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

Enhancing capacity of Zimbabwe’s health system to respond to climate change induced drought: a rapid nutritional assessment

Introduction: Zimbabwe experienced the negative effects of the devastating cyclone Idai which affected several districts in the country, and the drought due to low rainfall that has affected the whole country. As a result of these catastrophes, the food and nutrition security situation in the country has deteriorated. For this reason, we carried out a rapid assessment of the health facilities in 19 sampled high global acute malnutrition and high food insecurity districts from the ten provinces of Zimbabwe to ascertain the preparedness of the facilities to respond to drought effects. Methods: we conducted a rapid nutritional assessment in 19 purposely selected districts with highest rates of global acute malnutrition from the 10 provinces of Zimbabwe. From these districts, we selected a district hospital and a rural health facility with high number of acute malnutrition cases. We adapted and administered the WHO recommended checklist (Multi-Cluster/Sector Initial Rapid Assessment (MIRA) as the assessment tool. We used STATA to generate frequencies, and proportions. Results: about 94% (16/19) of the districts had less than 50% health workers trained to manage acute malnutrition. A total of 26% (5/19) of the district hospitals and 32% (6/19) of the primary health care facilities were not admitting according to integrated management of acute malnutrition (IMAM) protocol. Twelve districts (63%) had none of their staff trained in infant and young child feeding (IYCF), 58% (11/19) had no staff trained in growth monitoring and 63% (12/19) of the districts had no trained staff in baby friendly hospital initiative (BFHI). A total of 60% of the provinces did not have combined mineral vitamin mix stocks, 80% had no resomal stocks, 20% did not have micronutrient powder stocks and 30% had no ready to use supplementary food stocks in all their assessed facilities. Fifty percent (50%) of the health facilities were not adequately stocked with growth monitoring cards. Manicaland had the least (20%) number of health facility with a registration system to notify cases of malnutrition. Conclusion: we concluded that the Zimbabwe health delivery system is not adequately prepared to respond to the effects of the current drought as most health workers had inadequate capacity to manage acute malnutrition, the nutrition surveillance was weak and inadequate stocks of commodities and anthropometric equipment was noted. Following this, health workers from six of ten provinces were trained on management of acute malnutrition, procurement of some life -saving therapeutic and supplementary foods was done. We further recommend food fortification as a long-term plan, active screening for early identification of malnutrition cases and continuous training of health workers

Food borne illness amongst health care workers, at a Central Hospital, Harare, Zimbabwe, 2016: a retrospective cohort study

Abstract Objectives Health care workers (HCW) at a Central Hospital, were served lunch at the hospital canteen on 12 December 2016. On 12 December 2016 at 1700 h, there was a sudden onset of symptoms suggestive of gastrointestinal illness among HCW. We conducted a retrospective cohort study to determine the cause and the factors associated with illness among the HCW at the hospital. Results We interviewed 96 respondents. The median incubation period was 6 h (Q1 = 4; Q3 = 12). Abdominal pain (97.5%) and watery diarrhoea (95%) were the most common symptoms. The majority (97.5%) took antibiotics before collection of stool specimen for analysis, with 24 (60%) of 40 HCW treating themselves. Eating chicken (RR = 44.2, CI 74.07; 95.34) during lunch was associated with the illness. Staphylococcus aureus and Escherichia coli were isolated from food handlers’ hands, kitchen utensils and work surfaces. Staphylococcus aureus was isolated from chicken. None of food handlers had valid medical certificates. One out of four food handlers was formally trained

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

Abstract Background Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10–19 years) on antiretroviral therapy (ART) in Harare city. Methods We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI. Results We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80–11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22–22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20–9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01–0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23–0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21–0.80)] were protective. Conclusion Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

Abstract Background Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10–19 years) on antiretroviral therapy (ART) in Harare city. Methods We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI. Results We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80–11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22–22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20–9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01–0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23–0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21–0.80)] were protective. Conclusion Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure

Effectiveness of quality improvement on occurrence of needle stick injuries (NSIs) in Harare city, Zimbabwe, 2017: A quasi-experimental study

Introduction: Globally, healthcare workers (HCWs) incur an estimated two million needle stick injuries (NSIs) per year and 90% of these injuries occur in Africa. In Zimbabwe, neither the prevalence nor the factors associated with HCW-acquired NSI are known. Harare city recorded an increase in NSIs among nurses from 1% in 2013 to 7% in 2016, highest being from the Southern District. We designed and evaluated the effectiveness of a quality improvement (QI) approach towards reduction of NSI incidence. Methods: We conducted a quasi-experimental study purposively among 83 nurses in southern District. We designed and implemented an intervention package comprising training, deployment of social behavioral change materials and workflow re-organisation. We measured effectiveness of the intervention using Plan, Do Check Act cycle. Data on intervention effectiveness was collected pre and six months post-implementation, using structured questionnaires. Analysis was presented with frequencies, means, and proportions. Results: Lack of knowledge 99% (82/83), unorganised activities 60% (50/83) and limited space in the treatment rooms 59% (49/83), were the major reasons for NSI before intervention. Pre-intervention, 10% (8/83) of the nurses had good knowledge level while 96% (80/83) had good knowledge level post- intervention. The NSI incidence rates pre-intervention was 0.97 NSI/month and 0.17 NSI/month post-intervention, a decline rate of 82% (p&lt; 0.01). Total cost saved by the intervention was $5 777.00. Conclusion: Lack of knowledge on occurrence of NSI, unorganised activities, and limited working space in the treatment rooms were the major reasons for NSIs before the intervention. The QI intervention was effective in reducing incidence of NSI. We recommend HCW trainings on NSI, promotion of socio-behavioral change and workflow re-organisation in order to offset economic efforts directed at managing NSIs