Measles vaccine efficacy in Masvingo district, Zimbabwe.

OBJECTIVE: To carry out a survey in Masvingo District to determine the efficacy of measles vaccine. DESIGN: A retrospective study, using existing health care facility records and interviews with care givers. SETTING: Using the standard WHO-EPI cluster sampling methodology, 30 clusters were randomly selected in Masvingo District. SUBJECTS: 14 or more children in each of the 30 clusters were selected. MAIN OUTCOME MEASURES: Occurrence of measles or lack of it among the children aged 12 to 23 months, age at vaccination, status, the age at which the child had measles and availability of a health card. RESULTS: In Masvingo District from 1987 to 1994, measles incidence remained very high, though mortality drastically declined. Using field survey data measles vaccine efficacy was estimated at 78.3pc (95pc CI 54.1; 89.8). Vaccine coverage was estimated to be 75pc. CONCLUSION: The efficacy results fall at the lower end, but within the normal limits, of those expected for measles vaccine as used in Zimbabwe. Steps to increase vaccine coverage are of the highest priority.

Hospitalized dysentery cases during an outbreak of Shigella dysenteriae type I: Ndanga District Hospital, Zimbabwe.

OBJECTIVE: To describe the characteristics of patients admitted with bloody diarrhoea; to assess clinical management; and to identify organisms isolated in laboratories and their antimicrobial susceptibility pattern. DESIGN: This was a retrospective study which used data from case files of patients admitted for dysentery at Ndanga District Hospital. The three admission registers from the hospitals male, female and paediatric wards were examined for patients with dysentery as their admitting diagnosis from December 1993 to February 1994. Using case file numbers from the admission registers, we retrieved case files from the records office. SETTING: Ndanga District Hospital in Zaka, Masvingo Province, Zimbabwe. SUBJECTS: All patients admitted for dysentery at Ndanga District Hospital. MAIN OUTCOME MEASURES: Patients sex, age, clinical presentation, complications, drugs given, culture results, and antimicrobial susceptibility, duration of stay and outcome. RESULTS: The peak admission period was the last week of January, during which 17 patients were admitted with bloody diarrhoea. The age distribution of cases was bimodal, children less than five and those 15 to 29 being most likely to be hospitalized; 52pc of the patients were females. Signs and symptoms recorded were bloody diarrhoea 100pc, abdominal pain 45pc, dehydration 38pc, fever 34pc, vomiting 26pc, loss of appetite 20pc, weight loss 17pc and anaemia 5pc. Shigella dysenteriae type 1 (SD1) was isolated in 80pc of the 58 stools examined. Most cases were treated with kanamycin (67pc),nitrofurantion (61pc), and metronidazole (43pc). The average number of antibiotics given per patient was 2.3. Seventeen cases developed complications and four patients died, one each with renal failure, haemolytic uraemic syndrome, and severe anaemia. The other patient who died had developed rectal prolapse. CONCLUSIONS: 80pc of the patients in the study received multiple antibiotics. The most frequently used drugs were kanamycin and nitrofurantion, yet neither of these drugs has been shown to be effective in treating dysentery. While the organisms were largely sensitive to nalidixic acid, little of that was prescribed, almost certainly because it was not available until late in the study period. There is need for adherence to the Ministry's recommended dysentery treatment guideline: prompt treatment with an effective antimicrobial to which the organism has been recently shown to be sensitive, and supportive care and prompt referral if complications arise.