A comparison of risk factors associated with community-associated methicillin-resistant and -susceptible Staphylococcus aureus infections in remote communities.

In this case-control study, cases [community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), n=79] and controls [community-associated methicillin-susceptible S. aureus (CA-MSSA), n=36] were defined as a laboratory-confirmed infection in a patient with no previous hospital-associated factors. Skin and soft tissue were the predominant sites of infection, both for cases (67.1%) and controls (55.6%). Most of the cases (79.7%) and controls (77.8%) were aged <30 years. Investigations did not reveal any significant statistical differences in acquiring a CA-MRSA or CA-MSSA infection. The most common shared risk factors included overcrowding, previous antibiotic usage, existing skin conditions, household exposure to someone with a skin condition, scratches/insect bites, and exposure to healthcare workers. Similar risk factors, identified for both CA-MRSA and CA-MSSA infections, suggest standard hygienic measures and proper treatment guidelines would be beneficial in controlling both CA-MRSA and CA-MSSA in remote communities.

Does a direct cholera threat necessarily improve the knowledge, attitude and practices on the disease?

OBJECTIVE: To assess and compare the knowledge, attitude, practices and beliefs on cholera in Mudzi and Wedza districts. Mudzi district shares a long border with Mozambique where cholera was already prevalent before the study, while Wedza district does not share any international border. DESIGN: Cross sectional community based survey, Data was collected through interviews using a structured questionnaire. In villages, The source of water for domestic use as well as the toilets of the interviewed individuals were also inspected. SETTING: Two districts of Mashonaland East Province in Zimbabwe. SUBJECTS: Grade seven pupils, form four students and villagers. MAIN OUTCOME MEASURES: a. The level of knowledge on cholera. b. The prevalence of negative beliefs on the disease. c. The proportion of households using unsafe water. d. The proportion of households not using toilets. RESULTS: 140 and 116 individuals were interviewed in Mudzi and Wedza respectively. The level of knowledge on cholera was very poor in both districts and poorer in Mudzi which shares a border with Mozambique. Twenty pc of the people interviewed had negative beliefs towards the disease; 35pc were using unsafe water; 20pc of households did not have toilets and 4.5 to 7.7pc of the available toilets were not being used. CONCLUSION: Health education activities on cholera should target all districts with the same intensity. Specific strategies should be found in order to address the misconceptions which may hinder the control of cholera.

Measles vaccination status, delay in recognizing measles outbreaks and outbreak outcome.

From July to October 1994, Mashonaland East Province in Zimbabwe experienced measles outbreaks in which 2118 cases were reported. According to routine statistics, 69 pc of these patients were previously vaccinated against measles, 22 pc were not vaccinated and 9 pc had an unknown vaccination status. The measles vaccine coverages in the nine districts of this province during the year prior to the outbreak ranged from 58 pc to 87 pc with a provincial average of 72 pc. Three hundred and fifty eight patients who came in contact with health services during one month were investigated further. The prevalence of measles related complications among vaccinated and unvaccinated patients was 18,5 pc and 51,7 pc respectively (X2 = 56,01, p < 0,001; df = 2. While no death occurred among vaccinated patients, the case fatality rate among unvaccinated patients was 27,3 pc (X2 = 45,15, p < 0,001; df = 2). The later an outbreak was recognized the longer it was likely to last and the higher the case fatality rate was (Correlation coefficient = 0,76; 95 pc CI 0,02 - 0,96). It is concluded that the Expanded Programme on Immunization in this area is not a failure and that for outbreak control measures to be effective, they have to be implemented as early as possible, preferably within one week of the onset of an outbreak. District managers should put more emphasis on the use of data by Rural Health Centre staff in order to recognize outbreaks early.

Factors associated with incidence of domestic accidents in children aged 0-5 years in Chikomba District, Mashonaland East, Zimbabwe.

This community based study utilized responses from questionnaire assisted interviews of mothers and child minders to determine background factors to domestic unintentional injuries in children aged five years old and below. The study was done in three wards in a rural communal area of Chivhu District in Mashonaland East Province in Zimbabwe. One hundred and ninety six mothers or child minders were interviewed and 25.5 pc of these reported children who had had inadvertent injuries in the two weeks before the survey. Unintentional injuries which took place in the children's lifetime prior to the two weeks constituted 20.4 pc of the sample. Both recent and lifetime injuries were not significantly different in the 105 boys and 91 girls among whom domestic accidents were reported. Falls (68.8 pc), burns (16.3 pc) and scalds (4.7 pc) featured as prevalent types of injuries. The varying severity of injuries was indicated by whether an injured child was taken to a health centre for treatment or cared for at home and the treatment the child received at the place of care. Socio-economic, environmental and behavioral factors did not associate significantly with occurrence of unintentional injuries in the survey though it is suspected that the absence of paraffin poisoning is related to the availability of storage space in the households. Results of the survey indicate that unintentional accidents in five year olds and below are a general problem (chi 2 = 7.22, p = 0.007) in this age group although mothers or child minders realized this only after their children were involved in an accident.(ABSTRACT TRUNCATED AT 250 WORDS)