A journal article on the pattern of HIV infection in a rural Zimbabwe district.After the first case of HIV-infection had been diagnosed in 1986 in a Northern district of Zimbabwe, a local hospital based surveillance system, was introduced. In order to monitor the spread of the epidemic in the district, residence, age, sex and clinical presentation of all newly diagnosed HIV-paticnts were recorded. After three years, the data were compiled and analysed with the following results. Altogether 887 symptomatic HIV-patients (0,5 pc of the district population) were diagnosed. The most common HIV-associated signs and symptoms were PGL (47 pc), chest infection (29 pc), herpes zoster (24 pc) and chronic STDs (15 pc). The fcmalc-to-malc ratio in adults was 1,4. The average age on diagnosis in women was 26,0±6,7 years and in men 30,7±8,6 years. The three years’ cumulative incidence of HIV-cases was 27,2/1 000 in the urban area and 3/1 000 in the rural areas of the district

Denhe, K.

Dhlakama, D.

Huss, R.

Mawadza, M.

McClean, D.

Richter, C.

English

IDS OpenDocs

The
Central African 
Journal 
of
Medicine
Supplementary Issue to 1992 Volume 38,
1991 University of Zimbabwe Annual Research Day
Vol. 38, No. 4, April, 1992
Pattern of HIV-infection 
in Hurungwe district, 
Mashonaland West, 
Zimbabwe
K DENHE, D DHLAKAMA, C RICHTER, M 
MAWADZA, D McCLEAN, R HUSS
SUMMARY
After the first case of HIV-infection had been 
diagnosed in 1986 in a Northern district of 
Zimbabwe, a local hospital based surveillance 
system, was introduced. In order to monitor the 
spread of the epidemic in the district, residence, age, 
sex and clinical presentation of all newly diagnosed 
HIV-paticnts were recorded. After three years, the 
data were compiled and analysed with the following 
results. Altogether 887 symptomatic HIV-patients 
(0,5 pc of the district population) were diagnosed. 
The most common HIV-associated signs and 
symptoms were PGL (47 pc), chest infection (29 pc), 
herpes zoster (24 pc) and chronic STDs (15 pc). The 
fcmalc-to-malc ratio in adults was 1,4. The average 
age on diagnosis in women was 26,0±6,7 years and 
in men 30,7±8,6 years. The three years’ cumulative 
incidence of HIV-cases was 27,2/1 000 in the urban 
area and 3/1 000 in the rural areas of the district.
INTRODUCTION
In Zimbabwe, the first adult AIDS-case was notified 
to WHO in 1983j1 some paediatric cases were 
diagnosed in Harare in 1985.2 Since then a few 
studies on clinical manifestations and transmission of 
HIV-infection have been carried out in the capital,3, 
4 but no information is available on its clinical and 
epidemiological pattern in rural areas of Zimbabwe.
From  L usaka c lin ica l m an ife sta tio n s  of 
HIV-infection were first reported in 1986.5
Correspondence to:
K Denhe
Academic Unit of Public Health Medicine
University of Leeds
20 Hyde Terrace
Leeds LS2 9LN
UK
139
The purpose of this study was to explore and 
present data on HI V-infcction from a rural district in 
Zimbabwe.
MATERIALS AND METHODS
Patients: The district hospital served as a referral 
centre for 13 peripheral health centres and two rural 
hospitals. The district population is 195 000. The 
district consists of one urban area, communal land 
with a growth point, resettlement area and large-scale 
commercial farms. The vast majority of the 
population has easy access to health institutions 
through a regular bus service or short footing 
distances.
All patients presenting at the hospital with signs 
and symptoms suspected to be associated with 
HIV-infection were offered an HIV-test. A few 
healthy partners were tested. HIV-infection was 
suspected in eases of PGL (in most eases in 
combinations with other symptoms such as pruritus, 
skin rashes, general malaise and chronic fatigue), 
chronic diarrhoea and/or weight loss, chronic STDs, 
herpes zoster, oral candidiasis, failure-to-thrive (in 
infants), Kaposi’s sarcoma and atypical and chronic 
chest infections.
Persistent generalised lymphadenopathy was 
defined as enlarged lymphnodes (>1 cm) in at least 
two non-contiguous extranguinal sides. Any genital 
discharge or ulcer not responding to treatment within 
two weeks was regarded as chronic STD. A patient 
was diagnosed as having chronic diarrhoea if at least 
two unusually loose stools per day for at least 30 days 
during the last two months were reported. Weight loss 
was defined as profound involuntary weight loss 
sufficient for the patient to notice a marked change in 
the fit of clothes or documented weight loss of at least 
10 pc on two consecutive measures at least one month 
apart.
C hest in fec tio n s  inc lu d ed  tu b e rc u lo s is , 
pneumonias and unexplained chronic cough for at 
least four weeks. Kaposi’s sarcoma was confirmed 
histologically.
Tuberculosis was either confirmed by positive 
sputum examination or typical chest X-ray. All other 
diagnoses were made on clinical grounds.
Blood samples: Samples from all patients were 
tested for HIV at the blood transfusion centre or the 
public health laboratory in Harare using two different
CENTRAL AFRICAN
JOURNAL OF MEDICINE
ELISA tests: some positives were confirmed by 
Western blot.
Data collection: During the course of this study, from
1986 to 1989, AIDS was not a notifiable disease in 
Zimbabwe. HIV-infection and AIDS were not 
included in the in-patient and out-patient forms 
routinely used in the Zimbabwean health information 
system.
Therefore a separate recording system was started 
in the district. From 1986, when the first HIV-positive 
patient was diagnosed, to 1987, names, sex, age, 
symptoms and addresses of all HIV-positive patients 
tested for HIV were recorded.
At the end of the three-year study period the data 
were compiled and analysed.
Statistics: P ercen tages, m eans and standard  
deviations were used for exploratory data analysis.
RESULTS
Number of HIV-cases: In 1988 and 1989, 72 pc of 
all tested patients were HIV-positivc. In 1986 and
1987 not all HIV-negative patients were recorded so 
that the HIV-seropositivity rate could not be 
calculated.
Over the three years’ period, 887 patients were 
found to be HIV-positive. The number of newly 
diagnosed HIV-cases rose from 19 in 1986 to 290 in 
1987 and 433 in 1988. During the first three months 
of 1989,145 cases were diagnosed (Figure I).
Vol. 38, No. 4, April, 1992
Table I: Incidence o f symptomatic HIV-infection 
confirmed by ELISA: by area and year (1:10 000)
Growth Communal Resettle-
Urban Point Land ment Farms
1986 7 — — 8 1
1987 83 73 6 58 8
1988
1086-88
141 100 11 28 12
(3+ months
1989) 272 200 21 116 26
Age-sex-characteristics: The female-to-male ratio 
in adult HIV-positive patients was 1,4 (1,2-1,6). The 
mean age on diagnosis was 26,0 (SD = 6,7) in women 
and 30,7 (SD = 8,6) in men (Figure II). One hundred 
and two HIV-positive children below the age of five 
were diagnosed. The five seropositive patients in the 
age group of 5-14 years were all female.
140
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 4, April, 1992
Figure I: Number o f confirmed HIV-infections by year
6 0 0
5 0 0
4 0 0
3 00
200
100
0
Number of cases
1986 1987 1988 1989
Year
S e r ie s  A ESS Series B PROJECTED
Figure II: Age!sex distribution o f IllV-infeclion
Number of cases
2 5 0  |---------------------------------
0 -4  5-14 15-24 2 5 -3 4  35+
AGE (years)
Series A Males Series B Females
141
Distribution by area: There was a sharp increase of 
new cases in all socio-economic areas in the district 
(Table I). The urban area accounted for about 44 pc 
of the total number of cases.
Distribution of cases by signs and symptoms: The 
most common signs and symptoms were PGL, chest 
infections and herpes zoster (Table II).
Table II: The most common signs and symptoms 
(Total number o f cases: 889)
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Number of Cases Percentage
P G L 4 1 7 4 7
C he st In fe c tio n 2 5 7 29
H erpes Z o s te r 211 24
C hro n ic  S T D 135 15
C hro n ic  D ia rrh o e a /
W e ig h t L o ss 116 13
Fa ilu re  to  T h r iv e 72 8
Notes: PGL = Persistent Generalised Lympbadenopathy 
STD =  Sexually Transmitted Disease
During the study period, 44 cases of HIV-positive 
pulmonary TB and pleural effusion were seen. Eight 
cases of Stevens-Johnson-syndrome in seropositive 
patients were treated. Five of them were known 
TB-cases on TB-treatment.
Typhoid-like symptoms with positive serology 
were recorded in five HIV-paticnts.
Positive p re d ic tiv e  v a lu es: T he h ighest 
HIV-seropositivity rate was 89 pc among patients 
with herpes zoster (Table III).
Table III: Positive predictive values o f signs and 
symptoms associated with M V  (1988-1989)
Number o( 
Cases HIV-positive Percentage
Herpes Zoster 182 162 89
Oral thrush 30 25 83
PGL 432 328 76
Weight Loss/Chronic
Diarrhoea 127 89 70
DISCUSSION
Hurungwc district lies along the Hararc-Lusaka road, 
the main transport route between Zambia and 
Zimbabwe. Karoi, the district capital, serves as 
stop-over for long-distance lorry' drivers. From 1986 
onwards more than 40 pc of the new HIV cases were
reported from that small urban area which comprises 
less than 10 pc of the district population.
However, by 1987, cases of sym ptom atic 
HI V-infcction were reported from all socio-economic 
areas. Good bus services allow for high mobility of 
people within the district and consequently for the 
rapid spread of the infection to the periphery. At the 
beginning of 1989, the majority of patients came from 
rural areas (communal land and commercial farms). 
N evertheless, the incidence there rem ained 
comparatively low. The growth point, situated in the 
communal land, with a population of roughly 1 500 
represents a second focus of the epidemic in the 
district. The fluctuation of the HIV-incidence in the 
small resettlement area is difficult to explain.
In most rural areas of Zimbabwe the femalc/male
ratio is greater than one due to job related migration.
In Hurungwc District it is 1,03.6 The femalc/male
ratio of HIV-paticnts was significantly different.
Recently some scroprevalcnce studies in Central
African countries have found an even higher ratio.7, 
8 Q■ The authors suggest an increased HIV 
transmissibility in females. Alternatively, in our study 
some HIV-positive women may have been picked up 
at family planning and MCH clinics.
The marked difference in the manifestation age of 
males and females probably reflects the earlier 
beginning of sexual activity in girls10 and the 
continuing sexual activity up to a later age in men. 
Our results correspond closely with those of Hira et 
al from Zambia.5
The clinical features of HIV-infcction did not 
differ significantly from those reported from the 
University Teaching Hospital in Lusaka.’ The 
presentation of zoster in otherwise healthy patients, 
the high rate of HI V-scropositivity in TB-palients and 
the development of Stevens-Johnson-syndrome due 
to tubercu losis  trea tm ent confirm  find ings 
elsewhere. ’ ’ The inclusion of non-typhoid
salmonella bacteraemia in any case definition of adult 
AIDS in Africa, as suggested in a study from Rwanda, 
is not recommended.14 There was serological and 
clinical evidence for salmonella septicaemia in only 
a few cases. Moreover, no blood cultures are 
available in most Zimbabwean district hospitals.
The easy diagnosis of herpes zoster and its high 
positive predictive value make it a valuable tool to 
monitor the spread of HIV-infcction in a given area, 
as is discussed in a separate study by the same 
author.15
Vol. 38, No. 4, April, 1992
142
ACKNOWLEDGEMENTS
We are grateful to many people who helped to prepare 
this paper. We would like to thank the nursing staff of 
Karoi D istrict Hospital who helped with the 
collection of data. Many thanks to the Principal 
Medical Director, Dr. Katito, for useful comments 
and encouragement. Finally we would like to thank 
the Secretary for Health for permission to publish.
REFERENCES
1. The Panos Institute: AIDS and the Third 
World, Tinker J (ed), London, 1988; 167.
2. Nkrumah F K, Choto R G, Emmanual J, 
K um ar R :‘C lin ica l p re sen ta tio n  of 
symptomatic immunodeficiency virus in 
children’, Centr Afr J  o f Med, 1990; 36(5): 
116-120.
3. Latif AS, Katzenstein D A, Bassett M T, 
Houston S, Emmanual J C, Marowa E: 
‘Genital ulcers and transmission of HIV 
among couples in Zimbabwe, AIDS, 1989; 
3(8)519-23.
4. Topley J M: ‘HIV infection in Zimbabwe’, 
Archives o f Disease in Childhood, 1988; 
842-844.
5. Hira S K, Ngandu N, Wadhawan D, et al: 
‘Clinical and epidemiological features of 
HIV-infection at a referral clinic in Zambia’, 
Journal o f Acquired Immune Deficiency 
Syndromes, 1990; 3(1): 87-91.
6. Central Statistical Office: District Population 
Sheets, Mashonaland West Province, Harare, 
1989.
7. T rebucq  A. M unam  L. L ouis J P: 
‘HIV-infection in males and females in 
Central Africa’, Lancet, 1988; 11: 225-6.
8. Rwandan HIV Seroprevalence Study Group: 
‘Nationwide community-based survey of 
HIV-I and other human retrovirus infections 
inaCentral African countiy’, Lancet, 1989; 1: 
941—43.
9. Berkeley S, Naamora W, Okware S, et al:. 
‘AIDS and HIV-infection in Uganda — are 
women infected than men?’ AIDS, 1990; 
4(12): 1237-42.
10. Wildon D, Greenspan R and Wilson C: 
‘Knowledge about AIDS about self-reported 
behaviour among Zimbabwean adolescents’, 
Social Science and Medicine, 1989; 28(9): 
957-61.
CENTRAL AFRICAN
JOURNAL OF MEDICINE
11. Van de Perre, Bakkers E, Batungwanayo J, et 
al.: ‘Herpes zoster in African patients: an early 
m an ife sta tio n  of H IV -in fec tio n ’, 
Scandinavian Journal o f Infectious Diseases, 
1988; 20(3): 277-82.
12. Lesbordes J L, Baquillon G, Georges M C, et 
al.: ‘Tuberculosis in infection with HIV in 
Bangui’, Medecine Tropicale, (Mars), 1988; 
48(1): 21-5.
13. Kadcndc P, Standaert B, Niragira F, et al.: 
‘Tropical AIDS and tuberculosis’, Medecine 
Tropicale (Mars), 1988; 48(1): 19-20.
14. Rogcria F, Olt D, Wolff R, et al.: ‘Salmonella 
bacteracmia and generalised cryptococcosis, 
a double indicator of A frican AIDS’, 
Medecine Tropicale (Mars), 1987; 185-8.
15. Denhe K L, Dhlakama D G, Richter C, et al.: 
‘Herpes zoster as epidemiological indicator of 
HIV-infection in Africa’, Tropical Doctor (in 
press), 1992.
Vol. 38, No. 4, April, 1992
143
This work is licensed under a 
Creative Commons
Attribution -  Noncommercial - NoDerivs 3.0 License.
To view a copy of the license please see: 
http://creativecommons.org/licenses/by-nc-nd/3.0/
This is a download from the BLDS Digital Library on OpenDocs
http://opendocs.ids.ac.uk/opendocs/
Institute of 
Development Studies


Pattern of hiv-infection in Hurungwe District, Mashonaland West, Zimbabwe

https://opendocs.ids.ac.uk/opendocs/bitstream/20.500.12413/12031/1/Denhe%2cK%20et%20al%20Pattern%20of%20HIV%20infection%20%28CAJM%20Vol%2038%20no%204%29.pdf

Pattern of hiv-infection in Hurungwe District, Mashonaland West, Zimbabwe

Abstract

Similar works

Full text

Available Versions

IDS OpenDocs