Effects of repeated blood donation on iron status of blood donors in Zimbabwe: A cross-sectional study.

INTRODUCTION: Iron deficiency is a major complication of repeated blood donation. However, most of the blood screening methods employed by blood collection agents do not include iron status markers, leading to possible subclinical iron deficiency. The aim of this study was to evaluate the effects of repeated blood donation on the iron status of this vulnerable population in Zimbabwe. METHODS: All donors were categorized into groups based on number of donations made in the previous 2-year period prior to enrolment into the study. Serum iron, total iron-binding capacity (TIBC), and ferritin were analyzed on automated chemistry analyzers while transferrin saturation (TSAT) was calculated. The Wilcoxon rank-sum and ANOVA tests were used to assess the variation of iron profiles by gender and frequency of donations. All data analysis was performed using Stata software v13. RESULTS: Study participants included 170 repeat donors and 20 first-time blood donors. The median (IQR) age was 23 (19-27) years, while the majority were males 57% (n = 109/190). The overall prevalence of iron deficiency and reduced iron stores was 12.6% and 38.9%, respectively. There were statistically significant differences between males and females in all the iron status parameters (P < .05). TIBC increased with number of donations, while iron, ferritin, and TSAT decreased with increased number of donations. CONCLUSION: A high proportion of blood donors had iron deficiency despite being eligible to donate. Repeated blood donation may lead to substantial reduction in iron stores among blood donors. Inclusion of iron biochemical markers may enhance proper screening and monitoring of blood donors in Zimbabwe to prevent development of iron deficiency anemia

Diagnostic sensitivity of direct wet mount microscopy for soil-transmitted helminth infections in Jimma Town, Ethiopia

Introduction: Soil-transmitted helminthiasis (STH) remains a major public health problem in school children in Ethiopia. Although direct wet mount microscopy (DWMM) is the means to diagnose parasitic diseases in health care facilities in Ethiopia, it remains unclear what its diagnostic performance is for STH. Methodology: A cross-sectional study was performed in Jimma Town (Ethiopia) and included 600 children from 10 primary schools. The diagnostic sensitivity of DWMM was compared to a composite reference standard (CRS) consisting of Kato-Katz, McMaster and Mini-FLOTAC. We also explored the impact of intensity of infection (the highest faecal egg counts (FECs; expressed as eggs per gram of stool (EPG)) across the CRS) on the diagnostic sensitivity of DWMM. Results: Based on the CRS, there were 210 Ascaris (35.0%), 312 Trichuris (52.0%) and 102 hookworm cases (17.0%). The median intensity of infections equalled 2,057 EPG for Ascaris, 200 EPG for Trichuris and 110 EPG for hookworms. The sensitivity of DWMM was 73.8% for Ascaris, but was around 17% for both Trichuris and hookworms. The sensitivity significantly increased with intensity of STH. For Ascaris, the odds for detecting an infection intensity of 1,000 EPG was 6.2 times higher than detecting an infection of 100 EPG. For Trichuris and hookworms, these odds ratios were 7.1 and 14. Conclusions: The diagnostic sensitivity of DWMM is low for STH, but it is able to detect those subjects that are in the highest need of treatment, and hence contributes to the global goal to eliminate STH as a public health problem

Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000-2018.

OBJECTIVES: Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018. DESIGN: Ecological study using aggregate national data. SETTING: Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT. RESULTS: ART coverage in the public sector increased from 1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001). CONCLUSIONS: This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage

Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece.

Sexual violence can have destructive impact on the lives of people. It is more common in unstable conditions such as during displacement. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers arriving there. This study aimed to describe the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. Methods This is s a descriptive study using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). Results We enrolled 215 survivors of sexual violence who reported and were treated, of whom 60 (28%) were male. The majority of incidents reported (90%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) on Lesvos were also observed. The perpetrator was known in 23% of the cases. Only XXX received mental health care, and the need exceeded the capacity of available mental care services. Conclusion Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and protection measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed

Use of a sustainable livelihood framework-based measure to estimate socioeconomic impact of tuberculosis on house-holds

Tuberculosis (TB) disproportionally affects impoverished members of society. The adverse socioeconomic impact of TB on households is mostly measured using money-centric approaches which have been criticised as one-dimensional and risk either overestimating or underestimating the true socioeconomic impacts of TB. We propose to use the sustainable livelihood framework, which includes five household capital assets: human, financial, physical, natural and social, and conceptualises that households employ accumulative strategies in times of plenty and coping (survival) strategies in response to shocks such as TB. The proposed measure ascertains to what extent the five capital assets are available to households affected by TB as well as the coping costs (reversible and non-reversible) that are incurred by households at different time points (intensive, continuation and post-TB treatment phase). We assert that our approach is holistic, multi-dimensional and draws attention to multisectoral responses to mitigate the socioeconomic impact of TB on households

Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study

BACKGROUND: Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings. METHOD: We prospectively determined health-seeking behavioural patterns and associations with treatment outcomes and costs among 68 RR-TB patients attending conveniently selected facilities in a decentralised system in Harare, Zimbabwe. RESULTS: From initial symptoms to initiation of effective treatment, patients made a median number of three health care visits (IQR 2-4 visits) at a median cost of 13% (IQR 6-31%) of their total annual household income (mean cost, US$410). Cumulatively, RR-TB patients most frequently first visited private facilities, i.e., private pharmacies (30%) and other private health care providers (24%) combined. Median patient delay was 26 days (IQR 14-42 days); median health system delay was 97 days (IQR 30-215 days) and median total delay from symptom onset to initiation of effective treatment was 132 days (IQR 51-287 days). The majority of patients (88%) attributed initial delay in seeking care to "not feeling sick enough." Total delay, total cost and number of health care visits were not associated with treatment or clinical outcomes, though our study was not adequately powered for these determinations. CONCLUSIONS: Despite the public availability of rapid molecular TB tests, patients experienced significant delays and high costs in accessing RR-TB treatment. Active case finding, integration of private health care providers and enhanced service delivery may reduce treatment delay and TB associated costs

High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe.

INTRODUCTION: Health care workers (HCWs), especially from sub-Saharan Africa, are at risk of occupational exposure to HIV. Post exposure prophylaxis (PEP) can reduce this risk. There is no published information from Zimbabwe, a high HIV burden country, about how PEP works. We therefore assessed how the PEP programme performed at the Parirenyatwa Hospital, Harare, Zimbabwe, from 2017-2018. METHODOLOGY: This was a cohort study using secondary data from the staff clinic paper-based register. The chi square test and relative risks were used to assess associations. RESULTS: There were 154 HCWs who experienced occupational injuries. The commonest group was medical doctors (36%) and needle sticks were the most frequent type of occupational injury (74%). The exposure source was identified in 114 (74%) occupational injuries: 91% of source patients were HIV-tested and 77% were HIV-positive. All but two HCWs were HIV-tested, 148 were eligible for PEP and 142 (96%) started triple therapy, all within 48 hours of exposure. Of those starting PEP, 15 (11%) completed 28 days, 13 (9%) completed < 28 days and in the remainder PEP duration was not recorded. There were no HCW characteristics associated with not completing PEP. Of those starting PEP, 9 (6%) were HIV-tested at 6-weeks, 3 (2%) were HIV-tested at 3-months and 1 (< 1%) was HIV-tested at 6-months: all HIV-tests were negative. CONCLUSIONS: While uptake of PEP was timely and high, the majority of HCWs failed to complete the 28-day treatment course and even fewer attended for follow-up HIV-tests. Various changes are recommended to promote awareness of PEP and improve adherence to guidelines

Access to second-line drug susceptibility testing results among patients with Rifampicin resistant tuberculosis after introduction of the Hain® Line Probe Assay in Southern provinces, Zimbabwe.

OBJECTIVES: To determine the proportion of rifampicin-resistant tuberculosis (RR-TB) patients who accessed second-line drug susceptibility testing (SL-DST) results following introduction of the Hain technology in southern provinces, Zimbabwe. DESIGN: Cohort study using secondary data. RESULTS: Xpert MTB/RIF results were used to identify 133 RR-TB patients for this study. Their mean age (SD) was 37.9 (11.1) years, 83 (62%) were males and 106 (80%) were HIV-infected. There were 6 (5%) participants who had pre-treatment attrition. Of the 133 pulmonary TB (PTB) patients, 117 (80%) had additional sputum specimens collected; 96 (72%) specimens reached the National TB Reference Laboratory (NTBRL); 95 (71%) were processed; 68 (51%) had SL-DST results. Only 53 (40%) SL-DST results reached the peripheral facilities. Median time from specimen reception at the NTBRL to SL-DSTs was 40 days, interquartile range (IQR: 28-67). Median time from presumptive diagnosis of RR-TB by health care worker to SL-DST results was 50days (IQR: 39-80), and increased to 79days (IQR: 39-101) in facilities >250km from the NTBRL. The proportion with any fluoroquinolone resistance was 9 (13.2%). CONCLUSION: Although RR-TB patients with PTB were initiated timely on treatment, access to SL-DSTs by facilities needs improvement. Health inequities exist as remote areas are less likely to get SL-DST results in time

How has the Zimbabwe mycobacterial culture and drug sensitivity testing system among re-treatment tuberculosis patients functioned during the scale-up of the Xpert MTB/RIF assay?

Background: In Zimbabwe, while the Xpert MTB/RIF assay is being used for diagnosing tuberculosis and rifampicin-resistance, re-treatment tuberculosis (TB) patients are still expected to have culture and drug sensitivity testing (CDST) performed at national reference laboratories for confirmation. The study aim was to document the Xpert MTB/RIF assay scale-up and assess how the CDST system functioned for re-treatment TB patients. Methods: We performed an ecologic study using national aggregate data. Results: Use of the Xpert MTB/RIF assay increased from 11 829 to 68 153 between 2012 and 2016. Xpert assays worked well, with successful tests in more than 90% of cases, TB detection rates at 15-17% and rifampicin resistance in <10%. During Xpert scale-up, the number of sputum specimens from re-treatment TB patients reaching national reference laboratories for CDST increased from 12% to 51%. In terms of laboratory performance, culture contamination increased from 3% to 17%, positive cultures from 13% to 17% and successful CDST from 6% to 14%: the proportion of CDST showing any resistance to rifampicin averaged 44%. From 2009 to 2016, the proportion of notified re-treatment TB patients with successful CDST increased from <1% to 7%. Conclusions: While components of Zimbabwe's CDST system for re-treatment TB patients showed some changes during the scale-up of the Xpert MTB/RIF assay, overall performance was poor. The country must either invest in improving CDST performance or in advanced molecular diagnostic technology