An audit of malaria mortality using the “Malaria Death Investigation Form” at United Bulawayo Hospitals, Zimbabwe: 1996-2000

A research paper on malaria mortality in Zimbabwe.More than 90% of worldwide malaria morbidity and mortality occurs in sub-Saharan Africa where about one million direct deaths are recorded annually. The fight against the pandemic is based on a long- term use of highly efficacious treatment and transmission control. However, incomplete and imprecise case detection and diagnosis impede an accurate quantification of the disease burden. In Zimbabwe, malaria is a serious public health problem with uneven geographical distribution and impact on local institutions and communities. For instance, no malaria, transmission has been reported in the two cities of Harare and Bulawayo that host the country's four tertiary level hospitals. However, conversely, the rate of parasite resistance to available drugs in some rural areas (Chirundu, Hwange etc .. ) has put the country in the "action period" according to the WHO/AFRO classification

Risk factors for tuberculosis treatment failure among pulmonary tuberculosis patients in four health regions of Burkina Faso, 2009: case control study

Introduction: In Burkina Faso, the tuberculosis (TB) treatment failure rate increased from 2.5% in 2000 to 8.3% in 2006. The risk factors for TB treatment failure in the country are not well known. The study aims to determine the risk factors for treatment failure among pulmonary tuberculosis patients in four health region of Burkina Faso and to recommend appropriate interventions. Methods: A case control study was conducted among pulmonary TB patients who began TB treatment in 2009. A case was any patient who remained smear-positive at fifth month of TB treatment and a control was a patient who tested smear-negative at fifth month of treatment. A structured questionnaire was administered to one hundred cases and one hundred controls to collect information on exposure factors. Odds ratio were calculated using bivariate and multivariate analysis to determine the association between exposures and outcome. Results: Multivariate analysis showed that independent risk factors for TB treatment failure were fail to take TB drugs for more than 14 consecutive days (OR=18.53; 95% CI:4.56 - 75.22), sputum smearpositive at two months of treatment (OR=11.52; 95%CI:5.18-25.60), existence of comorbidity (OR=5.74; 95%CI:1.69-19.44), and use of traditional medicines or herbs (OR=2.97; 95%CI:1.12-7.85). Conclusion: Early identification of patients with the above risk factors for intense case management will improve TB treatment outcome. Patient with smear positive at 2ndnd month of treatment require more intense follow-up, and involving traditional healers who provide traditional medicines or herbs in the educational programme on TB are required. The national referral laboratory capacity needs to be strengthened to do drug susceptibility testing and routine drug monitoring on cases of non conversion at 2nd month of treatment

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

A research article on behavioural factors that determine how some residents in Musadzi area,Zimbabwe contract human cutaneous anthrax.Anthrax is a bacterial disease caused by Bacillus anthracis. It is primarily a disease of herbivores, although few, if any, warm-blooded species are entirely immune to it. From earliest historical records until the development of an effective veterinary vaccine midway through the 20th century, anthrax was one of the foremost causes of uncontrolled mortality in domestic animals worldwide. Humans contract anthrax directly from animals or through animal products. The disease is still enzootic in most countries of Africa and Asia, a number of European countries, and countries/areas of the American continent and certain areas of Australia. It still occurs sporadically in many other countries

Measles complications: the importance of their management in reducing mortality attributed to measles

A clinical study of the effects and management of measles in Zimbabwean children.Measles is among the commonest and most serious disease conditions in childhood accounting for an estimated 1.4 million measles deaths annually.1-2 However, in recent years measles deaths have been declining world wide. This decline has been attributed to many factors including improved care of complicated cases.2 In the city of Gweru, Zimbabwe, mortality attributed to measles has been declining since 1967.3 This paper examines the occurrence of complicated measles in Gweru and the effect of the care of these cases on measles mortality in the period 1967 to 89

Treatment outcomes of patients on anti-retrovirals after six months of treatment, Khami Clinic, Bulawayo, Zimbabwe

A CAJM review of HIV/AIDS treatment of infected patients on medication after 6 months of administering anti-retrovirals.It was in 1985 that the first case of HIV tested positive in Zimbabwe. The AIDS epidemic has grown since then to become one of the most serious public health challenges to ever face the nation. According to the 2003 HIV estimates, 24,6% of adults aged 15 to 49 years were infected. Whilst they cannot cure HIV/AIDS, treatment of HIV with Highly Active Antiretroviral Therapy (HAART) can transform the natural course of HIV infection by reducing morbidity and mortality as has been observed in many industrialized countries. It is recommended for patients with symptomatic AIDS, WHO Adult Stage IV and advanced Stage III irrespective of the CD4 cell count or total lymphocyte count

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

Factors associated with contracting malaria in Ward 29 of Shamva District, Zimbabwe, 2014

Background. Malaria cases at Wadzanayi Clinic in Shamva District, Zimbabwe, increased drastically, surpassing the epidemic threshold, in week four of December 2013. This rise was sustained, which necessitated an investigation of the outbreak.Objectives. To identify risk factors and system weaknesses to improve epidemic preparedness and response.Methods. An unmatched 1:1 case-control study was conducted in Ward 29 of Shamva District in Zimbabwe. Epidemic preparedness and response were assessed using the Zimbabwean epidemic preparedness and response guidelines.Results. The sociodemographic characteristics of all participants were similar, except for gender. The risk factors for contracting malaria were performing early morning chores (odds ratio (OR) 2.75; 95% confidence interval (CI) 1.20 - 6.32), having a body of water near the home (OR 3.41; 95% CI 1.62 - 7.20) and having long grass near the home (OR 2.61; 95% CI 1.10 - 6.37). Protective factors were staying indoors at night (OR 0.13; 95% CI 0.06 - 0.28) and staying in a sprayed home (OR 0.36; 95% CI 0.21 - 0.92). All cases were diagnosed with a malaria rapid diagnostic test. All complicated cases were treated with quinine. Four out of 58 uncomplicated cases were treated with quinine. The rest were treated with co-artemether. There was no documentation of the outbreak response by the district health executive. Respraying (indoor residual spraying) was carried out, with a coverage of 78% of rooms sprayed. One nurse out of seven at Wadzanayi Clinic was trained in integrated disease surveillance and response, and malaria case management. District malaria thresholds were outdated. Malaria commodities such as drugs and sprays did not have reorder limits.Conclusion. This study re-emphasises the importance of environmental- and personal-level factors as determinants of malaria. Poor outbreak preparedness and response may have propagated the malaria outbreak in this setting. Health education and the use of mosquito repellants should be emphasised. Larvicide may reduce the malaria burden. Epidemic preparedness and response need to be strengthened. Outbreak investigation remains important. This study emphasises the need for malaria interventions to be tailored to locally prevailing determinants to avert outbreaks

Field Epidemiology and Laboratory Training Programs in sub-Saharan Africa from 2004 to 2010: need, the process, and prospects

As of 2010 sub-Saharan Africa had approximately 865 million inhabitants living with numerous public health challenges. Several public health initiatives [e.g., the United States (US) President’s Emergency Plan for AIDS Relief and the US President’s Malaria Initiative] have been very successful at reducing mortality from priority diseases. A competently trained public health workforce that can operate multi-disease surveillance and response systems is necessary to build upon and sustain these successes and to address other public health problems. Sub-Saharan Africa appears to have weathered the recent global economic downturn remarkably well and its increasing middle class may soon demand stronger public health systems to protect communities. The Epidemic Intelligence Service (EIS) program of the US Centers for Disease Control and Prevention (CDC) has been the backbone of public health surveillance and response in the US during its 60 years of existence. EIS has been adapted internationally to create the Field Epidemiology Training Program (FETP) in several countries. In the 1990s CDC and the Rockefeller Foundation collaborated with the Uganda and Zimbabwe ministries of health and local universities to create 2-year Public Health Schools Without Walls (PHSWOWs) which were based on the FETP model. In 2004 the FETP model was further adapted to create the Field Epidemiology and Laboratory Training Program (FELTP) in Kenya to conduct joint competencybased training for field epidemiologists and public health laboratory scientists providing a master’s degree to participants upon completion. The FELTP model has been implemented in several additional countries in sub-Saharan Africa. By the end of 2010 these 10 FELTPs and two PHSWOWs covered 613 million of the 865 million people in sub-Saharan Africa and had enrolled 743 public health professionals. We describe the process that we used to develop 10 FELTPs covering 15 countries in sub-Saharan Africa from 2004 to 2010 as a strategy to develop a locally trained public health workforce that can operate multi-disease surveillance and response systems.Key words: Field epidemiology, laboratory management, multi-disease surveillance and response systems, public health workforce capacity buildin