Cholera: A comparison of the 2008-9 and 2010 Outbreaks in Kadoma City, Zimbabwe

Introduction: Kadoma City experienced cholera outbreaks in 2008-9, and 2010, affecting 6,393 and 123 people, respectively. A study wasconducted to compare epidemiology of the cholera outbreaks. Methods: a descriptive cross sectional study was conducted, analyzing line list data for the 2 outbreaks. Proportions, means were generated and compared using the Chi Square test at 5% level of significance.Results: cholera cases were similar by gender and age, with the 20-30 years group being most affected. Rimuka township contributed 80% and 100% of city cases in 2008-9 and 2010, respectively, p value=0.000. In 2008-9, 91% of cholera cases presented within 2 days compared to 98% in 2010. Delay seeking treatment increased from 58% to 73% (p  value=0.001), with gender, and place equally affected. The 2010 outbreak evolved faster, resulting in higher proportion being managed in CTU. CFR was 2% in 2008-9, and 3.3% in 2010 (p value =0.31). Conclusion: the 2008-9 and 2010 cholera outbreaks were similar by age and gender.  Rimuka Township was most affected by the outbreaks. There was  worsening of delay seeking treatment. The 2010 outbreak was more rapid, leading to early opening of CTC. CFR was consistently above 1%

Indoor household residual spraying program performance in Matabeleland South province, Zimbabwe: 2011 to 2012; a descriptive cross-sectional study

Introduction: Matabeleland South launched the malaria pre-elimination campaign in 2012 but provincial spraying coverage has failed to attain95% target, with some districts still encountering malaria outbreaks. A study was conducted to evaluate program performance against achievingmalaria pre-elimination. Methods: a descriptive cross sectional study was done in 5 districts carrying out IRS using the logical framework involving inputs, process, outputs and outcome evaluation. Health workers recruited into the study included direct program implementers, district and provincial program managers. An interviewer administered questionnaire, checklists, key informant  interviewer guide and desk review of records were used to collect data. Results: we enrolled 37 primary respondents and 5 key informants. Pre-elimination, Epidemic Preparedness and Response plans were absent in all districts. Shortages of inputs were reported by 97% of respondents, with districts receiving 80% of requested budget. Insecticides were procured centrally at national level. Spraying started late and districts failed to spray all targeted households by end of December. The province is using makeshift camps with inappropriate evaporation ponds where liquid DDT waste is not safely accounted for. The provincial IHRS coverage for 2011 was 84%. Challenges cited included; food shortages for spraymen, late delivery of inputs and poor state of IHRS equipment. Conclusion: the province has failed to achieve Malaria pre-elimination IRS coverage targets for 2011/12 season. Financial and logistical challenges led to delays in supply of program inputs, recruitment and training of sprayers. The Province should establish camping infrastructure with standard evaporation ponds to minimise contamination of the  environment

Risk factors for contracting anthrax in Kuwirirana ward, Gokwe North, Zimbabwe

Background: A report of an anthrax outbreak was received at Gokwe district hospital from the Veterinary department on the 23 rd January 2007. This study was therefore conducted to determine risk factors for contracting anthrax amongst residents of Kuwirirana ward. Methods: We conducted a 1:1 unmatched case control study. A case was any person in Kuwirirana ward who developed a disease which manifested by itching of the affected area, followed by a painful lesion which became papular, then vesiculated and eventually developed into a depressed black eschar from 12 January to 20 February 2007. A control was a person resident of Kuwirirana ward without such diagnosis during the same period. Results: Thirty-seven cases and 37 controls were interviewed. On univariate analysis, eating contaminated meat (OR = 7.7, 95% CI 2-29.8), belonging to a household with cattle deaths (OR= 9.7, 95% CI 2.9-33), assisting with skinning anthrax infected carcasses (OR= 5.4(95% CI 1.7-17), assisting with meat preparation for drying (OR = 5(95%CI 1.9-13.9), assisting with cutting contaminated meat (OR = 4.8(95% CI 1.7-13.2), having cuts or wounds during skinning (OR = 19.5, 95% CI 2.4-159) and belonging to a village with cattle deaths (OR = 6.5(95%CI 1.3-32) were significantly associated with anthrax. Conclusion : Anthrax in Kuwirirana resulted from contact with and consumption of anthrax infected carcasses. We recommend that the district hold regular zoonotic committee meetings and conduct awareness campaign for the community and carry out annual cattle vaccinations

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

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Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection.Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe.Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews.Results: Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects.Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background: Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.Objective: To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.Methods: A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities  for other ailments. We interviewed 77 cases and 154 controls.Results: Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42-20.85), relationships less than one year, OR= 9.33 (95% CI 3.53-24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64-16.25) and paying for sex OR= 23.65 (95% CI 6.23-89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02-6.04) and relationships less than one year OR=3.19 (95% CI 1.41-7.23). Significant differences in attitudes were evident among cases and controls.Conclusion: Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women

Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection. Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe. Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews. Results: Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Risk factors associated with cholera in Harare City, Zimbabwe, 2008

Objective: Two suspected cholera cases at Beatrice Road Infectious Diseases Hospital were reported to Harare City Health on 14 October 2008 setting in motion investigation and control measures. We determined the extent of the epidemic and risk factors for contracting cholera.Methods: An unmatched 1:1 case-control study was conducted. Case: Any resident of Harare City, 2years and above, with acute watery diarrhoea, with or without vomiting from 30 October 2008 to 01 December 2008. Control: Any resident of Harare City, 2years and above, neighbour to a case, who did not contract cholera during the same period.Results: From 14 October 2008 to 21 January 2009, 11203 cases and case fatality rate (CFR)= 3.98%. We interviewed 140 cases and 140 controls. Median age was 28years (Q1= 20; Q3= 37.5) and 28.5years (Q1= 23; Q3= 38) for cases and controls respectively. Having a diarrhoea contact at home [AOR= 12.02; 95% CI (5.46 - 26.44)], having attained less than secondary education [AOR= 4.40; 95% CI (2.28 - 8.48)]; eating cold food [AOR= 4.24; 95% CI (1.53 - 11.70)] were independent risk factors while drinking tap water [AOR= 0.05; 95% CI (0.03 - 0.11)], washing hands after using toilet [AOR= 0.19; 95% CI (0.09 - 0.39)]; eating hot food always [AOR= 0.29; 95% CI (0.17 - 0.49)] were independently protective.Discussion: The high CFR may be due to poor case management and staff shortage in treatment camps. The cholera outbreak in Harare resulted from poor personal and hygiene practices that occur when water supplies are cut. Lack of water, low knowledge on cholera prevention measures and delays in community health education campaigns contributed to the protracted outbreak. Having a diarrhoea contact at home increases chances of household members acquiring infection. Provision of safe drinking water, community health education, recruitment of staff and training of health workers on cholera case management must be prioritized