Strengthening field epidemiology in Africa: The Zimbabwe Field Epidemiology Training Program

The Zimbabwe Masters in Public Health Program is a 2-year competency based training that consists of classroom teaching (30%) and on the job field training (70%). The MPH program was created in 1993 with the aim of assisting the Ministry of Health and Child Welfare create a permanent capacity to recruit, train, and employ public health practitioners to sustain the public health infrastructure. The MPH program is operated from two sites: the DCM at the College of Health Sciences, of University of Zimbabwe (UZ) and the Health Studies Office (HSO) in MOHCW. The HSO in the MOHCW oversees the operation of field training in collaboration with approved Field Supervisors at the training sites. MOHCW provides field training sites through its eight provincial medical directorates. In addition the health directorates of the major cities in the country are designated field training sites. Since 1993, the program has had 18 Cohorts trained of which three are part-time. The part-time program was initiated in 2008 with an intake of 10 trainees. Since 2003, the full time program has experienced an increase in intake with the highest intake recorded being 16 trainees in 2003. The average intake from 2003 - 2011 has been 12 trainees. A total of 169 trainees have been enrolled in the last 19 years. Of the 143 trainees enrolled by 2009, 136 (95%) have graduated. The part-time program has had one cohort graduating with 5 out 10 successfully completing the course. Since the launch of the program, the majority of the graduates have filled most of the key public health positions and even so the positions in most of the nongovernmental organisations

Determinants of perinatal mortality in Marondera district, Mashonaland East Province of Zimbabwe, 2009: a case control study

Background: Marondera District recorded perinatal mortality ratios of 58.6/1000 and 64.6/1000 live births in 2007 and 2008 respectively. These ratios were above provincial averages of 32/1000 and 36/1000 during the same periods. We determined factors associated with perinatal mortality in Marondera District. Methods: A 1:2 unmatched case control study was carried out from June to August 2009. A case was any mother in Marondera District who had a stillbirth or early neonatal death from 01/08/2008 to 31/07/2009. A control was any mother whose baby survived the perinatal period during the same period. We calculated Odds Ratios and their 95% confidence intervals. Results: We interviewed 103 cases and 206 controls. Primary or no maternal education [OR=5.50 (3.14-9.33)] labor complications [OR=7.56 (4.38-13.06)], home delivery [OR=7.38 (4.03-13.68)] and preterm delivery [OR=15.06 (8.24-27.54)] increased the risk for perinatal mortality. Antenatal care booking [OR=0.19 (0.10-0.34)], having a gainfully employed husband [OR=0.36 (0.20-0.63)] and living within 5km of a health facility [OR=0.41 (0.22-0.78)] reduced the risk. Independent determinants of perinatal mortality included being apostolic [AOR=3.11 (1.05-9.18)], having a home delivery [AOR 7.17 (2.48-20.73)], experiencing labor complications [AOR=8.99 (3.11-25.98)], maternal HIV infection [AOR=5.36 (2.02-14.26)], antenatal care booking [AOR=0.32 (0.18-0.87)] and birth weight below 2500g [AOR=9.46 (3.91-27.65)]. Conclusion: Labor complications, belonging to apostolic sect, having a home delivery, maternal HIV infection, low birth weight and antenatal care booking were independently associated with perinatal mortality. Health worker training in emergency management of obstetric and neonatal care was initiated. Marondera District started holding perinatal mortality meetings.Key words: Perinatal mortality, determinants, neonatal deat

Factors associated with severe occupational injuries at mining company in Zimbabwe, 2010: a cross-sectional study

Introduction: Injury rate among mining workers in Zimbabwe was 789/1000 workers in 2008. The proportion of severe occupational injuries increased from 18% in 2008 to 37% in 2009. We investigated factors associated with severe injuries at the mine. Methods: An unmatched 1:1 case-control study was carried out at the mine, a case was any worker who suffered severe occupational injury at the mine and was treated at the mine or district hospital from January 2008 to April 2010, a control was any worker who did not suffer occupational injury during same period. We randomly selected 156 cases and 156 controls and used interviewer administered questionnaires to collect data from participants. Results: Majority of cases, 155(99.4%) and of controls 142(91%) were male, 127(81.4%) of cases and 48(30.8%) of controls worked underground. Majority (73.1%) of severe occupational injuries occurred during night shift. Underground temperatures reached 500C. Factors independently associated with getting severe occupational injuries included working underground (AOR=10.55; CI 5.97-18.65), having targets per shift (AOR=12.60; CI 3.46-45.84), inadequate PPE (AOR= 3.65 CI 1.34-9.89) and working more than 8 hours per shift (AOR=8.65 CI 2.99-25.02). Conclusion: Having targets exerts pressure to perform on workers. Prolonged working periods decrease workers' attention and concentration resulting in increased risk to severe injuries as workers become exhausted, lose focus and alertness. Underground work environment had environmental hazards so managers to install adequate ventilation and provide adequate PPE. Management agreed to standardize shifts to eight hours and workers in some departments have been supplied with adequate PPE.Pan African Medical Journal 2013; 14:

Determinants of perinatal mortality in Marondera district, Mashonaland East Province, Zimbabwe, 2009: a case control study

BACKGROUND: Marondera District recorded perinatal mortality ratios of 58.6/1000 and 64.6/1000 live births in 2007 and 2008 respectively. These ratios were above provincial averages of 32/1000 and 36/1000 during the same periods. We determined factors associated with perinatal mortality in Marondera District, Zimbabwe

Evaluation of the adverse events following immunizations surveillance system in Harare City, Zimbabwe, 2016: a descriptive cross sectional study

Introduction: Vaccines safety are monitored by looking for Adverse Events Following Immunizations (AEFIs). A review of the 2014 Harare City consolidated monthly return form (T5) revealed that 28 AEFIs were seen in 2014. However, only 21 were reported through the system. We therefore evaluated the Harare City AEFI surveillance system to assess its usefulness. Methods: A descriptive cross sectional study was conducted. Twenty one of 41 clinics were randomly selected and 51 health workers were randomly recruited. Interviewer administered questionnaires were used to collect data. Epi info 7 was used to generate frequencies, means and proportions. Results: Out of 51 respondents, 50 (98%) knew the purpose of AEFI system, 48 (94%) knew at least two presenting symptoms of AEFIs and 39 (77%) knew the correct date of form submission to the next level. Receiving no feedback 24 (47.1%), fear of victimisation 16 (31.4%) and work overload 11 (21.6%) were the major reasons for under reporting. Eighty six percent perceived the system to be simple and 43 (84%) were willing to continue participating. Fifty three percent (27) reported taking public health actions (such as awareness campaigns & making follow ups) basing on AEFI data collected. All 46 reviewed forms were completely filled and submitted in time. All 21 clinics had written AEFI guidelines and case definitions. Only 14 of 21 clinics had adequately stocked emergency drugs. The total cost for a single notification was estimated at US$22.30. Conclusion: The system was useful, simple, acceptable, timely, stable, representative but costly. The good performance of the system reported in this evaluation could be attributed to high health worker knowledge. Following this evaluation, replenishment of out of stock drugs and follow up of missing 2014 AEFI feedback from MCAZ were done. In addition, making the system electronic is recommended

Evaluation of sexual and gender-based violence program in Harare City, Zimbabwe, 2016: a descriptive cross-sectional study

Introduction: in Zimbabwe, there is a gap between sexual violence (SV) survivors' health care needs versus the existing facilities. Harare city started Sexual Gender Based Violence (SGBV) project in 2011, with the aim to reduce SV morbidity.Only 592 (42%) of 1425 SV survivors reported for medical services within 72 hours in 2015. HIV post-exposure prophylaxis (PEP) is effective within 72hours of post exposure. We evaluated the program performance in Harare city. Methods: we conducted a process-outcome evaluation using a logic model. We purposively recruited all eight SGBV sites and key informants. We randomly selected 27nurses into the study. Interviewer-administered questionnaires and checklists were used to collect data. To generate frequencies, means and proportions we used Epi info 7. Results: the program adequately received inputs except for counselling rooms (1/8). About 4285 survivors were recorded from 2013-2016. Of these, 97% were counselled, 93% received HIV test, 41% reported to the clinic within 72hrs of post-rape, and 12% received PEP. About 16% of the total survivors were followed up. The programme failed to meet its targets on decentralised sites (8/10), awareness campaigns(16/32) and sensitisation activities(16/32). About 500(12.5%) IEC materials were distributed. All 96-targeted supervisory visits were achieved. Two ofeight district supervisors were trained. Majority of health workers(25/35) citedlack of awareness as major reasons for underperformance. Conclusion: availability of resources did not translate to program performance. Most survivors were not reporting to the clinic timeously due to the low level of awareness of the programme to the community, hence were not protected from getting HIV through PEP. The programme was not well disseminated, as most supervisors were not trained. Following this evaluation, we distributed150 IEC materials to each of the eight facilities. A follow-up study on outcomes of clients referred for services and training of district officers were recommended

Trends in performance of the National Measles Case-Based Surveillance System, Ministry of Health and Child Welfare, Zimbabwe (1999 - 2008)

Introduction: Since adoption of the measles case-based surveillance system in Zimbabwe in 1998, data has been routinely collected at all levelsof the health delivery system and sent to national level with little or no documented evidence of use to identify risky populations, monitor impact of interventions and measure progress towards achieving measles elimination. We analysed this data to determine trends in the national measles case-based surveillance system (NMCBSS).Methods: A retrospective record review of the NMCBSS dataset for period 1999 –2008 was conducted, assessing trends in proportions of investigated cases; timeliness and nature of specimens received at laboratory; timeliness of feedback of serology results, proportion of cases confirmed as measles and national annualized rates of investigation. Comparisons with WHO performance indicators were done. The secondary data analysis was done in Excel and Epi-Info statistical software.Results: Cumulatively 4994 suspected cases were reported and investigated between 1999 and 2008. Reported suspected and confirmed measles cases declined from 24, 5% and 5.9% respectively in 2000 to 3.9% and 1.0% respectively in 2008. Proportion of cases with blood specimens collected and proportion reaching laboratory timely increased from 83% and 65% respectively in 1999, to 100% and 82% respectively in 2008. Proportion of specimens arriving at laboratory in good condition improved from 65% in 2004 to 94% in 2008 while timeliness of feedback of serology results improved from 4% in 2004 to 65% in 2008. Sensitivity of the NMCBSS however has been weakening, declining from 9.04 cases investigated per 100 000 population per year in 2000 to 1.58 cases/100 000/year in 2008.Conclusion: The NMCBSS improved in quality, timeliness and feedback of laboratory results of specimens sent for investigation, but its sensitivity declined mainly due to reduced capacity to detect and confirm measles cases. We recommend training staff on active surveillance of cases and more support and supervisory visits to strengthen EPI surveillance

Evaluation of the notifiable diseases surveillance system in sanyati district, Zimbabwe, 2010-2011

Introduction: the Notifiable disease surveillance system (NDSS) was established in Zimbabwe through the Public Health Act. Between January and August 2011, 14 dog bites were treated at Kadoma Hospital. Eighty-six doses of anti-rabies vaccine were dispensed. One suspected rabies case was reported, without epidemiological investigations. The discrepancy may imply under reporting of Notifiable Diseases. The study was conducted to evaluate the NDSS in Sanyati district. Methods: a descriptive cross sectional study was conducted. Healthcare workers in selected health facilities in urban, rural, and private and public sector were interviewed using questionnaires. Checklists were used to assess resource availability and guide records review of notification forms. Epi InfoTM was used to generate frequencies, proportions and Chi Square tests at 5% level. Results: we recruited 69 participants, from 16 facilities. Twenty six percent recalled at least 9 Notifiable diseases, 72% correctly mentioned the T1 form for notification, 39% correctly mentioned the forms completed in triplicate and 20% knew it was a legal requirement to notify. Ninety six percent of respondents indicated willingness to participate, whilst 41% had ever received feedback. Three out of 16 health facilities had T1 forms. Conclusion: NDSS is useful, acceptable, simple, and sensitive. NDSS is threatened by lack of T1 forms, poor feedback and knowledge of health workers on NDSS. T1 forms and guidelines for completing the forms were distributed to all health facilities, public and private sector. On the job training of health workers through tutorials, supervision and feedback was conducted

Evaluation of the adverse drug reaction surveillance system Kadoma City, Zimbabwe 2015

Introduction: Medicines have the potential to cause adverse drug reactions and because of this Zimbabwe monitor reactions to medicines through the Adverse Drug Reaction Surveillance System. The Medicines Control Authority of Zimbabwe monitors reactions to medicines through the Adverse Drugs Reactions Surveillance System. The system relies on health professionals to report adverse drug reactions to maximize patient safety. We report results of an evaluation of the Adverse Drugs Reactions Surveillance System in Kadoma District.Methods: A descriptive crosssectional study was conducted using the updated CDC guidelines in six health facilities in Kadoma City. Data were collected using a pretested interviewer administered questionnaire, checklists and records review. Data was analyzed using Epi InfoTM to calculate frequencies and means. Qualitative data were analyzed manually. Written informed consent was obtained from all study participants.Results: The surveillance system did not meet up to its objectives as it failed to detect the adverse drug reactions and there was no monitoring of increases in known events. Fewer than half (43%) of the participants were aware of at least 2 objectives of the surveillance system but 83% of health workers willing to participate. However the system was not acceptable, 79% did not perceive the system to be necessary with the majority saying ''why should we fill in the forms when the reactions were already known or minor''. Though the system was supposed to identify potential patient risk factors for particular types of events health workers were reluctant to participate as evidenced by only one form filled out of 20 reactions experienced in the district. The system was simple as the notification form has 16 fields which require easily obtainable information from the patient records.Conclusion: The surveillance system was not useful and was not acceptable to health workers but was simple and stable. Health workers lacked knowledge. Sharing of results with the Medicines Control Authority of Zimbabwe through the Matrons facilitated training of health workers in Kadoma City. Health workers were encouraged to notify any drug reaction and to completely fill in the notification forms. Patients were also encouraged to report any drug reaction to health care workers.Keywords: Adverse drug reactions, surveillance system, Kadoma, Zimbabw

Prevalence and risk factors for obstructive respiratory conditions among textile industry workers in Zimbabwe, 2006

INTRODUCTION: Workers in the cotton processing industries risk developing obstructive respiratory conditions due to prolonged exposure to cotton dust. We noted a tenfold increase in asthma among workers in a Textile Manufacturing Company. We determined the prevalence of respiratory obstructive conditions among workers in various sections. METHODS: We conducted a cross sectional analytic study. Workers were randomly sampled and data was collected using interviewer-administered questionnaires. Respiratory function was assessed using spirometry and chest auscultation. A walk through survey was conducted and a checklist was used to capture hazards and control measures in the work place. RESULTS: A total of 194 workers participated. The prevalence of severe respiratory obstruction was 27.8%. It was 50.0% among the blowers, 35.3% in waste recovery, 32.5% in carders, 15.0% in spinners and 7.5% among weavers. The mean years of exposure between the affected and the non-affected were significantly different (T =2.20; p less than 0.05). Working in the blowing department was significantly associated with developing respiratory obstruction (OR=3.53; 95% CI= 1.61- 7.79) but working in the weaving department was significantly protective (OR 0.16; CI 0.04-0.59).Working in a department for less than 10 years was protective (OR =0.94; 95% CI= 0.48- 1.85), but not significant. CONCLUSION: Obstructive respiratory conditions are common among textile workers, with those in blowing and waste recovery sections being the most affected. We recommended worker rotation every six months, regular spirometric screening employment of a medical officer