Factors associated with malaria infection in Mudzi District, Mashonaland East Zimbabwe, 2019: a case-control study.

BACKGROUND: Kondo Rural Health Centre recorded 27 malaria patients between the 27th of January 2019 and the 2nd of February 2019 against an epidemic threshold of 19 with the malaria outbreak being confirmed on the 5th of February 2019. Indoor residual spraying as part of integrated vector management control activities had been done in the district before the onset of the rainy season as well as social behaviour change communication but residents were contracting malaria. We, therefore, investigated the risk factors associated with this outbreak to recommend scientifically effective prevention and control measures. METHODS: We conducted a 1:1 unmatched case-control study. A case was a resident of Mudzi from the 4th of February 2019 who had a positive rapid diagnostic test for malaria randomly selected from the clinic's line list whilst controls were randomly selected from the neighbourhood of cases. Pretested interviewer-administered questionnaires were used to collect information on demographic characteristics, knowledge and practices of residents in malaria prevention. Data were analysed using Epi info 7. RESULTS: A total of 567 confirmed malaria cases was recorded with an overall attack rate of 71.7 per 1000 population. Sixty-three case-control pairs were interviewed. The majority of cases 78% (49/63) were from Makaza, Chanetsa and Nyarongo villages which are within 3 km from Vhombodzi dam. A stagnant water body near a house [aOR = 8.0, 95%CI = (2.3-28.6)], engaging in outdoor activities before dawn or after dusk [aOR = 8.3, 95%CI = (1.1-62.7)] and having a house with open eaves [aOR = 5.4, 95%CI = (1.2-23.3)] were independent risk factors associated with contracting malaria. Wearing long-sleeved clothes when outdoors at night [aOR = 0.2, 95%CI = (0.1-0.4)] was protective. CONCLUSION: A stagnant water pool close to the homestead and engaging in outdoor activities before dawn and after dusk were modifiable risk factors associated with the malaria outbreak despite the community being knowledgeable on the transmission and prevention of malaria. Community sensitisation and mobilisation in the destruction of stagnant water bodies and cutting of tall grass around homesteads were recommended measures to contain the outbreak.

Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012.

BACKGROUND: Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT. METHODS: A UAT dataset was created by capturing socio-demographic, testing practices from the woman's booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites. RESULTS: Pooled HIV prevalence was 15.8 % (95 % CI 15.3-16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %-16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %-19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %-19.5 %) among acceptors in ANC registers. There were variations in prevalence by site. CONCLUSION: Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning.

Determinants of premature births in two central hospital Harare, Zimbabwe, 2011.

Introduction: Prematurity is a major determinant of neonatal morbidity and mortality in Zimbabwe. Although 8-10% of deliveries are premature , prematurity contributes 33% of neonatal deaths. Identifying local risk factors for prematurity could help incoming up with local intervention and prevention strategies. Design: 1:1 unmatched case control study. Setting: Harare and Parirenyatwa central hospitals maternity units. Subjects: All mothers who delivered in the units June to July 2011. Acase was a mother who had delivered a premature baby and control was a mother who delivered a term baby. Results: We interviewed 188 cases and 188 controls. Independent risk factors for premature delivery were -A previous premature delivery [AOR 3.15 95% CI 1.17 8.49, 4.61] being admitted with a medical complication in pregnancy[AOR 2.15 95% CI 1.18-3.92]. Birth interval > 24 months [AOR 0.26 95% CI 0.12 0.59] being well nourished evidenced by BMI ≥20kg/m [ AOR 0.926 95% CI 0.88 0.97] and MUAC ≥23cm [AOR 0.95 95% CI 0.91 0.95] reduced the risk of premature delivery. HIV test was done on 87% of participants, 12% were positive (66% controls, 33% cases) (p≤0.001). Conclusion: Birth interval < 24 months, previous premature delivery, only one ANC attendance, maternal under nutrition and being hospitalized with complications in pregnancy were associated with premature delivery. There was no association with HIV infection. Efforts should be made to give food supplements to pregnant undernourished women.

Factors associated with occupational injuries at a beverage manufacturing company in Harare, Zimbabwe--2008.

OBJECTIVE: A beverage manufacturing company reported 59.3% increase in occupational injuries between 2006 and 2007. Factors associated with occupational injuries at this company in Harare were characterized, described the injuries, identified the hazards and control measures in place. DESIGN: An analytical cross sectional study was conducted. SETTING: Two plants of a beverage manufacturing company in Harare. SUBJECTS: We interviewed randomly selected workers at the 2 plants of the company MAIN OUTCOME MEASURES: Prevalence of occupational injuries, Factors associated with injury, occupational hazards, control measures RESULTS: Of 392 workers interviewed, 53.3% reported having had a work-related injury. Twenty-six percent had not reported the injuries. Independent risk factors were: working in packaging department OR = 3.64 (95% CI: 2.25-5.88), having sleep disorder OR = 2.26 (95% CI: 1.21-4.22) and 7 day working week without rest OR = 1.88 (95% CI: 1.01-3.47). Hazards identified were noise, broken bottles, unguarded machines and coal dust. High risk areas were automated. Common injuries were cuts/lacerations (70.8%) and the most affected parts being the fingers 27.3% (57/209) and the hands 17.2% (36/209). Most injuries (74.8%) occurred in the packaging department due to breaking bottles. CONCLUSION: Prevalence of occupational injuries is high. We recommended regular machinery maintenance to minimize bottle breakages, reduction in working time and supply of adequate personal protective clothing.

An audit of malaria mortality using the "malaria death investigation form" at United Bulawayo Hospitals, Zimbabwe: 1996-2000.

OBJECTIVE: To identify the main causes of confirmed malaria deaths and assess the validity and the relevance of use of the MDIF in determining areas for improvement of care. DESIGN: A cross sectional study. SETTING: United Bulawayo Hospitals, a tertiary hospital in Zimbabwe. SUBJECTS: Patients whose cause of death was malaria using MIDF. RESULTS: Of 470 confirmed cases admitted in UBH during the study period, 53 (11.2%) died and were included in the study. Most deaths occurred in the over 15 years age group (88.6%) with only 3 deaths each in the other groups. All patients were referred or admitted to UBH with complicated and severe malaria; 39(74 %) had more than one complication such as CM and acute renal failure (ARP). Most patients came from or had visited a rural area and did not implement basic prophylactic and therapeutic measures put in place by the NMCP such as early self-medication. Three pregnant women aborted. Guidelines regarding investigations and treatment were not strictly adhered to. Delay in seeking treatment and in referring was generally observed at all levels of the health system. Cases of malaria deaths were found in the city in people who had not travelled to rural area. The MDIF was used in one case only. CONCLUSION: Malaria mortality accounted for 11 % of confirmed cases. Main causes of death were CM and ARP Parameters contained in the MDIF were those utilised by most authors who have investigated malaria mortality in Africa and there was a similarity in the observations. In view of the information it could provide if properly used, the MDIF is a valid tool for collecting data that the NMCP needs in order to rationalise its strategies at UBH and in other health facilities. Its use should be generalised and compulsory.

Cerebral Blood Flow Velocity is Not Associated with Serum Hemoglobin in Children with Malaria-Associated Anemia.

BACKGROUND AND PURPOSE: Hemoglobin (Hbg) is often thought to impact cerebral blood flow velocity (CBFV). This study was performed to investigate the relationship between Hbg value and CBFV in African children with malaria. METHODS: In this prospective, observational study, children aged 3 months to 18 years with malaria and a normal Blantyre coma score underwent a single transcranial Doppler ultrasound (TCD) examination with a concurrent Hbg check. RESULTS: One hundred fifty-six children with a mean age of 43 months were enrolled. Thirty-three children (21%) had severe anemia (Hbg <5g/dL), 46 (29%) had moderate anemia (Hbg 5-6.9 g/dL), 63 children (41%) had mild anemia (7-9.9 g/dL), and 14 children (9%) had no anemia (Hbg >10 g/dL) at the time of TCD examination. Mean averaged CBFV in the middle cerebral artery (MCA) for the cohort was 99% of predicted based on normative values standardized for age. There was no significant correlation between Hbg levels and measured CBFV in the MCA (r = -.09; 95% CI, -.24-.07; P = .29). CONCLUSION: In a large sample of African children with malaria, Hbg did not correlate with CBFVs as measured by TCD. Future work that includes baseline TCD measurements and Hbg values as well as other physiological parameters known to influence CBFVs is necessary to confirm these findings.

Behavioural factors associated with cutaneous anthrax in Musadzi area of Gokwe North, Zimbabwe.

OBJECTIVES: To determine behaviour factors for contracting human cutaneous anthrax among residents of Musadzi area. DESIGN: We conducted a matched case-control study for age, sex, and village. SETTING: A rural community in Musadzi area of Gokwe North district. SUBJECTS: We interviewed 35 cases and 35 controls. A case was defined as any resident/visitor of Musadzi, diagnosed with anthrax between 9 September and 10 November 2004. A control was any resident who had not been diagnosed with anthrax and had no lesions suggestive ofanthrax on day of the interview. MAIN OUTCOME MEASURES: Behaviour factors associated with contracting anthrax. RESULTS: In September 2004, cattle were reported to be dying in Musadzi area. Bacillus anthracis was positively identified in a blood smear from some of the carcasses. The attack rate among humans was 5%. Risk factors associated with contracting anthrax were: skinning of animals that had died from unknown causes AOR=3.8 (95% CI:1.3-10.7); preparation of the meat for cooking (AOR=3.1 (95% CI:1.16-8-4); preparation of the meat for drying AOR=2.7 (95% CI: 1.0081-7.4); belonging to a religious or ethnic sect that allow handling of meat from animals that had died from unknown causes (AOR=5.2 (95% CI: 1.8-14.8). CONCLUSION: The human anthrax outbreak was secondary to an anthrax epizootic occurring in cattle. The Ministry of Health activated the local zoonotic committee, carried out anthrax awareness campaigns, supervised the destruction of carcasses, disinfected potentially contaminated sites and introduced a participatory health education tool on anthrax. The veterinary department quarantined and vaccinated cattle.

Treatment outcomes of patients on antiretrovirals after six months of treatment, Khami Clinic, Bulawayo, Zimbabwe.

OBJECTIVE: To describe treatment outcomes of patients on anti-retrovirals at six months of treatment. STUDY DESIGN: We conducted pre-intervention post intervention surveys using a pretest-post test design. SETTING: Khami Municipal Clinic, Bulawayo. SUBJECTS: We interviewed consecutive patients eligible to receive antiretroviral drugs (ARVs). All patients had a history of TB treatment and a CD4 count less than 200 cells/mm. MAIN OUTCOME MEASURES: Mean change in CD4 count, weight, body mass index, and Karnofsky performance measured before and at six months ofantiretroviral treatment. RESULTS: 72 subjects were interviewed at baseline, their median age was 38 years (Q1, 32 years, Q3, 43 years). Of these, 17 (24%) died before six months of treatment. Three (4%) defaulted treatment follow up. A total of 52 respondents were alive and interviewed at six months though only 50, had repeat CD4 counts at six months. Among the 50 survivors, the mean CD4 count at six months was significantly higher than at baseline (p = 0.0003). There was a 4.2 point statistical significant increase in the mean weight from baseline (p = 0.0005). Similarly, the mean Body Mass Index (BMI) significantly increased by 1.5 kg/m2 from baseline, (p = 0.001). The mean Karnofsky performance increased from 89% at baseline to 95% at six months (p = 0004). The researchers noted that patients on TB treatment were being deferred antiretroviral therapy until they completed TB treatment. CONCLUSION: The Khami project bears testimony that even in a resource poor setting; treatment of HIV/AIDS with antiretroviral drugs is feasible. We recommend early treatment initiation for those on TB treatment in line with national guidelines.

Schistosomiasis infection among school children in the Zhaugwe resettlement area, Zimbabwe April 2005.

OBJECTIVES: To investigate the prevalence and factors associated with contracting schistosomiasis in Zhaugwe resettlement area of Shurugwi district. DESIGN: Cross sectional study. STUDY SETTING: The community in the Zhaugwe resettlement area of Shurugwi district, Midlands Province, Zimbabwe. SUBJECTS: School children in primary and secondary levels. MAIN OUTCOME MEASURES: Prevalence of schistosomiasis infection, risk factors for contracting schistosomiasis. RESULTS: Prevalence of S. haematobium and S. mansoni was 68% and 0.2%, respectively. Participating in watering the respondents' household garden (O.R = 8.1, 95% CI 1.65 to 40.2), fetching water for the home garden (O.R=3,96 95% CI 1.38 to 11.32), fishing with their legs in the water (O.R = 3.1 95% CI 1.6 to 5.8), bathing in the river or stream (O.R = 3.1 95% CI 1.68 to 5.8) were found to be statistically significantly associated with contracting schistosomiasis infection. Fishing with legs immersed in water, having a garden at home, and swimming in the river were positively associated with infection. Those who reported blood in their urine were 16 times more like to be positive for S. haematobium than those without. Vector snails were present at all water contact sites. CONCLUSION: Schistosomiasis is a major public health problem in the area. We recommend mass treatment of all school children in all other schools in the area. The community should be encouraged to cultivate Phytoloca dedocandra for snail control.

Determinants of multidrug resistance among previously treated tuberculosis patients in Zimbabwe, 2014.

SETTING: Zimbabwe. OBJECTIVE: To investigate the determinants of multidrug-resistant tuberculosis (MDR-TB) among previously treated TB patients. DESIGN: A 1:3 case-control study with bivariate analysis and logistic regression. RESULTS: Risk factors for MDR-TB were history of nursing an MDR-TB patient (adjusted OR [aOR] 4.46, 95%CI 2.02-9.88), history of hospitalisation for 3 days (aOR 2.91, 95%CI 1.62-5.23) and history of foreign travel and stay outside Zimbabwe (aOR 2.68, 95%CI 1.46-4.91). Protective factors were previous successful treatment (aOR 0.05, 95%CI 0.02-0.11), history of supervision by a health worker/village health worker (aOR 0.34, 95%CI 0.19-0.60) and having been treated not more than once previously for TB (aOR 0.18, 95%CI 0.08-0.38). No association between human immunodeficiency virus (HIV) infection and MDR-TB (aOR 1.00, 95%CI 0.53-1.88) was observed. However, among HIV-infected patients, those with CD4 <200 cells/mm3 were more likely to develop MDR-TB (aOR 4.62, 95%CI 2.49-8.53). CONCLUSION: Individual, service-related, social and demographic factors interact to determine multidrug resistance among previously treated TB patients. Infection control, treatment adherence, reduction of side effects and drug susceptibility testing must be strengthened to reduce the MDR-TB burden in Zimbabwe.

Challenges in data quality: the influence of data quality assessments on data availability and completeness in a voluntary medical male circumcision programme in Zimbabwe.

OBJECTIVES: To assess availability and completeness of data collected before and after a data quality audit (DQA) in voluntary medical male circumcision (VMMC) sites in Zimbabwe to determine the effect of this process on data quality. SETTING: 4 of 10 VMMC sites in Zimbabwe that received a DQA in February, 2015 selected by convenience sampling. PARTICIPANTS: Retrospective reviews of all client intake forms (CIFs) from November, 2014 and May, 2015. A total of 1400 CIFs were included from those 2 months across four sites. PRIMARY AND SECONDARY OUTCOMES: Data availability was measured as the percentage of VMMC clients whose CIF was on file at each site. A data evaluation tool measured the completeness of 34 key CIF variables. A comparison of pre-DQA and post-DQA results was conducted using χ2 and t-tests. RESULTS: After the DQA, high record availability of over 98% was maintained by sites 3 and 4. For sites 1 and 2, record availability increased by 8.0% (p=0.001) and 9.7% (p=0.02), respectively. After the DQA, sites 1, 2 and 3 improved significantly in data completeness across 34 key indicators, increasing by 8.6% (p<0.001), 2.7% (p=0.003) and 3.8% (p<0.001), respectively. For site 4, CIF data completeness decreased by 1.7% (p<0.01) after the DQA. CONCLUSIONS: Our findings suggest that CIF data availability and completeness generally improved after the DQA. However, gaps in documentation of vital signs and adverse events signal areas for improvement. Additional emphasis on data completeness would help support high-quality programme implementation and availability of reliable data for decision-making.

Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.

BACKGROUND: The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique. METHODS: The studies calculated per male circumcision unit costs using a cost-analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated. RESULTS: The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique. DISCUSSION: PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.

Using epidemiologic tools to control an outbreak of diarrhoea in a textile factory, Bulawayo, Zimbabwe.

Dysentery is endemic in Zimbabwe. More than 260,000 cases and a case fatality of four per thousand were reported in 1993. In late July 1994, the Health Services Department in Bulawayo was informed of two cases of Shigella dysenteriae type I at a textile factory that employs 138 workers. Workers were interviewed at the factory regarding the date of the onset of illness, symptoms, food consumed, and treatment received. Factory water supply, cooking, and sanitary facilities were inspected. Stool and water samples were obtained for analysis. A case was defined as an employee presenting with diarrhoea with onset from July 24 to August 25, 1994. Of the 99 workers on day and evening shifts, 75 (75%) were interviewed. Thirty eight workers met the case definition (Attack Rate 51%). Common symptoms were abdominal cramps (71%), and blood in stools (37%); median duration of diarrhoea was 11 days (range 5 to 32 days). Thirty seven (64%) of 58 workers who drank borehole water were ill compared to one (6%) of the 17 who did not (RR = 10.8, 95% CI = 1.6-73). No food items consumed were significantly associated with the illness. Two different shigella species (2 sonnei and 2 boydii) were isolated from five (13%) of 38 stool specimens. Water samples from the two boreholes yielded numerous faecal coliforms. Neither borehole was registered as required by the municipal bylaws, which also forbid use of borehole water for drinking. The epidemiologic and laboratory evidence implicate contaminated borehole water as the most likely cause of this outbreak. Enforcement of municipal bylaws on drilling, registration and use of boreholes is essential to avoid further outbreaks of waterborne diseases.

PIP: In response to reports of 2 cases of Shigella dysenteriae type I infection in late July 1994 at a textile factory employing 138 workers in Bulawayo, Zimbabwe's second largest city, public health workers interviewed workers at the factory regarding the date of the onset of illness, symptoms, food consumed, and treatment received. Factory water supply, cooking, and sanitary facilities were inspected and stool and water samples obtained for analysis. 75 of 99 workers on day and evening shifts were interviewed over the course of 2 days. 38 workers experienced the onset of diarrhea during July 24 to August 25, 1994, and were therefore classified as cases. 71% reported having abdominal cramps and 37% had bloody stools; the median duration of diarrhea was 11 days of range 5-32 days. 37 of the 58 workers who drank borehole water were ill compared to 1 of the 17 who did not. No food items consumed were significantly associated with the illness and shigella species 2 sonnei and 2 boydii were isolated from 5 of the 38 stool specimens. Water samples from the boreholes produced many faecal coliforms. Neither borehole was registered as required by municipal laws, which also forbid the use of borehole water for drinking. The epidemiologic and laboratory evidence suggest that contaminated borehole water probably caused the outbreak of disease.

Comparison of protection afforded by single measles vaccination and late revaccination schedules.

An intervention study compared the protection afforded vaccinees by single measles vaccination and late revaccination schedules in 1990-94. During the intervention a single revaccination (after initial vaccination at nine months of age) was applied to children at any point in time between 12 and 23 months of age. Cases of measles aged 10-23 months were identified through an active surveillance system and in this period 5, 11 and 11 cases of revaccinated, single vaccination and unvaccinated children were identified. Measles incidence rates were 392.2-415.6 (mean = 405.6, SD = 6.7), 75.4-112.1 (median = 91.7, SD = 13.3) and 12.8-15.2 (mean = 13.9, DS = 0.99) per 100,000 population in children who were unvaccinated, with single vaccination and revaccinated respectively. Relative risk of contracting measles in children who were unvaccinated or with single vaccination was 26.5-32.5 (mean = 29.4, SD = 2.3) and 5.8-8.8 (mean = 6.8, SD = 1.2) respectively compared with revaccinated children. Vaccine efficacies that were determined were 73-81% (mean = 77.2, SD = 2.9) and 96.2-96.9% (mean = 96.6, SD = 0.27) for single vaccination and late revaccination schedules respectively. It was concluded that late revaccination affords vaccinees better protection than single vaccination through improvement in vaccine.

Factors associated with measles complications in Gweru, Zimbabwe.

OBJECTIVE: To investigate factors associated with complications or death among measles cases. DESIGN: A cross-sectional study. SETTING: Health facilities in the city of Gweru, Zimbabwe. SUBJECTS: Six hundred and thirty seven measles cases randomly selected from measles surveillance data. MAIN OUTCOME MEASURES: (a) Associations of respiratory complications and diarrhoea with death among complicated cases; (b) associations of age at infection, gender of cases and vaccination status of cases with occurrence of either respiratory complications or diarrhoea or death among measles cases. RESULTS: Among cases with respiratory complications, twenty two (29%) had died, while five (5%) had died among those with diarrhoea (OR=7.06,95% CI=2.55-22.35, p<0.001). On rates of respiratory complications among cases, age groups 24-59 and 60+ months were protective by 57% (95% CI=11-79%) and 76% (95% CI=52-88%) respectively compared to the age group <24 months, and vaccination was protective by 42% (95% CI=2-65%) compared to those unvaccinated. Concerning rates of diarrhoea among cases, the age group 60+ months was protective by 80% (95% CI=62-89%) compared to age group <60 months, while vaccination was protective by 64% (95% CI=42-77%) compared to those unvaccinated. With respect to rates of mortality among cases, age was protective by six per cent (95% CI=3-9 %) for every year older. CONCLUSION: It was concluded that: (a) the risk of death was higher in cases with respiratory complications than diarrhoea; (b) the risk of complications and death was inversely related to age at infection and older age groups were protective against occurrence of complications or death; (c) the risk of complications was higher in unvaccinated cases and vaccination was protective against occurrence of complications.

Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe.

OBJECTIVE: To determine the association between HIV infection and progression of Plasmodium falciparum malaria illness in Hurungwe district, Zimbabwe. DESIGN: Prospective cohort. SETTING: Hurungwe Rural Hospital in Mashonaland West Province, Zimbabwe. SUBJECTS: Blood slide positive P. falciparum malaria patients. MAIN OUTCOME MEASURES: Development of severe and complicated malaria. RESULTS: A total of 659 clinical malaria cases were investigated and 237 (36.0%) confirmed cases entered the study. The total HIV positive malaria patients were 82 (34.6%) of confirmed cases or 12.4% of the total clinical cases. The case fatality rate was 5.9% (14 deaths) in the confirmed cases and 11 of these deaths were HIV positive. The commonly reported complications were high parasite count of 2% or more (38.5%), anaemia (29.0%), cerebral malaria (23.1%), low blood pressure (8.3%) and renal failure (1.2%). The HIV positive cases which developed severe and complicated malaria were 72, 30.4% of the sample studied or 55.8% of the total severe and complicated cases. The mode of transport to the nearest health centre was the only confounding factor identified during the analysis. After adjusting for this confounding factor, the risk of developing severe and complicated malaria was 2.35 (95% CI 1.85 to 2.98) times more in the HIV positive malaria patients than in HIV negative patients. CONCLUSION: We conclude that HIV infection is significantly associated with the development of severe and complicated malaria. There is need for future studies to determine whether HIV positive malaria patients require different management protocol from HIV negative malaria patients.

The health information system in the City of Bulawayo, Zimbabwe: how good is it?

OBJECTIVE: To evaluate the operations and attributes of the outpatient diseases (OPD) surveillance system in the City of Bulawayo. DESIGN: Cross sectional and descriptive study. The system's attributes were evaluated using Centres for Disease Control and Prevention (CDC) evaluation guidelines. We also held focus group discussions with health personnel regarding the use of collected data. SETTING: 6 of 17 health care clinics in Bulawayo, the second largest city in Zimbabwe. SUBJECTS: 34 health personnel were interviewed. MAIN OUTCOME MEASURES: Knowledge of the system's operations, and attributes of the system. RESULTS: Data providers interviewed and all those who participated in Focus Group Discussions (FGDs) had good knowledge of the system's operations. The system is complex. It reports on 94 health events, of which only six (6%) have standard case definitions. All 17 clinics participated in this surveillance. However, of 54 returns studied, 67% were incomplete, and 69% were sent in after the deadline. The system has no plans on how data should be analyzed, used and disseminated. CONCLUSIONS: The CODROPA system is potentially useful in detecting trends of diseases. However, the long delay between data collection and data analysis does not allow for early detection of epidemics and clusters of diseases may be missed. A simpler and less time consuming surveillance system should be started to improve the system's attributes particularly, timeliness of reporting and acceptability of the system to those who have or need to participate.

Consultations at central hospitals: reasons and outcome of referrals from urban clinics in Bulawayo, Zimbabwe.

OBJECTIVE: To quantify the main reasons for referral from urban primary health care clinics to central hospitals and to assess the outcome of such referrals in Bulawayo. DESIGN: Descriptive cross sectional study. SETTING: Mpilo Central Hospital, a quaternary level hospital and referral centre for urban clinics. SUBJECTS: 914 patients referred by urban clinics who attended the hospital in April and May 1995. MAIN OUTCOME MEASURES: Frequency of referrals by referrer, reasons for referral, outcome of referrals, diagnosis of admitted referrals. RESULTS: Of 914 referrals studied, 863 (94%) were made by registered general nurses and 51 (6%) by medical officers. Four hundred and forty four (49%) referrals made by registered general nurses were for doctors to establish the diagnosis, and 341 (37%) were for treatment or operation. The other referrals were for specialists to take over management, for advice on management and referral back to the clinic, and for the hospital to carry out specific tests. Of all referrals, 844 (92%) were consulted by generalist medical officers (GMOs), and only 70 (8%) by specialists. A total of 148 (16%) patients were admitted. Of these, 84 (57%) were females and 47% of admissions were aged 15 years or more. Nine (18%) of 51 referrals made by medical officers were admitted compared to 139 (16%) of 863 by registered general nurses. The rate of admission was not different by referrer (p = 0.7). CONCLUSIONS: The main reasons for referral from urban clinics to central hospitals are for doctors to either establish the diagnosis or provide treatment. There is scope for reducing the number of referrals made primarily for these reasons if a secondary or tertiary level of care institution is availed to Bulawayo and/or if clinic operations are reorganized to make medical officers' advice more accessible to registered general nurses during working hours.

Knowledge and practices of family planning in Zimbabwe.

OBJECTIVE: To assess the level of knowledge and use of family planning in Zimbabwe. DESIGN: Cross sectional study. SETTING: All eight provinces and two major cities in Zimbabwe. SUBJECTS: Women of child bearing age (15 to 49 years, 6,083 respondents). MAIN OUTCOME MEASURES: Number of live births, knowledge of contraceptive methods, previous, current and intention for future use of contraceptives, method related problems. RESULTS: The contraceptive prevalence rate was 59.6% (CI 95% 58.4 to 60.9). The median number of live births was two (Q1 = 1, Q3 = 4) among all women, and seven (Q1 = 6, Q3 = 8) among women aged 40 to 49 years. Of 6,083 women interviewed, 5,849 (96.2%) knew at least one method of modern family planning, and 4,743 (78.0%) had ever used contraceptive in their life. Health concerns were the main reason for both discontinuation (28.5%) and postponement (22.8%) of contraceptive use. CONCLUSIONS: As compared to the 1991 Mother and Child Health Survey, knowledge and coverage of family planning services have improved further, and the introduction of injectable contraceptives has proved a success. Areas which need attention include the groups with high parity that remain under served, the low knowledge and use of condoms as a contraceptive, and the high level of health concerns among current and potential users.

Risk awareness of HIV/AIDS among commercial farm workers in Zimbabwe.

OBJECTIVE: To determine levels of perceived risk of HIV infection and the determinants of these perceptions among commercial farm workers. DESIGN: Cross sectional. SETTING: Commercial farms in Manicaland, Mashonaland Central, Mashonaland West and Mashonaland East provinces of Zimbabwe. SUBJECTS: 406 male and 411 female adults. MAIN OUTCOME MEASURES: Perceived risk of HIV infection. RESULTS: Out of 33 female respondents aged less than 20 years, 19 (57.6%) reported that they had no chance of acquiring the HIV infection. The majority (15) of these 19 teenagers indicated that they had no chance of being HIV infected because they had sex only with their spouses. Of the respondents aged 20 years or more, 235 (64.6%) males and 182 (55.3%) females reported that they had no chance of being HIV infected (OR = 1.47, 95% CI 1.07 to 2.02, p = 0.016). Most males (57.0%) and females (59.9%) of age 20 years or more said that they had no chance of being HIV infected because they had sex with only their spouses. Among the respondents of age 20 years or more who indicated they had a moderate to high chance of being infected or were already infected, 35 (33.3%) of the males reported that they had multiple partners and 41 (40.6%) of the females reported that their spouses had multiple partners. CONCLUSION: In general, despite high seroprevalence rates in Zimbabwe, many individuals do not perceive themselves at risk. Future health education intervention studies should seek to increase the general perception of low risk so that adequate precaution can be taken against being infected.