout the presumptive cascade and undesirable treatment outcomes in selected cities. Chegutu District had pre-diagnosis and pretreatment losses to follow-up while Mutare City among others had 22.0% of outcomes not evaluated in the second quarter of 2021, and death rates as high as 14% were recorded in Gweru District. The problem persists despite training on data analysis and use. The TB cohorts were analysed to determine the performance of the care cascade and the spatial distribution of treatment outcomes in Zimbabwe. METHODS: Using data from district health information software version 2.3 (DHIS2.3), a secondary data analysis of 2020 drug-sensitive (DS) TB treatment cohorts was conducted. We calculated the percentage of pre-diagnosis, and pre-treatment loss to follow-up (LTFU). For TB treatment outcomes, 'cured' and 'treatment completed' were categorized as treatment success, while 'death', 'loss to follow-up (LTFU), and 'not evaluated' were categorized as undesirable outcomes. Univariate analysis of the data was conducted where frequencies were calculated, and data was presented in graphs for the cascade, treatment success, and undesirable outcomes while tables were created for the description of study participants and data quality. QGIS was used to generate maps showing undesirable treatment outcomes. RESULTS: An analysis of national data found 107583 people were presumed to have TB based on symptomatic screening and or x-ray and 21.4% were LTFU before the specimen was investigated. Of the 84534 that got tested, 10.0% did not receive their results. The treatment initiation rate was 99.1%. Analysis of treatment outcomes done at the provincial level showed that Matabeleland South Province had the lowest treatment success rate of 77.3% and high death rates were recorded in Matabeleland South (30.0%), Masvingo (27.3%), and Matabeleland North (26.1%) provinces. Overall, there were high percentages of not-evaluated treatment outcomes. CONCLUSION: Pre-diagnosis LTFU was high, and high death and loss to follow-up rates were prevalent in provinces with artisanal and small-scale mining (ASM) activities. Unevaluated treatment outcomes were also prevalent and data quality remains a challenge within the national TB control program. We recommended strengthening patient follow-up at all levels within the TB care cascade, strengthening capacity-building for data analysis and use, further analysis to determine factors associated with undesirable outcomes and a study on why LTFU remains high.

Risk factors for contracting watery diarrhoea in Mzilikazi, Bulawayo City, Zimbabwe, 2020: a case control study.

Introduction: Mzilikazi clinic had an upsurge of diarrhoea cases with 41 cases from the 28th to the 30th of September 2020, against a threshold of 11. We therefore, investigated the risk factors associated with this outbreak to recommend prevention and control measures. Methods: we conducted a 1:1 unmatched case-control study. A case was any person who suffered from diarrhoea, and was resident in the clinic´s catchment since the 21st of September 2020. Demographic data, knowledge and practices related to diarrhoea were collected using a standard questionnaire for both cases and controls. Environmental assessment, water quality and stool testing was also done. We conducted univariate and multivariate analysis at 95% confidence interval, to determine factors independently associated with contracting diarrhoea. Results: the median age was 30 years (Q1=12, Q3=46) for cases and 30 years (Q1=22, Q3=48) for controls. The dominant gender was female for cases and male for controls. The independent risk factors were: drinking borehole water [adjusted Odds Ratio (aOR)=2.66; 95%CI=(1.41-5.00)], storing water in open container [aOR=2.76; 95%CI=(1.38-5.53)] and being under-five years old [aOR=5.73; 95%CI=(2.06-15.89)]. Boiling drinking water [aOR=0.39; 95%CI=(0.20-0.75)] was protective. Coliforms were detected from boreholes and stored water samples, and Shigella flexneri was isolated from 2 of the 13 stool specimens collected. Residents accessed water from decommissioned boreholes due to severe municipal water rationing. Conclusion: being under-five years old, drinking borehole water and storing water in open containers were independent risk factors. Health education on home water treatment, distribution of water storage containers, and Aquatabs was done.

An evaluation of the notifiable disease surveillance system in Chegutu District, Zimbabwe, 2020: a cross-sectional study.

Introduction: in 2018-2019 Chegutu District had one notification form Tally 1 (T1) that was completed instead of seven for detected notifiable diseases. Different figures of cholera were reported through weekly rapid disease notification system with 106 patients and Notifiable Diseases Surveillance System (NDSS) with 111 patients, causing data discrepancy. We evaluated the NDSS to determine reasons for underperformance and data discrepancy. Methods: we conducted descriptive cross-sectional study using updated centres for disease control and prevention guidelines for surveillance system evaluation. We recruited forty-six health workers. Interviewer-administered questionnaires and checklists were used to collect data on reasons for underperformance, reasons for data discrepancy, knowledge of NDSS, surveillance system attributes and usefulness. Epi InfoTM7 generated frequencies, proportions, and means. Likert scale was used to assess health worker knowledge. Results: of the forty-six health workers, 34 (78%) had fair knowledge of NDSS. The reason for system underperformance was lack of training in NDSS 42 (91%). Data discrepancy was attributed to typographical mistakes made during data entry on WhatsApp platform 32 (70%). Eighty per cent (37) were willing to complete T1 forms. Six participants who were timed took ten minutes to complete T1 forms. Among 17 health facilities, only three had fifteen T1 forms that were adequate to notify first five cases in an outbreak. Notifiable diseases surveillance system data was used for planning health education 28 (68%). Conclusion: the NDSS was unstable due to health workers' inadequate knowledge and unavailability of T1 forms. Notifiable diseases surveillance system was found to be simple, acceptable, and useful. We recommended NDSS training of health workers.

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.

Anthrax outbreak investigation in Tengwe, Mashonaland West Province, Zimbabwe, 2022.

BACKGROUND: Anthrax continues to be a disease of public health concern in Zimbabwe. Between December 2021 and February 2022, Tengwe reported 36 cases of human anthrax. Gastrointestinal anthrax has the potential to cause serious outbreaks leading to loss of human life. We investigated the outbreak, identified the risk factors using one health approach to inform outbreak control. MATERIALS AND METHODS: We conducted descriptive analysis of the outbreak and a 1:2 unmatched case control study to identify risk factors for anthrax. A case was any Tengwe resident who developed an ulcer and/or abdominal symptoms and epidemiologically linked to a confirmed environmental exposure. Validated, structured interviewer-administered questionnaires were used to collect data from the cases and neighbourhood controls. Soil and dried meat samples were collected for laboratory investigations. District preparedness and response was assessed using a checklist. Data was analysed using Epi Info version 7.2.5. The odds of exposure were calculated for each risk factor examined. Multivariable logistic regression analysis was performed to identify the independent factors associated with contracting anthrax. RESULTS: Through active case finding we identified 36 cases, 31 were interviewed. Twenty-one (67.7%) were males. The median age was 33 years (Inter quartile range: 22-54). Nineteen (61.2%) cases presented with abdominal symptoms with zero deaths reported. The independent risk factor for contracting anthrax was eating under-cooked meat (aOR = 12.2, 95% CI: 1.41-105.74, p = 0.023). All samples collected tested positive for anthrax. No livestock vaccinations or zoonotic meetings were being conducted prior to the outbreak. Notification of the outbreak was done 11 days after index case presentation however one health response was instituted within 24 hours. CONCLUSION: The anthrax was confirmed in Tengwe. Consumption of under-cooked meat was associated with gastrointestinal anthrax. The timely one health response resulted in excellent outcomes. Using one health approach in managing zoonotic threats is encouraged.

Evaluation of the acute flaccid paralysis (AFP) surveillance system in Mwenezi district, Masvingo, 2018: a descriptive study.

OBJECTIVES: Poliomyelitis is an infectious disease caused by the polio virus which affects mostly young children below the age of 15 years. For surveillance children with acute flaccid paralysis (AFP) are tracked. In Zimbabwe every district should report two cases per 100,000 population of children under the age of 15 years old. In 2017, Mwenezi district failed to detect any AFP cases. We therefore evaluated the AFP surveillance system in Mwenezi district. We conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers in Mwenezi district and looked at AFP records from January to December 2017. RESULTS: The main reasons for failure to report a case in 2017 were the vastness of the district with bad road networks as well as lack of a dedicated vehicle to carry out EPI outreach activities. About a quarter, 24%, of the health workers did not know the specimen that is used in AFP diagnosis. The AFP surveillance system in Mwenezi district was performing poorly due to lack of active search of cases in the community caused by disruption of EPI outreach activities.

Early Infant Diagnosis Sample Management in Mashonaland West Province, Zimbabwe, 2017.

BACKGROUND: In 2016, Mashonaland West Province had 7.4% (520) dried blood spot (DBS) samples for early infant diagnosis (EID) rejected by the Zimbabwe National Microbiology Reference Laboratory (NMRL). The samples were suboptimal, delaying treatment initiation for HIV-infected children. EID is the entry point to HIV treatment services in exposed infants. We determined reasons for DBS sample rejections and suggested solutions. METHODS: A cause-effect analysis, modelled on Ishikawa, was used to identify factors impacting DBS sample quality. Interviewer-administered questionnaires and evaluation of sample collection process, using Standard Operating Procedure (SOP) was conducted. Rejected samples were reviewed. Epi Info™ was used to analyze findings. RESULTS: Eleven (73.3%) facilities did not adhere to SOP and (86.7%) did not evaluate DBS sample quality before sending for testing. Delayed feedback (up to 4 weeks) from NMRL extended EID delay for 14 (93.3%) of the facilities. Of the 53 participants, 62% knew valid sample identification. Insufficient samples resulted in most rejections (77.9%). Lack of training (94.3%) and ineffective supervision (69.8%) were also cited. CONCLUSION: Sample rejections could have been averted through SOP adherence. Ineffective supervision, exacerbated by delayed communication of rejections, extended EID delay, disadvantaging potential ART beneficiaries. Following this study, enhanced quality control through perstage evaluations was recommended to enhance DBS sample quality.

Evaluation of sexual and gender-based violence program in Harare City, Zimbabwe, 2016: a descriptive cross-sectional study.

INTRODUCTION: In Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city. METHODS: We conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7. RESULTS: The program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers (25/35) citedlack of awareness as major reasons for underperformance. CONCLUSION: Availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended.