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1.
BMJ Glob Health ; 7(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1622049

ABSTRACT

WHO launched the Good Governance for Medicines (GGM) programme in 2004 with the aim of fighting the problem of corruption in the pharmaceutical sector. Zimbabwe adopted the GGM programme in 2015 and developed its own implementation framework (GGM-IF) in 2017 based on the WHO global guidelines and recommendations. Zimbabwe's GGM-IF emerged from; (1) home-based expertise, (2) extensive local consultations and (3) effective incorporation into existing institutions. The GGM-IF committed to implementing a focused programme over a 5-year period from 2017 to 2022 with the expressed goal of improving transparency and accountability in the pharmaceutical sector as a key enabler to improve access to medicines. Midway through its projected lifespan, some notable achievements materialised attributed to key success drivers, including mutual collaboration with the Ministry of Health and Child Care's existing Global Fund supported Quality Assurance Programme. Key challenges faced include limited funding for the programme, a shifting policy environment driven by a political transition and reorientation of priorities in the wake of the COVID-19 pandemic. This manuscript articulates 3-year operationalisation of Zimbabwe's GGM-IF highlighting the success drivers, implementation challenges and lessons learnt.


Subject(s)
COVID-19 , Pandemics , Humans , SARS-CoV-2 , Social Responsibility , Zimbabwe
2.
Pan Afr Med J ; 40: 180, 2021.
Article in English | MEDLINE | ID: covidwho-1614292

ABSTRACT

Introduction: Zimbabwe was one of the first countries to run a national COVID-19 vaccination programme in Africa. Lessons learnt could inform the roll-out of similar programmes in sub-Saharan Africa. To describe the trends of uptake of the COVID-19 vaccines in the first three months (February - May 2021) of the Zimbabwe vaccination programme and the lessons learnt. Methods: a secondary descriptive analysis of routinely available COVID-19 vaccination data extracted from the daily situation reports published by the Ministry of Health and Child Care. Results: in the first three months of the programme, 1 020 078 doses were administered, with 675 678 being first doses and 344 400 were second doses. Using population estimates, at three months, 5.2% of the population had received at least one dose and 2.6% had received the full two doses. Uptake was initially slow, followed by a gradual, and subsequently an exponential increase. Conclusion: by the end of May 2021, Zimbabwe had rolled out one of the largest COVID-19 vaccination programme in sub-Saharan Africa. The uptake followed a pattern and trend that is consistent with vaccine hesitancy reported in the literature, driven by a combination of confidence, complacency and convenience factors. The gradual increase in uptake followed a series of national and local community engagement programmes. The roll-out of similar programmes must recognise likely patterns of uptake across the population and ensure plans are in place to address vaccine hesitancy. The available data did not allow granular analysis to understand the demographics of people who participated in the programme, which is important for surveillance, targeted action, preventing inequalities and ensuring adequate and proportionate protection of residents prioritising the most vulnerable. Further analysis of the process, outcomes and impact of the programme will be helpful in informing the roll-out of similar programmes across Africa.


Subject(s)
COVID-19 Vaccines , COVID-19 , Africa South of the Sahara , Cross-Sectional Studies , Humans , SARS-CoV-2 , Vaccination , Zimbabwe
4.
Int J Environ Res Public Health ; 18(21)2021 10 20.
Article in English | MEDLINE | ID: covidwho-1512276

ABSTRACT

Artisanal and small-scale miners (ASMs) labour under archaic working conditions and are exposed to high levels of silica dust. Exposure to silica dust has been associated with an increased risk of tuberculosis and silicosis. ASMs are highly mobile and operate in remote areas with near absent access to health services. The main purpose of this study was to evaluate the prevalence of tuberculosis, silicosis and silico-tuberculosis among ASMs in Zimbabwe. A cross-sectional study was conducted from 1 October to 31 January 2021 on a convenient sample of 514 self-selected ASMs. We report the results from among those ASMs who attended an outreach medical facility and an occupational health clinic. Data were collected from clinical records using a precoded data proforma. Data variables included demographic (age, sex), clinical details (HIV status, GeneXpert results, outcomes of chest radiographs, history of tuberculosis) and perceived exposure to mine dust. Of the 464 miners screened for silicosis, 52 (11.2%) were diagnosed with silicosis, while 17 (4.0%) of 422 ASMs were diagnosed with tuberculosis (TB). Of the 373 ASMs tested for HIV, 90 (23.5%) were sero-positive. An HIV infection was associated with a diagnosis of silicosis. There is need for a comprehensive occupational health service package, including TB and silicosis surveillance, for ASMs in Zimbabwe. These are preliminary and limited findings, needing confirmation by more comprehensive studies.


Subject(s)
HIV Infections , Occupational Health , Silicosis , Tuberculosis , Cross-Sectional Studies , Gold , HIV Infections/epidemiology , Humans , Silicosis/epidemiology , Silicosis/etiology , Zimbabwe/epidemiology
5.
Pan Afr Med J ; 40: 46, 2021.
Article in English | MEDLINE | ID: covidwho-1488856

ABSTRACT

Since the beginning of June 2021, Zimbabwe entered into a harsh third wave of the COVID-19 pandemic, which saw an increase in the cumulative number of cases from approximately 38,000 to 120,000 in just two months. This exponential case rise was accompanied by an increase in the absolute number of case fatalities, with a corresponding strain on the public health sector. To effectively inform public health responses, policy and strategy to deal with the current wave and prepare for further waves, we discuss the drivers and challenges of control for this current wave and future waves, and offer practical recommendations. Vaccination will be the most important public health intervention to deal with the spread, morbidity and mortality of COVID-19, therefore, efforts to fight vaccine hesitancy and build vaccine confidence and availability will be critical. Similarly, it will be important to build public health sector capacity and resilience to adequately deal with large-scale outbreaks and absorb the shock waves associated with such. Resuscitating and building the economy is an indispensable component of protecting public health. Therefore, collaborative efforts from relevant public health stakeholders, economists, politicians and other players are required to effectively coordinate the necessary responses and formulate the right policies and strategies.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , Public Health , Vaccination , COVID-19/mortality , COVID-19/prevention & control , Capacity Building , Cooperative Behavior , Health Policy , Humans , Vaccination Refusal , Zimbabwe/epidemiology
7.
Lancet Glob Health ; 9(12): e1658-e1666, 2021 12.
Article in English | MEDLINE | ID: covidwho-1475185

ABSTRACT

BACKGROUND: Advances in SARS-CoV-2 sequencing have enabled identification of new variants, tracking of its evolution, and monitoring of its spread. We aimed to use whole genome sequencing to describe the molecular epidemiology of the SARS-CoV-2 outbreak and to inform the implementation of effective public health interventions for control in Zimbabwe. METHODS: We performed a retrospective study of nasopharyngeal samples collected from nine laboratories in Zimbabwe between March 20 and Oct 16, 2020. Samples were taken as a result of quarantine procedures for international arrivals or to test for infection in people who were symptomatic or close contacts of positive cases. Samples that had a cycle threshold of less than 30 in the diagnostic PCR test were processed for sequencing. We began our analysis in July, 2020 (120 days since the first case), with a follow-up in October, 2020 (at 210 days since the first case). The phylogenetic relationship of the genome sequences within Zimbabwe and global samples was established using maximum likelihood and Bayesian methods. FINDINGS: Of 92 299 nasopharyngeal samples collected during the study period, 8099 were PCR-positive and 328 were available for sequencing, with 156 passing sequence quality control. 83 (53%) of 156 were from female participants. At least 26 independent introductions of SARS-CoV-2 into Zimbabwe in the first 210 days were associated with 12 global lineages. 151 (97%) of 156 had the Asp614Gly mutation in the spike protein. Most cases, 93 (60%), were imported from outside Zimbabwe. Community transmission was reported 6 days after the onset of the outbreak. INTERPRETATION: Initial public health interventions delayed onset of SARS-CoV-2 community transmission after the introduction of the virus from international and regional migration in Zimbabwe. Global whole genome sequence data are essential to reveal major routes of spread and guide intervention strategies. FUNDING: WHO, Africa CDC, Biotechnology and Biological Sciences Research Council, Medical Research Council, National Institute for Health Research, and Genome Research Limited.


Subject(s)
COVID-19/epidemiology , Epidemics , Genome, Viral , Public Health Surveillance , SARS-CoV-2/genetics , Travel-Related Illness , Adolescent , Adult , COVID-19/transmission , COVID-19/virology , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Molecular Epidemiology , Retrospective Studies , Whole Genome Sequencing , Young Adult , Zimbabwe/epidemiology
9.
Pan Afr Med J ; 39: 255, 2021.
Article in English | MEDLINE | ID: covidwho-1468748

ABSTRACT

In response to COVID-19 pandemic, the Zimbabwe government put in place various rigorous measures to curb the spread of the virus. Although roll-out and access to COVID-19 vaccines in Africa have been slow, the World Health Organization (WHO)-led COVID-19 Vaccines Global Access (COVAX) consortium and the African vaccine acquisition task team are striving to provide 720 million doses of COVID-19 vaccines to achieve 60% coverage in Africa by June, 2022. In line with this, the Zimbabwe vaccination programme commenced on the 26th February 2021 and as of 9th June 2021, approximately, 2.6% of the population have been fully vaccinated in the country. Although the COVID-19 pandemic has crippled the economy and caused significant strain on the public health system, much has been done in the country since the first case was recorded (20th March 2020). However, much more needs to be done to finally reach the expected 60% herd immunity by June 2022.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Immunity, Herd , Pandemics/prevention & control , COVID-19/epidemiology , Humans , SARS-CoV-2 , Zimbabwe
10.
MEDICC Rev ; 23(3-4): 15-20, 2021.
Article in English | MEDLINE | ID: covidwho-1399827

ABSTRACT

The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefit having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.


Subject(s)
COVID-19 , Pandemics , Cuba , Humans , Rwanda/epidemiology , SARS-CoV-2 , South Africa/epidemiology , Zimbabwe/epidemiology
11.
BMC Health Serv Res ; 21(1): 928, 2021 Sep 07.
Article in English | MEDLINE | ID: covidwho-1398859

ABSTRACT

BACKGROUND: Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension care into the existing Friendship Bench in order to come up with an integrated care package for depression, hypertension and diabetes aimed at strengthening NCD care in primary health care systems in Zimbabwe. METHOD: A theory of change workshop with 18 stakeholders from diverse backgrounds was carried out in February 2020. Participants included grandmothers working on the Friendship Bench project (n = 4), policymakers from the ministry of health (n = 2), people with lived experience for the three NCDs (n = 4), health care workers (n = 2), and traditional healers (n = 2). Findings from earlier work (situational analysis, desk review, FGDs and clinic-based surveys) on the three NCDs were shared before starting the ToC. A facilitator with previous experience running ToCs led the workshop and facilitated the co-production of the ToC map. Through an iterative process, consensus between the 18 stakeholders was reached, and a causal pathway leading to developing a framework for an intervention was formulated. RESULTS: The ToC singled out the need to use expert clients (people with lived experience) to promote a patient-centred care approach that would leverage the existing Friendship Bench approach. In the face of COVID-19, the stakeholders further endorsed the use of existing digital platforms, notably WhatsApp, as an alternative way to reach out to clients and provide support. Leveraging existing community support groups as an entry point for people in need of NCD care was highlighted as a win-win by all stakeholders. A final framework for an NCD care package supported by Friendship Bench was presented to policymakers and accepted to be piloted in five geographical areas. CONCLUSIONS: The ToC can be used to build consensus on how best to use using an existing intervention for common mental disorders to integrate care for diabetes and hypertension. There is a need to evaluate this new intervention through an adequately powered study.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypertension , Depression , Diabetes Mellitus/therapy , Friends , Humans , Hypertension/therapy , SARS-CoV-2 , Zimbabwe/epidemiology
12.
Pan Afr Med J ; 39: 111, 2021.
Article in English | MEDLINE | ID: covidwho-1377120

ABSTRACT

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.


Subject(s)
COVID-19/therapy , Delivery of Health Care/organization & administration , Hospital Rapid Response Team/organization & administration , Delivery of Health Care/economics , Health Personnel/organization & administration , Hospital Rapid Response Team/economics , Humans , Zimbabwe
13.
BMJ Open ; 11(7): e049824, 2021 07 07.
Article in English | MEDLINE | ID: covidwho-1365197

ABSTRACT

OBJECTIVES: To examine the proportion of people living with HIV who screen positive for common mental disorders (CMD) and the associations between CMD and self-reported adherence to antiretroviral therapy (ART). SETTING: Sixteen government-funded health facilities in the rural Bikita district of Zimbabwe. DESIGN: Cross-sectional study. PARTICIPANTS: HIV-positive non-pregnant adults, aged 18 years or older, who lived in Bikita district and had received ART for at least 6 months. OUTCOME MEASURES: The primary outcome was the proportion of participants screening positive for CMD defined as a Shona Symptoms Questionnaire score of 9 or greater. Secondary outcomes were the proportion of participants reporting suicidal ideation, perceptual symptoms and suboptimal ART adherence and adjusted prevalence ratios (aPR) for factors associated with CMD, suicidal ideation, perceptual symptoms and suboptimal ART adherence. RESULTS: Out of 3480 adults, 18.8% (95% CI 14.8% to 23.7%) screened positive for CMD, 2.7% (95% CI 1.5% to 4.7%) reported suicidal ideations, and 1.5% (95% CI 0.9% to 2.6%) reported perceptual symptoms. Positive CMD screens were more common in women (aPR 1.67, 95% CI 1.19 to 2.35) than in men and were more common in adults aged 40-49 years (aPR 1.47, 95% CI 1.16 to 1.85) or aged 50-59 years (aPR 1.51, 95% CI 1.05 to 2.17) than in those 60 years or older. Positive CMD screen was associated with suboptimal adherence (aPR 1.53; 95% CI 1.37 to 1.70). CONCLUSIONS: A substantial proportion of people living with HIV in rural Zimbabwe are affected by CMD. There is a need to integrate mental health services and HIV programmes in rural Zimbabwe. TRIAL REGISTRATION NUMBER: NCT03704805.


Subject(s)
HIV Infections , Mental Disorders , Adult , Cross-Sectional Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Prevalence , Rural Population , Zimbabwe/epidemiology
14.
Pan Afr Med J ; 39: 149, 2021.
Article in English | MEDLINE | ID: covidwho-1359430

ABSTRACT

Cervical cancer is the leading gynaecological malignancy in Zimbabwe, constituting 33% of all female cancers in 2016. Primary prevention through vaccination and secondary prevention through screening are important public health interventions to reduce the cervical cancer burden. Unfortunately, the ongoing COVID-19 pandemic has brought unprecedented challenges to healthcare delivery, posing threats to prevention efforts at a time when the public health sector is extremely fragile. The fragility of the sector has complicated treatment for cervical cancer before and during the COVID-19 pandemic, and is expected to worsen beyond the pandemic. A multi-sectoral intersection between public health experts, clinicians and communities is urgently required to restore preventive and treatment services for cervical cancer and reduce the increased burden, morbidity and mortality stemming indirectly from the pandemic.


Subject(s)
COVID-19 , Mass Screening/statistics & numerical data , Public Health , Uterine Cervical Neoplasms/prevention & control , Delivery of Health Care/organization & administration , Early Detection of Cancer/statistics & numerical data , Female , Humans , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/therapy , Zimbabwe
15.
Emerg Infect Dis ; 27(7): 1991-1993, 2021 07.
Article in English | MEDLINE | ID: covidwho-1348451

ABSTRACT

An HIV-positive man from Zimbabwe living in South Africa sought treatment for multiple clinical signs, including fever, weight loss, anemia, and splenomegaly. We identified in his blood an African rodent piroplasm, Anthemosoma garnhami, related to Babesia species. This finding extends the known geographic and host range of A. garnhami.


Subject(s)
Babesia , HIV Infections , Piroplasmida , Humans , South Africa , Zimbabwe
16.
Bull World Health Organ ; 99(8): 546-547, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1344236

ABSTRACT

Governments worldwide are pressing ahead with COVID-19 passes, despite significant technical, ethical and social obstacles to implementation. Gary Humphreys reports.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Documentation/standards , Humans , SARS-CoV-2 , Zimbabwe
17.
Pan Afr Med J ; 39: 125, 2021.
Article in English | MEDLINE | ID: covidwho-1335409

ABSTRACT

Introduction: when the first cases of COVID-19 were reported in Zimbabwe in March 2020, the local outbreak was characterised by an insidious increase in national caseload. This first wave was mainly attributable to imported cases, peaking around July 2020. By October 2020, the number of cases reported daily had declined to less than 100 cases per day signalling the end of the first wave. This pattern mirrored the global trends. In December 2020, reports of new COVID-19 variants emerged and coincided with the beginning of the second wave within the ongoing pandemic. This paper reports on the analysis conducted on the new wave of COVID-19 beginning December 2020 to January 2021. The objective of this study was to document the evolving presumptive second wave of the COVID-19 pandemic in Zimbabwe from December 2020 to January 2021. Methods: this is a retrospective analysis of secondary data extracted from the daily situation reports published by the Ministry of Health and Child Welfare, Zimbabwe and World Health Organization Country Office, Zimbabwe. The period under consideration started from 1st December 2020 to 31st January 2021. Results: there was a 333% increase in the number of confirmed COVID-19 cases starting 1st December 2020, to 31st January 2021. These new cases were mainly attributed to community transmission though there were a few imported cases. There was a 439% increase in the absolute number of deaths; however, the case fatality rate remained low at 3.6%, and comparable to that from other countries. Harare, Bulawayo and Manical and provinces accounted for 60% of the case burden, with the other seven provinces only accounting for 40%. By mid-January, the number of incident COVID-19 cases started to decline significantly, to levels similar to the residual levels seen during the first wave. Conclusion: the second wave, which lasted a period of less than 2 months, had a steep rise and sharp decline in the incident cases and fatalities. The steep rise was attributable to increased mobility, with a consequent increase in the chains of community transmission. The declines, noted from mid-January 2021, may be partly attributable to a strict national lockdown, though more in-depth exploration of the drivers of transmission is needed to tailor effective interventions for future control. Differentiated strategies maybe needed according to the case burdens in the different provinces. In anticipation of further waves, the introduction of safe and effective vaccines might be the game changer if the vaccines are widely availed to the population to levels adequate to achieve herd immunity. Meanwhile, infection prevention and control guidelines must continue to be observed.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , Communicable Disease Control/methods , COVID-19/prevention & control , COVID-19/transmission , Humans , Retrospective Studies , Zimbabwe/epidemiology
18.
Sci Rep ; 11(1): 13240, 2021 06 24.
Article in English | MEDLINE | ID: covidwho-1281737

ABSTRACT

Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and 'at-risk' populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.


Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Mycoses/epidemiology , Adolescent , Adult , Child , Female , Humans , Incidence , Male , Prevalence , Risk Factors , Zimbabwe
19.
Bull World Health Organ ; 99(2): 85-91, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1261333

ABSTRACT

Objective: To investigate community and health-care workers' perspectives on the coronavirus disease 2019 (COVID-19) pandemic and on early pandemic responses during the first 2 weeks of national lockdown in Zimbabwe. Methods: Rapid qualitative research was carried out between March and April 2020 via phone interviews with one representative from each of four community-based organizations and 16 health-care workers involved in a trial of community-based services for young people. In addition, information on COVID-19 was collected from social media platforms, news outlets and government announcements. Data were analysed thematically. Findings: Four themes emerged: (i) individuals were overloaded with information but lacked trusted sources, which resulted in widespread fear and unanswered questions; (ii) communities had limited ability to comply with prevention measures, such as social distancing, because access to long-term food supplies and water at home was limited and because income had to be earned daily; (iii) health-care workers perceived themselves to be vulnerable and undervalued because of a shortage of personal protective equipment and inadequate pay; and (iv) other health conditions were sidelined because resources were redirected, with potentially wide-reaching implications. Conclusion: It is important that prevention measures against COVID-19 are appropriate for the local context. In Zimbabwe, communities require support with basic needs and access to reliable information to enable them to follow prevention measures. In addition, health-care workers urgently need personal protective equipment and adequate salaries. Essential health-care services and medications for conditions other than COVID-19 must also continue to be provided to help reduce excess mortality and morbidity.


Subject(s)
COVID-19/prevention & control , COVID-19/psychology , Communicable Disease Control/methods , Community Health Services/organization & administration , Health Personnel , Access to Information , Humans , Pandemics , Personal Protective Equipment/supply & distribution , Qualitative Research , Salaries and Fringe Benefits , Zimbabwe
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