Enhancing Schistosomiasis Control Strategy for Zimbabwe: Building on Past Experiences

Schistosoma haematobium and Schistosoma mansoni are prevalent in Zimbabwe to levels that make schistosomiasis a public health problem. Following three national surveys to map the disease prevalence, a national policy on control of schistosomiasis and soil transmitted helminths is being developed. This paper reviews the experiences that Zimbabwe has in the area of schistosomiasis control with a view to influence policy. A case study approach to highlight key experiences and outcomes was adopted. The benefits derived from intersectoral collaboration that led to the development of a model irrigation scheme that incorporates schistosomiasis control measures are highlighted. Similarly, the benefits of using plant molluscicides and fish and duck biological agents (Sargochromis codringtonii and Cairina moschata) are highlighted. Emphasis was also placed on the importance of utilizing locally developed water and sanitation technologies and the critical human resource base in the area of schistosomiasis developed over years. After synthesis of the case studies presented, it was concluded that while there is a need to follow the WHO recommended guidelines for schistosomiasis control it is important to develop a control strategy that is informed by work already done in the country. The importance of having a policy and local guidelines for schistosomiasis control is emphasized

Community engagement: health research through informing, consultation, involving and empowerment in Ingwavuma community

IntroductionThe goal of community involvement in health research is to improve a community’s ability to address its own health needs while ensuring that researchers understand and consider the community’s priorities. Recent data show that socio-economic and environmental challenges continue to be a barrier to informing, consulting, involving and empowering communities in community-based health research beneficial to them. The aim of this study was to assess the extent to which the Ingwavuma community in KwaZulu-Natal Province, in rural South Africa, was informed, consulted, involved and empowered about two research projects conducted between 2014 and 2021.MethodsThe study used the modified random-route procedure to administer a standardized questionnaire to 339 household heads selected randomly. The questionnaires were administered face-to-face. The sample size was estimated using the Yamane sample size generating formula. Chi-square tests were performed to assess associations between demographic variables (age, gender, education, village) and respondents’ knowledge and information of the projects, Malaria and Bilharzia in Southern Africa and Tackling Infections to Benefit Africa as well as their participation.ResultsThe communities were generally well-informed about the health projects that were being carried out. Fewer than half of those who had heard about the projects had directly participated in them. The majority had been tested for one or more diseases and conditions, mostly high blood pressure, diabetes, and schistosomiasis, and had participated in a community feedback group; many had given their children’s permission to be tested for schistosomiasis or to participate in project research activities. Others participated in public awareness campaigns and surveys. There was some evidence of a consultation process in the form of public consultation discussed in the projects, and not much discussion on empowerment.DiscussionThe findings demonstrate that researchers’ CE approach was adaptable as communities were largely educated, involved, and subsequently empowered though without much consultation and that researchers had provided a space for sharing responsibilities in all engagement process decision-making. For the empowerment of the community, projects should take into account the intrapersonal and personal aspects affecting the community’s capacity to effectively benefit from the information, consultation, involvement, and empowerment procedures

Spatial Heterogeneity Association of HIV Incidence with Socio-economic Factors in Zimbabwe

This study examined the spatial heterogeneity association of HIV incidence and socio-economic factors including poverty severity index,permanently employed females and males, unemployed females, percentage of poor households i.e., poverty prevalence, night lights index, literacy rate,household food security, and Gini index at district level in Zimbabwe.A mix of spatial analysis methods including Poisson model based on original log likelihood ratios (LLR), global Moran’s I, local indicator of spatial association - LISA were employed to determine the HIV hotspots.Geographically Weighted Poisson Regression (GWPR) and semi-parametric GWPR (s-GWPR) were used to determine the spatial association between HIV incidence and socio-economic factors. HIV incidence (number of cases per 1000) ranged from 0.6 (Buhera district) to 13.30 (Mangwe district). Spatial clustering of HIV incidence was observed (Global Moran’s I = - 0.150; Z score 3.038; p-value 0.002). Significant clusters of HIV were observed at district level. HIV incidence and its association with socioeconomic factors varied across the districts except percentage of females unemployed. Intervention programmes to reduce HIV incidence should address the identified socio-economic factors at district level

Capacity for providing caesarean section services in selected health centres and district hospitals in Tanzania

Objective: Tanzania has a high maternal mortality ratio of 556 per 100,000 live births. Timely caesarean sections avert mortality due to life threatening conditions like obstructed labour. This study assessed capacity of selected health facilities to provide caesarean sections in terms of infrastructure, equipment, essential supplies and skill mix. Methods: A cross-sectional mixed methods design was used to include systematic observations using highly structured checklists to determine the adequacy of infrastructure, functional status of equipment, availability of supplies and skill mix. An interview guide and a key-informant interview guide were used to collect data from assistant medical officers and key informants respectively. Descriptive data analysis was conducted using IBM SPSS software package.Results: Deficit for doctors ranged between 3 (37.5%) and 5 (62.5%) per each district hospital. Two out of 3 health centres did not have doctors. Deficit for assistant medical doctors ranged between 10 (62.5%) and 11 (68.8%) per each district hospital. In terms of absolute numbers, assistant medical doctors were more than doctors. Not all facilities had all the equipment, infrastructure or supplies. Challenges cited by most assistant medical officers were; shortage of theatre-trained nurses (91%; n=21), theatres not functioning (61%; n=14), inadequate blood supply (87%; n=20) and inadequate equipment (96%; n=22).Conclusion: Capacity of health facilities to provide caesarean sections was found to be sub-optimal due to health workforce shortages, inadequate infrastructure, equipment and supplies, thus increasing the risk of maternal deaths. These findings are useful in informing strategies to reduce maternal mortality. Funding: College of Health Sciences of the University of KwaZulu-Natal Keywords: Task sharing, skill mix, surgical equipment, assistant medical officers, infrastructure, caesarean sections, obstetric drugs and medical supplie

Predicted changes in habitat suitability for human schistosomiasis intermediate host snails for modelled future climatic conditions in KwaZulu-Natal, South Africa

Introduction: Climate change alters environmental and climatic conditions, leading to expansion or contraction and possible shifts in the geographical distribution of vectors that transmit diseases. Bulinus globosus and Biomphalaria pfeifferi are the intermediate host snails for human schistosomiasis in KwaZulu-Natal (KZN) province, South Africa.Methods: Using the Maximum entropy (MaxEnt) model, we modelled the current and future distribution of human schistosomiasis intermediate host snails in KZN using two representation concentration pathways (RCP4.5 and RCP8.5) for the year 2085. Thirteen and ten bioclimatic variables from AFRICLIM were used to model the habitat suitability for B. globosus and B. pfeifferi, respectively. The Jack-knife test was used to evaluate the importance of each bioclimatic variable.Results: Mean temperature warmest quarter (BIO10, 37.6%), the number of dry months (dm, 32.6%), mean diurnal range in temperature (BIO2, 10.8%), isothermality (BIO3, 6.7%) were identified as the top four bioclimatic variables with significant contribution to the model for predicting the habitat suitability for B. globosus. Annual moisture index (mi, 34%), mean temperature warmest quarter (BIO10, 21.5%), isothermality (BIO3, 20.5%), and number of dry months (dm, 7%) were identified as the four important variables for the habitat suitability of B. pfeifferi. Area under the curve for the receiving operating characteristics was used to evaluate the performance of the model. The MaxEnt model obtained high AUC values of 0.791 and 0.896 for B. globosus and B. pfeifferi, respectively. Possible changes in the habitat suitability for B. globosus and B. pfeifferi were observed in the maps developed, indicating shrinkage and shifts in the habitat suitability of B. pfeifferi as 65.1% and 59.7% of the current suitable habitats may become unsuitable in the future under RCP4.5 and RCP8.5 climate scenarios. Conversely, an expansion in suitable habitats for B. globosus was predicted to be 32.4% and 69.3% under RCP4.5 and RCP8.5 climate scenarios, with some currently unsuitable habitats becoming suitable in the future.Discussion: These habitat suitability predictions for human schistosomiasis intermediate host snails in KZN can be used as a reference for implementing long-term effective preventive and control strategies for schistosomiasis

A review of studies on community based early warning systems

Community-based early warning systems involve community driven collection and analysis of information that enable warning messages to help a community to react to a hazard and reduce the resulting loss or harm. Most early warning systems are designed at the national or global level. Local communities’ capacity to predict weather conditions using indigenous knowledge has been demonstrated in studies focusing on climate change and agriculture in some African countries. This review was motivated by successes made in non-disease specific community-based early warning systems with a view to identify opportunities for developing similar systems for malaria. This article reviewed the existing community-based early warning systems documented in literature. The types of disasters that are addressed by these systems and the methodologies utilised in the development of the systems were identified. The review showed that most of the documented community-based early warning systems focus on natural disasters such as floods, drought, and landslides. Community-based early warning systems for human diseases are very few, even though such systems exist at national and regional and global levels. There is a clear gap in terms of community-based malaria early warning systems. The methodologies for the development of the community-based early warning systems reviewed mainly derive from the four elements of early warning systems; namely risk knowledge, monitoring, warning communication and response capability. The review indicated the need for the development of community based early warning systems for human diseases. Keywords: community; early warning; disaster; hazard

Prevalence and factors associated with postnatal depression among women in two rural districts of Manicaland, Zimbabwe

Background: Low- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts. Objectives: This study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017. Methods: One hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post-delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed. Results: The mean age of participants was 23.7 years (standard deviation = 6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04–31.74). There was a higher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p = 0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR) = 2.8 (95% CI: 1.2–6.1), aOR = 2.5 (95% CI: 1.2–5.3) and aOR = 2.4 (95% CI: 1.1–5.6), respectively. Conclusion: The high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas

Malaria incidence trends and their association with climatic variables in rural Gwanda, Zimbabwe, 2005-2015.

BACKGROUND: Malaria is a public health problem in Zimbabwe. Although many studies have indicated that climate change may influence the distribution of malaria, there is paucity of information on its trends and association with climatic variables in Zimbabwe. To address this shortfall, the trends of malaria incidence and its interaction with climatic variables in rural Gwanda, Zimbabwe for the period January 2005 to April 2015 was assessed. METHODS: Retrospective data analysis of reported cases of malaria in three selected Gwanda district rural wards (Buvuma, Ntalale and Selonga) was carried out. Data on malaria cases was collected from the district health information system and ward clinics while data on precipitation and temperature were obtained from the climate hazards group infrared precipitation with station data (CHIRPS) database and the moderate resolution imaging spectro-radiometer (MODIS) satellite data, respectively. Distributed lag non-linear models (DLNLM) were used to determine the temporal lagged association between monthly malaria incidence and monthly climatic variables. RESULTS: There were 246 confirmed malaria cases in the three wards with a mean incidence of 0.16/1000 population/month. The majority of malaria cases (95%) occurred in the > 5 years age category. The results showed no correlation between trends of clinical malaria (unconfirmed) and confirmed malaria cases in all the three study wards. There was a significant association between malaria incidence and the climatic variables in Buvuma and Selonga wards at specific lag periods. In Ntalale ward, only precipitation (1- and 3-month lag) and mean temperature (1- and 2-month lag) were significantly associated with incidence at specific lag periods (p < 0.05). DLNM results suggest a key risk period in current month, based on key climatic conditions in the 1-4 month period prior. CONCLUSIONS: As the period of high malaria risk is associated with precipitation and temperature at 1-4 month prior in a seasonal cycle, intensifying malaria control activities over this period will likely contribute to lowering the seasonal malaria incidence

Exclusion and contests over wetlands used for farming in Zimbabwe: a case study of broad-ridge and broad-furrow tillage system on Zungwi Vlei

In Zimbabwe, a broad-ridge and broad-furrow tillage system was promoted by the state, scientists and a nongovernmental organisation for its presumed agronomic and environmental viability and economic returns for small farmers. Zungwi vlei, a wetland of value to the community was transformed from a common use natural resource into a limited access broad-ridge and broad-furrow irrigation landscape that benefited a small number of people. Our study sought to understand conflicts over natural resources access, use and management arising from this land use change. The study adopted mixed methods combining qualitative and quantitative data collection tools. The results indicated the presence of a wide range of internal and external conflicts following the transformation of the landscape. Prior to the transformation, low levels of conflict were noted. We concluded that despite the ability of the broad-ridge and furrow tillage system to boost agricultural productivity per square meter, it triggered considerable resource use conflicts as fewer families directly benefited from the innovation. Key words: Development, vlei, agricultural technology, resources conflict, political ecology, Zimbabw