Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care : evidence from midterm review of the Zimbabwe cervical cancer prevention and control strategy (2016-2020)

BACKGROUND: Cervical cancer is the fourth most common cancer amongst women globally and it accounts for the majority of cancer deaths among females in Zimbabwe. The objective of this midterm review analysis was to identify the gaps and opportunities for cervical cancer prevention, diagnosis, treatment, and care to inform the next cervical cancer strategy in Zimbabwe. METHODS: A mixed methods approach was used for the midterm review. Secondary data was collected from programme documents, published and grey literature. Primary data was collected in six provinces through key informant interviews with officials and focus group discussions with beneficiaries. After data analysis, a draft report was presented to a technical working group to validate the findings and to fill in any gaps. RESULTS: This midterm review revealed a myriad of gaps of the strategy particularly in diagnosis, treatment and care of cervical cancer and the primary focus was on secondary prevention. There was no data to quantify the level of awareness and advocacy for cervical cancer prevention. Our results revealed that there was no data on the proportion of women who ever tested for cervical cancer which existed nationally. Our findings suggest that some health facilities were screening women above 50 years old using VIAC, which is an inappropriate approach for those women. Quality control of VIAC and treatment of precancers were not part of the strategy. Pathological services were not efficient and effective due to lack of resources and additionally data on investigations were not routinely collected and available at the national level. Other gaps identified were limited funding, human resources, equipment, and commodities as well as lack of leadership at the national level to coordinate the various components of the cervical cancer programme. There are also numerous opportunities identified to build upon some successes realized to date. CONCLUSIONS: Our findings emphasized the importance of effective and holistic planning in cervical cancer screening programmes in low-resource settings. In addition, huge investments are required in cervical cancer programmes and governments need to take centre role in mobilizing the requisite resources.This midterm assessment was funded by OPHID in support of the Ministry of Health and Child Carehttp://www.biomedcentral.com/bmcpublichealth/pm2021School of Health Systems and Public Health (SHSPH

Population structure of Salmonella enterica Typhi in Harare, Zimbabwe (2012–19) before typhoid conjugate vaccine roll-out: A genomic epidemiology study

Background: The continued emergence of Salmonella enterica serovar Typhi, with ever increasing antimicrobial resistance, necessitates the use of vaccines in endemic countries. A typhoid fever outbreak in Harare, Zimbabwe, in 2018 from a multidrug resistant S Typhi with additional resistance to ciprofloxacin was the catalyst for the introduction of a typhoid conjugate vaccine programme. We aimed to investigate the emergence and evolution of antimicrobial resistance of endemic S Typhi in Zimbabwe and to determine the population structure, gene flux, and sequence polymorphisms of strains isolated before a typhoid conjugate vaccine programme to provide a baseline for future evaluation of the effect of the vaccination programme. Methods: In this genomic epidemiology study, we used short-read whole-genome sequencing of S Typhi isolated from clinical cases of typhoid fever in Harare, Zimbabwe, between Jan 1, 2012, and Feb 9, 2019, to determine the S Typhi population structure, gene flux, and sequence polymorphisms and reconstructed the evolution of antimicrobial resistance. Maximum likelihood time-scaled phylogenetic trees of Zimbabwe isolates in the context of global isolates obtained from the National Center for Biotechnology Information were constructed to infer spread and emergence of antimicrobial resistance. Findings: The population structure of S Typhi in Harare, Zimbabwe, from 2012 to 2019 was dominated by multidrug resistant genotype 4.3.1.1.EA1 (H58) that spread to Zimbabwe from neighbouring countries in around 2009 (95% credible interval 2008·5–2010·0). Acquisition of an IncN plasmid carrying antimicrobial resistance genes including a qnrS gene and a mutation in the quinolone resistance determining region of gyrA gene contributed to non-susceptibility and resistance to quinolone antibiotics. A minority population of antimicrobial susceptible S Typhi genotype 3.3.1 strains were present throughout. Interpretation: The currently dominant S Typhi population is genotype 4.3.1.1 that spread to Zimbabwe and acquired additional antimicrobial resistance though acquisition of a plasmid and mutation in the gyrA gene. This study provides a baseline population structure for future evaluation of the effect of the typhoid conjugate vaccine programme in Harare

The idea of a new Zimbabwe post- Mugabe

Zimbabwe has gone through deep political, economic and social challenges for close to three decades. Once known as the shining light of Africa, Zimbabwe is now often known for dominating international headlines for the wrong reasons. In November 2017, the country experienced a radical change to the constitutional and political order, which brought an end to former President Robert Mugabe’s 37-year reign. Emmerson Mnangagwa, who was once Mugabe’s right-hand man, assumed leadership of both the country and the ruling Zimbabwe African National Union–Patriotic Front (ZANU–PF). He was reelected in the July 2018 harmonised elections, although under disputed circumstances. The removal of Robert Mugabe has provided the country an opportunity to break from the past, and hopes have been raised for the birth of a new Zimbabwe. This chapter explores some of the measures that the administration post-Mugabe should implement to set the country on a new path. Thus, the purpose of this chapter is not to argue for a particular political formation or political leaders to govern. Rather, its objective is to explore whether the idea of a new Zimbabwe is possible and what it would take to realise this objective. Before discussing the prospects for this desired state of affairs, it is important to examine the current situation, which is explored in the first part of the chapter. A brief overview of the fall of Mugabe and rise of Mnangagwa is then provided to show how a leader who commanded respect beyond the shores of our continent could exit in such an undignified manner. The core section is dedicated to a discussion of the prospects for a new Zimbabwe, and concluding remarks end the chapter

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa

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The evolving SARS-CoV-2 epidemic in Africa: insights from rapidly expanding genomic surveillance

Investment in SARS-CoV-2 sequencing in Africa over the past year has led to a major increase in the number of sequences generated, now exceeding 100,000 genomes, used to track the pandemic on the continent. Our results show an increase in the number of African countries able to sequence domestically, and highlight that local sequencing enables faster turnaround time and more regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and shed light on the distinct dispersal dynamics of Variants of Concern, particularly Alpha, Beta, Delta, and Omicron, on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve, while the continent faces many emerging and re-emerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa.

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The impact of public relations strategies on taxpayer compliance levels in tax authorities.

This study examined the impact of Public Relations strategies employed by tax administrations on the level of tax compliance in SME‘s in Zimbabwe. The study sought to determine the extent to which the PR activities implemented in ZIMRA as the tax administration in Zimbabwe are assisting in improving the levels of tax compliance, the main areas of the study were establishing tax compliance levels, establishing how increasing media presence could also affect tax compliance and how tax education impacted on tax compliance levels. Theoretical and empirical literature were reviewed in line with these study objectives. Overall, the study was guided by the Press agentry model, public information model, two way asymmetrical model and two way symmetrical model as proposed by Grunig and Hunt. The study adopted a positivism philosophy to facilitate the use of quantitative techniques. The study adopted the deductive approach to understand the impact of Public Relations on the level of tax compliance in SME‘s in Zimbabwe. The target population and sample size were 650 and 242. Structured questionnaires designed using a 5-point Likert scale were self-administered to a number of SME‘s in Harare who were selected using simple random sampling and four Tax consultants were interviewed. Quantitative data was analyzed using SPSS. The study found out that most of that most of the SME‘s in Zimbabwe are not yet registered with ZIMRA and the reason being that the lack adequate knowledge on how they to go about the registration process. The study also found out that most of the corporate image of ZIMRA is not good and this is the major contributor to the low levels of tax compliance in the country. On tax education the programs were found out not to be effective as most of the respondents lacked adequate knowledge on the need to be tax compliant citizens and also on what the government uses the money they collect through taxation. The study also established that the press still plays a major role in the disbursement of vital information to the public, however it was realized that ZIMRA is not effectively using the media to transmit important information like policy changes as well as newly introduced products and services to the public. It was also realized that social media is increasingly playing a major role in information dissemination as a lot of people are now increasingly using the internet and the tax administration needed to increase their presence on these various social media platforms so as to increase their reach to the public. The study concluded that public relations is key in improving tax compliance and as such tax administrations need to increase their public relations vi | P a g e CHINGOZHO TAKAWIRA T R0723971R efforts. The research recommended that it was very important for tax administrations to improve their image to ensure acceptance in the public eye, there is also a need for tax administrations to increase their presence on various media platforms like the newspapers and electronic media platforms so as to increase accessibility of information by the public. Tax education was also suggested as a very important factor in improving tax compliance as most of the people lack adequate knowledge on the importance of being tax compliant citizens. The research then recommended the tax administration to engage with relevant authorities to ensure that tax education be incorporated into the curriculum both at basic and tertiary education so as to create a highly conscious society on taxation issues. It was also recommended that effective communication is also an important factor in improving tax compliance and the tax administration needed to create two way communication channels that would enable their public to reach out to them without a lot of challenges. The use of social media platforms was suggested as one of the best ways to expedite communication as they provide a chance for real time communication with the public but it would need ZIMRA to have experts manning the social media sites at all times to facilitate communication