Evaluating the efficacy, impact, and feasibility of community-based house screening as a complementary malaria control intervention in southern Africa: a study protocol for a household randomized trial.

BACKGROUND: Concerted effort to control malaria has had a substantial impact on the transmission of the disease in the past two decades. In areas where reduced malaria transmission is being sustained through insecticide-based vector control interventions, primarily long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), non-insecticidal complementary tools will likely be needed to push towards malaria elimination. Once interruption in local disease transmission is achieved, insecticide-based measures can be scaled down gradually and eventually phased out, saving on costs of sustaining control programs and mitigating any unintended negative health and environmental impacts posed by insecticides. These non-insecticidal methods could eventually replace insecticidal methods of vector control. House screening, a non-insecticidal method, has a long history in malaria control, but is still not widely adopted in sub-Saharan Africa. This study aims to add to the evidence base for this intervention in low transmission settings by assessing the efficacy, impact, and feasibility of house screening in areas where LLINs are conventionally used for malaria control. METHODS: A two-armed, household randomized clinical trial will be conducted in Mozambique, Zambia, and Zimbabwe to evaluate whether combined the use of house screens and LLINs affords better protection against clinical malaria in children between 6 months and 13 years compared to the sole use of LLINs. Eight hundred households will be enrolled in each study area, where 400 households will be randomly assigned the intervention, house screening, and LLINs while the control households will be provided with LLINs only. Clinical malaria incidence will be estimated by actively following up one child from each household for 6 months over the malaria transmission season. Cross-sectional parasite prevalence will be estimated by testing all participating children for malaria parasites at the beginning and end of each transmission season using rapid diagnostic tests. CDC light traps and pyrethrum spray catches (PSC) will be used to sample adult mosquitoes and evaluate the impact of house screening on indoor mosquito density, species distribution, and sporozoite rates. DISCUSSION: This study will contribute epidemiological data on the impact of house screening on malaria transmission and assess the feasibility of its implementation on a programmatic scale. TRIAL REGISTRATION: ClinicalTrials.gov PACTR202008524310568 . Registered on August 11, 2020.

Malaria incidence and mortality in Zimbabwe during the COVID-19 pandemic: analysis of routine surveillance data.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed a unique challenge to health care systems globally. To curb COVID-19 transmission, mitigation measures such as travel restrictions, border closures, curfews, lockdowns, and social distancing have been implemented. However, these measures may directly and indirectly affect the delivery and utilization of essential health services, including malaria services. The suspension of indoor residual spraying (IRS) and insecticide-treated net (ITN) distribution, shortages of malaria commodities, and reduced demand for health services have hindered the continued delivery of malaria services. The overall goal of this analysis was to describe the trends in malaria incidence and mortality in Zimbabwe prior to and during the pandemic to understand the consequences of COVID-19-related changes in the delivery and utilization of malaria services. METHODS: Monthly data on the number of malaria cases and deaths by district for the period January 2017 to June 2020 were obtained from the national health management information system (HMIS). District-level population data were obtained from the 2012 Census. Malaria incidence per 1000 population and malaria deaths per 100,000 population were calculated for 2017, 2018, 2019, and 2020 and mapped to describe the spatial and temporal variation of malaria at the district level. RESULTS: Compared to the same period in 2017, 2018 and 2019, there was an excess of over 30,000 malaria cases from January to June 2020. The number of malaria deaths recorded in January to June 2020 exceeded the annual totals for 2018 and 2019. District level maps indicated that areas outside high malaria burden provinces experienced higher than expected malaria incidence and mortality, suggesting potential outbreaks. CONCLUSIONS: The observed surge in malaria cases and deaths in January to June 2020 coincided with the onset of COVID-19 in Zimbabwe. While further research is needed to explore possible explanations for the observed trends, prioritizing the continuity of essential malaria services amid the COVID-19 pandemic remains crucial.

Spatial and spatio-temporal analysis of malaria cases in Zimbabwe.

BACKGROUND: Although effective treatment for malaria is now available, approximately half of the global population remain at risk of the disease particularly in developing countries. To design effective malaria control strategies there is need to understand the pattern of malaria heterogeneity in an area. Therefore, the main objective of this study was to explore the spatial and spatio-temporal pattern of malaria cases in Zimbabwe based on malaria data aggregated at district level from 2011 to 2016. METHODS: Geographical information system (GIS) and spatial scan statistic were applied on passive malaria data collected from health facilities and aggregated at district level to detect existence of spatial clusters. The global Moran's I test was used to infer the presence of spatial autocorrelation while the purely spatial retrospective analyses were performed to detect the spatial clusters of malaria cases with high rates based on the discrete Poisson model. Furthermore, space-time clusters with high rates were detected through the retrospective space-time analysis based on the discrete Poisson model. RESULTS: Results showed that there is significant positive spatial autocorrelation in malaria cases in the study area. In addition, malaria exhibits spatial heterogeneity as evidenced by the existence of statistically significant (P < 0.05) spatial and space-time clusters of malaria in specific geographic regions. The detected primary clusters persisted in the eastern region of the study area over the six year study period while the temporal pattern of malaria reflected the seasonality of the disease where clusters were detected within particular months of the year. CONCLUSIONS: Geographic regions characterised by clusters of high rates were identified as malaria high risk areas. The results of this study could be useful in prioritizing resource allocation in high-risk areas for malaria control and elimination particularly in resource limited settings such as Zimbabwe. The results of this study are also useful to guide further investigation into the possible determinants of persistence of high clusters of malaria cases in particular geographic regions which is useful in reducing malaria burden in such areas.

Scaling up malaria elimination management and leadership: a pilot in three provinces in Zimbabwe, 2016-2018.

BACKGROUND: Focus for improved malaria programme performance is often placed on the technical challenges, while operational issues are neglected. Many of the operational challenges that inhibit malaria programme effectiveness can be addressed by improving communication and coordination, increasing accountability, maintaining motivation, providing adequate training and supervision, and removing bureaucratic silos. METHODS: A programme of work was piloted in Zimbabwe with one malaria eliminating province, Matabeleland South in 2016-2017, and scaled up to include two other provinces, Matabeleland North and Midlands, in 2017-2018. The intervention included participatory, organization development and quality improvement methods. RESULTS: Workshop participants in Matabeleland South reported an improvement in data management. In Matabeleland North, motivation among nurses improved as they gained confidence in case management from training, and overall staff morale improved. There was also an improvement in data quality and data sharing. In Midlands, the poorly performing district was motivated to improve, and both participating districts became more goal-oriented. They also became more focused on monitoring their data regularly. Participants from all provinces reported having gained skills in listening, communicating, facilitating discussions, and making presentations. Participation in the intervention changed the mindset of malaria programme staff, increasing ownership and accountability, and empowering them to identify and solve problems, make decisions, and act within their sphere of influence, elevating challenges when appropriate. CONCLUSIONS: This pilot demonstrates that a participatory, organization development and quality improvement approach has broad ranging effects, including improving local delivery of interventions, tailoring strategies to target specific populations, finding efficiencies in the system that could not be found using the traditional top-down approach, and improving motivation and communication between different cadres of health workers. Scale-up of this simple model can be achieved and benefits sustained over time if the process is imbedded into the programme with the training of health staff who can serve as management improvement coaches. Methods to improve operational performance that are scalable at the district level are urgently needed: this approach is a possible tactic that can significantly contribute to the achievement of global malaria eradication goals.

Getting ready for integrated vector management for improved disease prevention in Zimbabwe: a focus on key policy issues to consider.

BACKGROUND: This paper outlines Zimbabwe's potential readiness in harnessing integrated vector management (IVM) strategy for enhanced control of vector-borne diseases. The objective is to provide guidance for the country in the implementation of the national IVM strategy in order to make improvements required in thematic areas of need. The paper also assesses the existing opportunities and gaps to promote and adopt the approach as a national policy. MAIN TEXT: Despite recent gains in combating vector-borne diseases, especially malaria, management of vector control programmes still remains insecticide-based and vertical in nature. Therefore, concerns have been raised on whether the current long-standing conventional vector control strategy still remains with sufficient action to continue to break the transmission cycle to the levels of elimination. This is so, given the continuous dwindling resources for vector control, changes in vector behaviour, the emergence of resistance to medicines and insecticides, climate change, environmental degradation, as well as diversity in ecology, breeding habitats, and community habits. Cognizant of all that, elements of a surveillance-driven IVM approach are rapidly needed to move vector control interventions a step further. These include advocacy, policy formulation, capacity building, public and private partnerships, community engagement, and increasingly basing decisions on local evidence. Understanding the existing opportunities and gaps, and the recognition that some elements of IVM are already imbedded in the current health programmes is important to encourage stakeholders to promptly support its implementation. Leveraging on the existing opportunities, combined with sufficient advocacy, IVM could easily be accepted by the Zimbabwe government as part of a wider integrated disease management strategy. The strategy could represent an excellent breakthrough to establish much needed intra and inter-sectoral dialogue, and coordination for improved vector-borne disease prevention. CONCLUSIONS: After synthesis of the opportunities and challenges clearly presented, it was concluded that it is imperative for Zimbabwe to adopt and implement IVM strategy that is informed by work already done, while addressing the bottlenecks. The significance of refocusing for improved disease prevention that has the potential to accomplish elimination of not only malaria but all vector borne diseases much earlier than anticipated under the existing vector control system is underscored.

Field-based evaluation of malaria outbreak detection and response in Mudzi and Goromonzi districts, Zimbabwe - 2017.

National-level evaluations may fail to identify capacity improvements for detecting and responding to outbreaks which begin and are first detected at the local level. In response to this issue, we conducted a field-based assessment of the malaria outbreak surveillance system in Mashonaland East, Zimbabwe. We visited eleven clinics in Mudzi and Goromonzi districts. Twenty-one interviews were conducted with key informants from the provincial (n = 2), district (n = 7), and clinic (n = 12) levels. Interviews focused on surveillance system activities, preparedness, data quality, timeliness, stability, and usefulness. Main themes were captured utilising standard qualitative data analysis techniques. While the surveillance system detects malaria outbreaks at all levels, we identified several gaps. Clinics experience barriers to timely and reliable reporting of outbreaks to the district level and staff cross-training. Stability of resources, including transportation (33% of informants, n = 7) and staff capacity (48% of informants, n = 10), presented barriers. Strengthening these surveillance barriers may improve staff readiness to detect malaria outbreaks, resulting in timelier outbreak response and a reduction in malaria outbreaks, cases, and deaths. By focusing at the local level, our assessment approach provides a framework for identifying and addressing gaps that may be overlooked when utilising tools that evaluate surveillance capacity at the national level.

Correction to: How far is the journey before malaria is knocked out in Zimbabwe: results of the malaria indicator survey 2016.

Following publication of the original article [1], the authors of the article flagged that their article had gone to publishing with an error in the title.

How far is the journey before malaria is knocked out in Zimbabwe: results of the malaria indicator survey 2016 [corrected].

BACKGROUND: Zimbabwe conducts Malaria Indicator Surveys after 3 years and Demographic and Health Surveys to track the impact of malaria interventions. The last one to be conducted was in 2016 and had set an aim aimed to collect data to track malaria indicators as well as to save as the baseline source for the Malaria Strategic Plan (2016-2020). METHODS: Malaria Indicator Survey-2016 utilized the frame of enumeration areas (EAs) from the Zimbabwe Master Sample (ZMS12) created after the 2012 population census for each of the survey districts. The design for the survey was a representative probability sample to produce estimates at national level for the respective domains, which are the forty-four malaria-endemic districts. Survey teams comprised of Ministry of Health personnel who administered the standard questionnaire (adapted to country setting) to respondents within sampled EAs, performed RDT, anaemia test, prepared microscopic slide and collected DBS and data analysis of collected information was analysed. Microscopic slides examined centrally at the National Institute of Health Research. RESULTS: The overall protection coverage by at least one major vector control measure, IRS and/or Nets, was 82.5%. Use of nets among high-risk groups 32.5% For children under five and 24.5% for pregnant women. LLIN utilization quite low taking into consideration the net ownership per household, which was 58% for the general population. Moreover, IPTp coverage has remained almost unchanged since the 2012 MIS, with only a third of pregnant women receiving at least two doses of IPTp. Malaria prevalence appears to be on the decline with 2016 MIS recording 0.2% compared to 0.4% as of 2012 MIS. Plasmodium falciparum remains the predominant parasite species in the country at 98%. CONCLUSION: The results indicated that some progress has been made in malaria control although there is still subsequent low malaria risk perception that comes with the reduced prevalence. It has been shown that there is low use of interventions shown by the low use of LLINs by vulnerable groups like pregnant women and children under five.

Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe.

BACKGROUND: In most developing economies particularly in Africa, more people are likely to die of HIV/AIDS and malaria compared to other diseases. HIV/AIDS tends to be superimposed on the long standing malaria burden particularly in sub-Saharan Africa. The detection and understanding of spatial overlaps in disease occurrence is important for integrated and targeted disease control. Integrated disease control can enhance efficiency and cost-effectiveness through the development of drugs targeting multiple infections in the same geographic space. METHODS: Using Zimbabwe as a case study, this study tests the hypothesis that malaria clusters coincide with HIV/AIDS clusters in space. Case data for the two diseases were obtained from the Ministry of Health and Child Care in Zimbabwe at district level via the District Health Information System (DHIS). Kulldorff's spatial scan statistic was used to test for spatial overlaps in clusters of high cases of HIV/AIDS and malaria at district level. The spatial scan test was used to identify areas with higher cases of HIV/AIDS and malaria than would be expected under spatial randomness. RESULTS: Results of this study indicate that primary clusters of HIV/AIDS and malaria were not spatially coincident in Zimbabwe. While no spatial overlaps were detected between primary clusters of the two diseases, spatial overlaps were detected among statistically significant secondary clusters of HIV/AIDS and malaria. Spatial overlaps between HIV/AIDS and malaria occurred in five districts in the northern and eastern regions of Zimbabwe. In addition, findings of this study indicate that HIV/AIDS is more widespread in Zimbabwe compared to malaria. CONCLUSIONS: The results of this study may therefore be used as a basis for spatially-targeted control of HIV/AIDS and malaria particularly in high disease burden areas. This is important as previous interventions have targeted the two diseases separately. Thus, targeted control could assist in resource allocation through prioritising areas in greatest need hence maximising the impact of disease control.

A review of progress towards sub-national malaria elimination in Matabeleland South Province, Zimbabwe (2011-2015): a qualitative study.

BACKGROUND: Malaria remains a public health problem in Zimbabwe. However, malaria elimination has become a foreseeable prospect with Matabeleland South Province making significant gains towards halting local malaria transmission. This study reviews malaria elimination progress and challenges to date utilizing the World Health Organization's Malaria Programme Review framework. RESULTS: Between 2011 and 2015, malaria incidence was less than one case per 1000 population at risk in all districts save for Beitbridge and Gwanda. The majority of cases were from Beitbridge with local transmission in the same. Incidence declined in Bulilima (p = 0.01), Gwanda (p = 0.72) and Umzingwane (p = 0.44), increasing in Beitbridge (p = 0.35), Insiza (p = 0.79) and Mangwe (p = 0.60). Overall provincial incidence declined although this was not statistically significant. Malaria transmission was bimodal, with a major peak in April and a minor peak in October. A case based malaria surveillance system existed but was not real-time. Foci response guidelines were not domesticated. Artemisinin formed the backbone of case management regimens with primaquine for gametocyte clearance. Indoor residual spraying coverages were below the national target of 95% for rooms targeted for spraying. CONCLUSION: Matabeleland South province has set precedence for targeting sub-national malaria elimination in Zimbabwe. This experience may prove useful for national scale up. There is need to improve surveillance, foci response and intensification of activities to halt residual malaria transmission in Beitbridge District.

Progress towards malaria elimination in Zimbabwe with special reference to the period 2003-2015.

BACKGROUND: An intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years. The successes have prompted the Zimbabwe's National Malaria Control Programme to commit to elimination of malaria. It is critical to analyse the changes in the morbidity trends based on surveillance data, and scrutinize reorientation to strategies for elimination. METHODS: This is a retrospective study of available Ministry of Health surveillance data and programme reports, mostly from 2003 to 2015. Malaria epidemiological data were drawn from the National Health Information System database. Data on available resources, malaria control strategies, morbidity and mortality trends were analysed, and opportunities for Zimbabwe malaria elimination agenda was perused. RESULTS: With strong government commitment and partner support, the financial gap for malaria programming shrank by 91.4% from about US$13 million in 2012 to US$1 million in 2015. Vector control comprises indoor residual house spraying (IRS) and long-lasting insecticidal nets, and spray coverage increased from 28% in 2003 to 95% in 2015. Population protected by IRS increased also from 20 to 96% for the same period. In 2009, diagnostics improved from clinical to parasitological confirmation either by rapid diagnostic tests or microscopy. Artemisinin-based combination therapy was used to treat malaria following chloroquine resistance in 2000, and sulfadoxine-pyrimethamine in 2004. In 2003, there were 155 malaria cases per 1000 populations reported from all health facilities throughout the country. The following decade witnessed a substantial decline in cases to only 22 per 1000 populations in 2012. A resurgence was reported in 2013 (29/1000) and 2014 (39/1000), thereafter morbidity declined to 29 cases per 1000 populations, only to the same level as in 2013. Overall, morbidity declined by 81% from 2003 to 2015. Inpatient malaria deaths per 100,000 populations doubled in 4 years, from 2/100,000 to 4/100,000 populations in 2012-2015 respectively. Twenty of the 47 moderate to high burdened districts were upgraded from control to malaria pre-elimination between 2012 and 2015. CONCLUSIONS: A significant progress to reduce malaria transmission in Zimbabwe has been made. While a great potential and opportunities to eliminate malaria in the country exist, elimination is not a business as usual approach. Instead, it needs an improved, systematic and new programmatic strategy supported strongly by political will, sustained funding, good leadership, community engagement, and a strong monitoring and evaluation system all year round until the cessation of local transmission.

Factors associated with malaria infection in Honde valley, Mutasa district, Zimbabwe, 2014: a case control study.

BACKGROUND: In January of 2014, an outbreak of malaria was declared in the Honde Valley region of Mutasa District in Zimbabwe. The area has a hot, temperate climate and high rainfall pattern ideal for vector breeding and malaria transmission. Gravity fed irrigation channels span the valley creating a number of breeding sites for malaria vectors, mosquitoes. Malaria outbreaks have been a common occurrence in the district over the past few years despite the district meeting set targets for prevention interventions like indoor residual spraying (IRS) with pyrethroids and long lasting insecticidal nets distribution. The objectives of this study were to describe the outbreak by person, place and time, to assess the community's knowledge on malaria transmission, signs and symptoms and treatment and to tease out factors associated with malaria infection in the district. METHODS: An unmatched case-control study was carried out. Interviewer guided questionnaires were administered to residents of the valley who met the inclusion criteria in order to tease out possible factors associated with malaria infection. A case was defined as a resident of Honde Valley with a history of malaria symptoms and a confirmed diagnosis from 13 January 2014 to 26 January 2014. A control was a resident of Mutasa District who was present in the district during the time of the outbreak but did not develop symptoms of malaria. A total of 87 cases and 87 controls were enrolled. RESULTS: Cases and controls were comparable in terms of socio-demographic characteristics and knowledge on malaria transmission, treatment and prevention. Risk factors associated with contracting malaria during the outbreak were being under the age of 5 years (OR = 9.92, CI 1, 2-80, 1), not using mosquito repellents (OR = 8, 25 CI 3, 78-18, 0), having outdoor activities before dawn and after dusk (OR = 2, 81 CI 1,04-7, 6). Having received indoor residual spraying in ones house was a risk factor for contracting malaria (OR = 1, 68 CI 0, 74-3, 83). This finding was not statistically significant. Sleeping under an insecticidal net and wearing protective clothing when outdoors after dusk were protective factors against contracting malaria (OR = 0, 27 CI 0, 12-0, 59 and OR = 0, 12 CI 0, 06-0, 25 respectively). All cases were treated according to the national malaria case management guidelines. CONCLUSIONS: Risk factors for contracting malaria were being under the age of 5 years, outdoor activities at night and not using mosquito repellents. Net use was a protective factor from contracting malaria in Mutasa District. Indoor residual spraying with pyrethroids in Honde Valley was not a protective factor against contracting malaria.

Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe.

BACKGROUND: To better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe. METHODS: Data on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011. RESULTS: Malaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President's Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%). CONCLUSIONS: The burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

Trends in performance of the national measles case-based surveillance system, Ministry of Health and Child Welfare, Zimbabwe (1999 - 2008).

INTRODUCTION: Since adoption of the measles case-based surveillance system in Zimbabwe in 1998, data has been routinely collected at all levels of the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations, monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS). METHODS: A retrospective record review of the NMCBSS dataset for period 1999 -2008 was conducted, assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results, proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software. RESULTS: Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24, 5% and 5.9% respectively in 2000 to 3.9% and 1.0% respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83% and 65% respectively in 1999, to 100% and 82% respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65% in 2004 to 94% in 2008 while timeliness of feedback of serology results improved from 4% in 2004 to 65% in 2008. Sensitivity of the NMCBSS however has been weakening, declining from 9.04 cases investigated per 100,000 population per year in 2000 to 1.58 cases/100,000/year in 2008. CONCLUSION: The NMCBSS improved in quality, timeliness and feedback of laboratory results of specimens sent for investigation, but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active surveillance of cases and more support and supervisory visits to strengthen EPI surveillance.

Trends in Performance of the National Measles Case-Based Surveillance System; Ministry of Health and Child Welfare; Zimbabwe (1999 - 2008)

Introduction: Since adoption of the measles case-based surveillance system in Zimbabwe in 1998; data has been routinely collected at all levels of the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations; monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS). Methods: A retrospective record review of the NMCBSS dataset for period 1999 -2008 was conducted; assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results; proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software. Results: Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24; 5 and 5.9 respectively in 2000 to 3.9and 1.0 respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83 and 65 respectively in 1999; to 100 and 82 respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65 in 2004 to 94 in 2008 while timeliness of feedback of serology results improved from 4 in 2004 to 65in 2008. Sensitivity of the NMCBSS however has been weakening; declining from 9.04 cases investigated per 100 000 population per year in 2000 to 1.58 cases/100 000/year in 2008. Conclusion: The NMCBSS improved in quality; timeliness and feedback of laboratory results of specimens sent for investigation; but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active surveillance of cases and more support and supervisory visits to strengthen EPI surveillance

Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006.

INTRODUCTION: Workers in the cotton processing industries risk developing obstructive respiratory conditions due to prolonged exposure to cotton dust. We noted a tenfold increase in asthma among workers in a Textile Manufacturing Company. We determined the prevalence of respiratory obstructive conditions among workers in various sections. METHODS: We conducted a cross sectional analytic study. Workers were randomly sampled and data was collected using interviewer-administered questionnaires. Respiratory function was assessed using spirometry and chest auscultation. A walk through survey was conducted and a checklist was used to capture hazards and control measures in the work place. RESULTS: A total of 194 workers participated. The prevalence of severe respiratory obstruction was 27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders, 15.0% in spinners and 7.5% among weavers. The mean years of exposure between the affected and the non-affected were significantly different (T =2.20; p< 0.05). Working in the blowing department was significantly associated with developing respiratory obstruction (OR=3.53; 95% CI= 1.61-7.79) but working in the weaving department was significantly protective (OR 0.16; CI 0.04-0.59).Working in a department for less than 10 years was protective (OR =0.94; 95% CI= 0.48-1.85), but not significant. CONCLUSION: Obstructive respiratory conditions are common among textile workers, with those in blowing and waste recovery sections being the most affected. We recommended worker rotation every six months, regular spirometric screening employment of a medical officer.