Factors associated with malaria infection in Mudzi District, Mashonaland East Zimbabwe, 2019: a case-control study.

BACKGROUND: Kondo Rural Health Centre recorded 27 malaria patients between the 27th of January 2019 and the 2nd of February 2019 against an epidemic threshold of 19 with the malaria outbreak being confirmed on the 5th of February 2019. Indoor residual spraying as part of integrated vector management control activities had been done in the district before the onset of the rainy season as well as social behaviour change communication but residents were contracting malaria. We, therefore, investigated the risk factors associated with this outbreak to recommend scientifically effective prevention and control measures. METHODS: We conducted a 1:1 unmatched case-control study. A case was a resident of Mudzi from the 4th of February 2019 who had a positive rapid diagnostic test for malaria randomly selected from the clinic's line list whilst controls were randomly selected from the neighbourhood of cases. Pretested interviewer-administered questionnaires were used to collect information on demographic characteristics, knowledge and practices of residents in malaria prevention. Data were analysed using Epi info 7. RESULTS: A total of 567 confirmed malaria cases was recorded with an overall attack rate of 71.7 per 1000 population. Sixty-three case-control pairs were interviewed. The majority of cases 78% (49/63) were from Makaza, Chanetsa and Nyarongo villages which are within 3 km from Vhombodzi dam. A stagnant water body near a house [aOR = 8.0, 95%CI = (2.3-28.6)], engaging in outdoor activities before dawn or after dusk [aOR = 8.3, 95%CI = (1.1-62.7)] and having a house with open eaves [aOR = 5.4, 95%CI = (1.2-23.3)] were independent risk factors associated with contracting malaria. Wearing long-sleeved clothes when outdoors at night [aOR = 0.2, 95%CI = (0.1-0.4)] was protective. CONCLUSION: A stagnant water pool close to the homestead and engaging in outdoor activities before dawn and after dusk were modifiable risk factors associated with the malaria outbreak despite the community being knowledgeable on the transmission and prevention of malaria. Community sensitisation and mobilisation in the destruction of stagnant water bodies and cutting of tall grass around homesteads were recommended measures to contain the outbreak.

Determinants of multidrug resistance among previously treated tuberculosis patients in Zimbabwe, 2014.

SETTING: Zimbabwe. OBJECTIVE: To investigate the determinants of multidrug-resistant tuberculosis (MDR-TB) among previously treated TB patients. DESIGN: A 1:3 case-control study with bivariate analysis and logistic regression. RESULTS: Risk factors for MDR-TB were history of nursing an MDR-TB patient (adjusted OR [aOR] 4.46, 95%CI 2.02-9.88), history of hospitalisation for 3 days (aOR 2.91, 95%CI 1.62-5.23) and history of foreign travel and stay outside Zimbabwe (aOR 2.68, 95%CI 1.46-4.91). Protective factors were previous successful treatment (aOR 0.05, 95%CI 0.02-0.11), history of supervision by a health worker/village health worker (aOR 0.34, 95%CI 0.19-0.60) and having been treated not more than once previously for TB (aOR 0.18, 95%CI 0.08-0.38). No association between human immunodeficiency virus (HIV) infection and MDR-TB (aOR 1.00, 95%CI 0.53-1.88) was observed. However, among HIV-infected patients, those with CD4 <200 cells/mm3 were more likely to develop MDR-TB (aOR 4.62, 95%CI 2.49-8.53). CONCLUSION: Individual, service-related, social and demographic factors interact to determine multidrug resistance among previously treated TB patients. Infection control, treatment adherence, reduction of side effects and drug susceptibility testing must be strengthened to reduce the MDR-TB burden in Zimbabwe.

Is Zimbabwe ready to transition from anonymous unlinked sero-surveillance to using prevention of mother to child transmission of HIV (PMTCT) program data for HIV surveillance?: results of PMTCT utility study, 2012.

BACKGROUND: Prevention of mother-to-child transmission of HIV (PMTCT) programs collect socio-demographic and HIV testing information similar to that collected by unlinked anonymous testing sero-surveillance (UAT) in antenatal settings. Zimbabwe evaluated the utility of PMTCT data in replacing UAT. METHODS: A UAT dataset was created by capturing socio-demographic, testing practices from the woman's booking-card and testing remnant blood at a laboratory from 1 June to 30 September 2012. PMTCT data were collected retrospectively from ANC registers. UAT and PMTCT data were linked by bar-code labels that were temporarily affixed to the ANC register. A questionnaire was used to obtain facility-level data at 53 sites. RESULTS: Pooled HIV prevalence was 15.8 % (95 % CI 15.3-16.4) among 17,349 women sampled by UAT, and 16.3 % (95 % CI 15.8 %-16.9 %) among 17,150 women in PMTCT datasets for 53 sites. Pooled national percent-positive agreement (PPA) was 91.2 %, and percent-negative agreement (PNA) was 98.7 % for 16,782 women with matched UAT and PMTCT data. Based on UAT methods, overall median prevalence was 12.9 % (Range 4.0 %-19.4 %) among acceptors and refusers of HIV test in PMTCT compared to 12.5 % ((Range 3.4 %-19.5 %) among acceptors in ANC registers. There were variations in prevalence by site. CONCLUSION: Although, there is no statistical difference between pooled HIV prevalence in UAT compared to PMTCT program, the overall PPA of 91.2 % and PNA of 98.7 % fall below World Health Organisation (WHO) benchmarks of 97.6 % and 99.6 % respectively. Zimbabwe will need to strengthen quality assurance (QA) of rapid HIV testing and data collection practices. Sites with good performance should be prioritised for transitioning.

Low tuberculosis case detection in Gokwe North and South, Zimbabwe in 2006.

BACKGROUND: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection. OBJECTIVE: To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe. METHODS: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews. RESULTS: Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. CONCLUSION: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough.

Factors associated with occupational injuries at a beverage manufacturing company in Harare, Zimbabwe--2008.

OBJECTIVE: A beverage manufacturing company reported 59.3% increase in occupational injuries between 2006 and 2007. Factors associated with occupational injuries at this company in Harare were characterized, described the injuries, identified the hazards and control measures in place. DESIGN: An analytical cross sectional study was conducted. SETTING: Two plants of a beverage manufacturing company in Harare. SUBJECTS: We interviewed randomly selected workers at the 2 plants of the company MAIN OUTCOME MEASURES: Prevalence of occupational injuries, Factors associated with injury, occupational hazards, control measures RESULTS: Of 392 workers interviewed, 53.3% reported having had a work-related injury. Twenty-six percent had not reported the injuries. Independent risk factors were: working in packaging department OR = 3.64 (95% CI: 2.25-5.88), having sleep disorder OR = 2.26 (95% CI: 1.21-4.22) and 7 day working week without rest OR = 1.88 (95% CI: 1.01-3.47). Hazards identified were noise, broken bottles, unguarded machines and coal dust. High risk areas were automated. Common injuries were cuts/lacerations (70.8%) and the most affected parts being the fingers 27.3% (57/209) and the hands 17.2% (36/209). Most injuries (74.8%) occurred in the packaging department due to breaking bottles. CONCLUSION: Prevalence of occupational injuries is high. We recommended regular machinery maintenance to minimize bottle breakages, reduction in working time and supply of adequate personal protective clothing.

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007.

BACKGROUND: Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases. OBJECTIVE: To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane. METHODS: A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls. RESULTS: Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42-20.85), relationships less than one year, OR= 9.33 (95% CI 3.53-24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64-16.25) and paying for sex OR= 23.65 (95% CI 6.23-89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02-6.04) and relationships less than one year OR=3.19 (95% CI 1.41-7.23). Significant differences in attitudes were evident among cases and controls. CONCLUSION: Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.

Low Tuberculosis Case Detection in Gokwe North and South; Zimbabwe in 2006

Background: Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection; treat them; and thus break the chain of infection. Objective: To determine the reasons of low tuberculosis case detection in Gokwe Districts; Zimbabwe. Methods: A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients; checklists; key informant interviews. Results: Thirty-eight nurses; forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis; listed signs and symptoms; preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. Conclusion: Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough

Risk factors for contracting anthrax in Kuwirirana ward, Gokwe North, Zimbabwe.

BACKGROUND: A report of an anthrax outbreak was received at Gokwe district hospital from the Veterinary department on the 23(rd) January 2007. This study was therefore conducted to determine risk factors for contracting anthrax amongst residents of Kuwirirana ward. METHODS: We conducted a 1:1 unmatched case control study. A case was any person in Kuwirirana ward who developed a disease which manifested by itching of the affected area, followed by a painful lesion which became papular, then vesiculated and eventually developed into a depressed black eschar from 12 January to 20 February 2007. A control was a person resident of Kuwirirana ward without such diagnosis during the same period. RESULTS: Thirty-seven cases and 37 controls were interviewed. On univariate analysis, eating contaminated meat (OR = 7.7, 95% CI 2-29.8), belonging to a household with cattle deaths (OR= 9.7, 95% CI 2.9-33), assisting with skinning anthrax infected carcasses (OR= 5.4(95% CI 1.7-17), assisting with meat preparation for drying (OR = 5(95%CI 1.9-13.9), assisting with cutting contaminated meat (OR = 4.8(95% CI 1.7-13.2), having cuts or wounds during skinning (OR = 19.5, 95% CI 2.4-159) and belonging to a village with cattle deaths (OR = 6.5(95%CI 1.3-32) were significantly associated with anthrax. CONCLUSION: Anthrax in Kuwirirana resulted from contact with and consumption of anthrax infected carcasses. We recommend that the district hold regular zoonotic committee meetings and conduct awareness campaign for the community and carry out annual cattle vaccinations.

Risk factors associated with cholera in Harare City, Zimbabwe, 2008.

OBJECTIVE: Two suspected cholera cases at Beatrice Road Infectious Diseases Hospital were reported to Harare City Health Department on 14 October 2008 setting in motion investigation and control measures. We determined the extent of the epidemic and risk factors for contracting cholera. METHODS: An unmatched 1:1 case-control study was conducted. CASE: Any resident of Harare City, 2 years and above, with acute watery diarrhoea, with or without vomiting from 30 October 2008 to 01 December 2008. CONTROL: Any resident of Harare City, 2 years and above, neighbour to a case, who did not contract cholera during the same period. RESULTS: From 14 October 2008 to 21 January 2009, 11203 cases were reported with a case fatality rate (CFR) of 3.98%. We interviewed 140 cases and 140 controls. Median age was 28 years (Q1 = 20; Q3 = 37.5) and 28.5 years (Q1 = 23; Q3 = 38) for cases and controls respectively. Having a diarrhoea contact at home [AOR = 12.02; 95% CI (5.46 - 26.44)], having attained less than secondary education [AOR = 4.40; 95% CI (2.28 - 8.48)]; eating cold food [AOR = 4.24; 95% CI (1.53 - 11.70)] were independent risk factors while drinking tap water [AOR = 0.05; 95% CI (0.03 - 0.11)], washing hands after using toilet [AOR = 0.19; 95% CI (0.09 - 0.39)]; eating hot food always [AOR= 0.29; 95% CI (0.17 - 0.49)] were independently protective factors. DISCUSSION: The high CFR may be due to poor case management and staff shortage in treatment camps. Th e cholera outbreak in Harare resulted from poor personal and hygiene practices that occur when water supplies are cut. Lack of water, low knowledge on cholera prevention measures and delays in community health education campaigns contributed to the protracted outbreak. Having a diarrhoea contact at home increases chances of household members acquiring infection. Provision of safe drinking water, community health education, recruitment of staff and training of health workers on cholera case management must be prioritized.