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.

Cerebral Blood Flow Velocity is Not Associated with Serum Hemoglobin in Children with Malaria-Associated Anemia.

BACKGROUND AND PURPOSE: Hemoglobin (Hbg) is often thought to impact cerebral blood flow velocity (CBFV). This study was performed to investigate the relationship between Hbg value and CBFV in African children with malaria. METHODS: In this prospective, observational study, children aged 3 months to 18 years with malaria and a normal Blantyre coma score underwent a single transcranial Doppler ultrasound (TCD) examination with a concurrent Hbg check. RESULTS: One hundred fifty-six children with a mean age of 43 months were enrolled. Thirty-three children (21%) had severe anemia (Hbg <5g/dL), 46 (29%) had moderate anemia (Hbg 5-6.9 g/dL), 63 children (41%) had mild anemia (7-9.9 g/dL), and 14 children (9%) had no anemia (Hbg >10 g/dL) at the time of TCD examination. Mean averaged CBFV in the middle cerebral artery (MCA) for the cohort was 99% of predicted based on normative values standardized for age. There was no significant correlation between Hbg levels and measured CBFV in the MCA (r = -.09; 95% CI, -.24-.07; P = .29). CONCLUSION: In a large sample of African children with malaria, Hbg did not correlate with CBFVs as measured by TCD. Future work that includes baseline TCD measurements and Hbg values as well as other physiological parameters known to influence CBFVs is necessary to confirm these findings.

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.

Challenges in data quality: the influence of data quality assessments on data availability and completeness in a voluntary medical male circumcision programme in Zimbabwe.

OBJECTIVES: To assess availability and completeness of data collected before and after a data quality audit (DQA) in voluntary medical male circumcision (VMMC) sites in Zimbabwe to determine the effect of this process on data quality. SETTING: 4 of 10 VMMC sites in Zimbabwe that received a DQA in February, 2015 selected by convenience sampling. PARTICIPANTS: Retrospective reviews of all client intake forms (CIFs) from November, 2014 and May, 2015. A total of 1400 CIFs were included from those 2 months across four sites. PRIMARY AND SECONDARY OUTCOMES: Data availability was measured as the percentage of VMMC clients whose CIF was on file at each site. A data evaluation tool measured the completeness of 34 key CIF variables. A comparison of pre-DQA and post-DQA results was conducted using χ2 and t-tests. RESULTS: After the DQA, high record availability of over 98% was maintained by sites 3 and 4. For sites 1 and 2, record availability increased by 8.0% (p=0.001) and 9.7% (p=0.02), respectively. After the DQA, sites 1, 2 and 3 improved significantly in data completeness across 34 key indicators, increasing by 8.6% (p<0.001), 2.7% (p=0.003) and 3.8% (p<0.001), respectively. For site 4, CIF data completeness decreased by 1.7% (p<0.01) after the DQA. CONCLUSIONS: Our findings suggest that CIF data availability and completeness generally improved after the DQA. However, gaps in documentation of vital signs and adverse events signal areas for improvement. Additional emphasis on data completeness would help support high-quality programme implementation and availability of reliable data for decision-making.

Comparative Cost Analysis of Surgical and PrePex Device Male Circumcision in Zimbabwe and Mozambique.

BACKGROUND: The PrePex device has proven to be safe for voluntary medical male circumcision (VMMC) in adults in several African countries. Costing studies were conducted as part of a PrePex/Surgery comparison study in Zimbabwe and a pilot implementation study in Mozambique. METHODS: The studies calculated per male circumcision unit costs using a cost-analysis approach. Both direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training) and selected indirect costs (capital and support personnel costs) were calculated. RESULTS: The cost comparison in Zimbabwe showed a unit cost per VMMC of $45.50 for PrePex and $53.08 for surgery. The unit cost difference was based on higher personnel and consumable supplies costs for the surgical procedure, which used disposable instrument kits. In Mozambique, the costing analysis estimated a higher unit cost for PrePex circumcision ($40.66) than for surgery ($20.85) because of higher consumable costs, particularly the PrePex device and lower consumable supplies costs for the surgical procedure using reusable instruments. Supplies and direct staff costs contributed 87.2% for PrePex and 65.8% for surgical unit costs in Mozambique. DISCUSSION: PrePex device male circumcision could potentially be cheaper than surgery in Zimbabwe, especially in settings that lack the infrastructure and personnel required for surgical VMMC, and this might result in programmatic cost savings. In Mozambique, the surgical procedure seems to be less costly compared with PrePex mainly because of higher consumable supplies costs. With reduced device unit costs, PrePex VMMC could become more cost-efficient and considered as complementary for Mozambique's VMMC scale-up program.

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.

Determinants of premature births in two central hospital Harare, Zimbabwe, 2011.

Introduction: Prematurity is a major determinant of neonatal morbidity and mortality in Zimbabwe. Although 8-10% of deliveries are premature , prematurity contributes 33% of neonatal deaths. Identifying local risk factors for prematurity could help incoming up with local intervention and prevention strategies. Design: 1:1 unmatched case control study. Setting: Harare and Parirenyatwa central hospitals maternity units. Subjects: All mothers who delivered in the units June to July 2011. Acase was a mother who had delivered a premature baby and control was a mother who delivered a term baby. Results: We interviewed 188 cases and 188 controls. Independent risk factors for premature delivery were -A previous premature delivery [AOR 3.15 95% CI 1.17 8.49, 4.61] being admitted with a medical complication in pregnancy[AOR 2.15 95% CI 1.18-3.92]. Birth interval > 24 months [AOR 0.26 95% CI 0.12 0.59] being well nourished evidenced by BMI ≥20kg/m [ AOR 0.926 95% CI 0.88 0.97] and MUAC ≥23cm [AOR 0.95 95% CI 0.91 0.95] reduced the risk of premature delivery. HIV test was done on 87% of participants, 12% were positive (66% controls, 33% cases) (p≤0.001). Conclusion: Birth interval < 24 months, previous premature delivery, only one ANC attendance, maternal under nutrition and being hospitalized with complications in pregnancy were associated with premature delivery. There was no association with HIV infection. Efforts should be made to give food supplements to pregnant undernourished 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 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.

Implementing Integrated Disease Surveillance and Response: Four African countries' experience, 1998-2005.

The Integrated Disease Surveillance and Response (IDSR) strategy was developed by the Africa Regional Office (AFRO) of the World Health Organisation (WHO) and proposed for adoption by member states in 1998. The goal was to build WHO/AFRO countries' capacity to detect, report and effectively respond to priority infectious diseases. This evaluation focuses on the outcomes in four countries that implemented this strategy. Major successes included: integration of the surveillance function of most of the categorical disease control programmes; implementation of standard surveillance, laboratory and response guidelines; improved timeliness and completeness of surveillance data and increased national-level review and use of surveillance data for response. The most challenging aspects were: strengthening laboratory networks; providing regular feedback and supervision on surveillance and response activities; routine monitoring of IDSR activities and extending the strategy to sub-national levels.

An audit of malaria mortality using the "malaria death investigation form" at United Bulawayo Hospitals, Zimbabwe: 1996-2000.

OBJECTIVE: To identify the main causes of confirmed malaria deaths and assess the validity and the relevance of use of the MDIF in determining areas for improvement of care. DESIGN: A cross sectional study. SETTING: United Bulawayo Hospitals, a tertiary hospital in Zimbabwe. SUBJECTS: Patients whose cause of death was malaria using MIDF. RESULTS: Of 470 confirmed cases admitted in UBH during the study period, 53 (11.2%) died and were included in the study. Most deaths occurred in the over 15 years age group (88.6%) with only 3 deaths each in the other groups. All patients were referred or admitted to UBH with complicated and severe malaria; 39(74 %) had more than one complication such as CM and acute renal failure (ARP). Most patients came from or had visited a rural area and did not implement basic prophylactic and therapeutic measures put in place by the NMCP such as early self-medication. Three pregnant women aborted. Guidelines regarding investigations and treatment were not strictly adhered to. Delay in seeking treatment and in referring was generally observed at all levels of the health system. Cases of malaria deaths were found in the city in people who had not travelled to rural area. The MDIF was used in one case only. CONCLUSION: Malaria mortality accounted for 11 % of confirmed cases. Main causes of death were CM and ARP Parameters contained in the MDIF were those utilised by most authors who have investigated malaria mortality in Africa and there was a similarity in the observations. In view of the information it could provide if properly used, the MDIF is a valid tool for collecting data that the NMCP needs in order to rationalise its strategies at UBH and in other health facilities. Its use should be generalised and compulsory.

Behavioural factors associated with cutaneous anthrax in Musadzi area of Gokwe North, Zimbabwe.

OBJECTIVES: To determine behaviour factors for contracting human cutaneous anthrax among residents of Musadzi area. DESIGN: We conducted a matched case-control study for age, sex, and village. SETTING: A rural community in Musadzi area of Gokwe North district. SUBJECTS: We interviewed 35 cases and 35 controls. A case was defined as any resident/visitor of Musadzi, diagnosed with anthrax between 9 September and 10 November 2004. A control was any resident who had not been diagnosed with anthrax and had no lesions suggestive ofanthrax on day of the interview. MAIN OUTCOME MEASURES: Behaviour factors associated with contracting anthrax. RESULTS: In September 2004, cattle were reported to be dying in Musadzi area. Bacillus anthracis was positively identified in a blood smear from some of the carcasses. The attack rate among humans was 5%. Risk factors associated with contracting anthrax were: skinning of animals that had died from unknown causes AOR=3.8 (95% CI:1.3-10.7); preparation of the meat for cooking (AOR=3.1 (95% CI:1.16-8-4); preparation of the meat for drying AOR=2.7 (95% CI: 1.0081-7.4); belonging to a religious or ethnic sect that allow handling of meat from animals that had died from unknown causes (AOR=5.2 (95% CI: 1.8-14.8). CONCLUSION: The human anthrax outbreak was secondary to an anthrax epizootic occurring in cattle. The Ministry of Health activated the local zoonotic committee, carried out anthrax awareness campaigns, supervised the destruction of carcasses, disinfected potentially contaminated sites and introduced a participatory health education tool on anthrax. The veterinary department quarantined and vaccinated cattle.

Treatment outcomes of patients on antiretrovirals after six months of treatment, Khami Clinic, Bulawayo, Zimbabwe.

OBJECTIVE: To describe treatment outcomes of patients on anti-retrovirals at six months of treatment. STUDY DESIGN: We conducted pre-intervention post intervention surveys using a pretest-post test design. SETTING: Khami Municipal Clinic, Bulawayo. SUBJECTS: We interviewed consecutive patients eligible to receive antiretroviral drugs (ARVs). All patients had a history of TB treatment and a CD4 count less than 200 cells/mm. MAIN OUTCOME MEASURES: Mean change in CD4 count, weight, body mass index, and Karnofsky performance measured before and at six months ofantiretroviral treatment. RESULTS: 72 subjects were interviewed at baseline, their median age was 38 years (Q1, 32 years, Q3, 43 years). Of these, 17 (24%) died before six months of treatment. Three (4%) defaulted treatment follow up. A total of 52 respondents were alive and interviewed at six months though only 50, had repeat CD4 counts at six months. Among the 50 survivors, the mean CD4 count at six months was significantly higher than at baseline (p = 0.0003). There was a 4.2 point statistical significant increase in the mean weight from baseline (p = 0.0005). Similarly, the mean Body Mass Index (BMI) significantly increased by 1.5 kg/m2 from baseline, (p = 0.001). The mean Karnofsky performance increased from 89% at baseline to 95% at six months (p = 0004). The researchers noted that patients on TB treatment were being deferred antiretroviral therapy until they completed TB treatment. CONCLUSION: The Khami project bears testimony that even in a resource poor setting; treatment of HIV/AIDS with antiretroviral drugs is feasible. We recommend early treatment initiation for those on TB treatment in line with national guidelines.

Schistosomiasis infection among school children in the Zhaugwe resettlement area, Zimbabwe April 2005.

OBJECTIVES: To investigate the prevalence and factors associated with contracting schistosomiasis in Zhaugwe resettlement area of Shurugwi district. DESIGN: Cross sectional study. STUDY SETTING: The community in the Zhaugwe resettlement area of Shurugwi district, Midlands Province, Zimbabwe. SUBJECTS: School children in primary and secondary levels. MAIN OUTCOME MEASURES: Prevalence of schistosomiasis infection, risk factors for contracting schistosomiasis. RESULTS: Prevalence of S. haematobium and S. mansoni was 68% and 0.2%, respectively. Participating in watering the respondents' household garden (O.R = 8.1, 95% CI 1.65 to 40.2), fetching water for the home garden (O.R=3,96 95% CI 1.38 to 11.32), fishing with their legs in the water (O.R = 3.1 95% CI 1.6 to 5.8), bathing in the river or stream (O.R = 3.1 95% CI 1.68 to 5.8) were found to be statistically significantly associated with contracting schistosomiasis infection. Fishing with legs immersed in water, having a garden at home, and swimming in the river were positively associated with infection. Those who reported blood in their urine were 16 times more like to be positive for S. haematobium than those without. Vector snails were present at all water contact sites. CONCLUSION: Schistosomiasis is a major public health problem in the area. We recommend mass treatment of all school children in all other schools in the area. The community should be encouraged to cultivate Phytoloca dedocandra for snail control.

Occupational injuries among workers in the cleansing section of the City Council's Health Services Department--Bulawayo, Zimbabwe, 2001-2002.

INTRODUCTION: During 2001-2002, a total of 97 occupational injuries occurred among workers in the cleansing section of the Bulawayo, Zimbabwe, City Council's Health Services Department. This report describes a study that was conducted to describe the nature of these injuries and determine the associated risk factors. METHODS: A retrospective, descriptive cross-sectional survey was conducted concerning occupational injuries incurred by workers in the cleansing section during 2001-2002. A total of 153 workers who had been in the section as of January 1, 2001, and 23 senior managers and section supervisors were interviewed, the occupational injury register was reviewed, and a walk-through survey was conducted to estimate risk factors. RESULTS: The occupational injury register indicated that during the study period, 62 workers sustained 67 injuries, including one that was fatal. Of these 67 injuries, 27 (40%) involved workers who sustained cuts inside a box-type refuse removal truck, and 11 (16%) involved workers who had sprained ankles and wrists as a result of improper lifting. Workers aged 18-25 years were more likely to incur an injury than workers aged >25 years. Working as a bin loader and not having received preemployment training were associated with injuries. None of the bin loaders had received preemployment training. Hazards identified during the walk-through survey included use of small jacks in workshops, contact with biologic and chemical materials on trucks and landfill sites, and poor use of protective clothing. Supervisors cited worker negligence as the main cause of injury, whereas 72 (84%) workers cited lack of adequate protective clothing as a source of injury, and eleven (7%) workers cited use of inappropriate equipment. CONCLUSION: On the basis of the modifiable risk factors for injury identified in this study, the Bulawayo City Council drafted a new health and safety training manual. New recruits now receive training before starting work on refuse collection trucks.

Factors associated with measles complications in Gweru, Zimbabwe.

OBJECTIVE: To investigate factors associated with complications or death among measles cases. DESIGN: A cross-sectional study. SETTING: Health facilities in the city of Gweru, Zimbabwe. SUBJECTS: Six hundred and thirty seven measles cases randomly selected from measles surveillance data. MAIN OUTCOME MEASURES: (a) Associations of respiratory complications and diarrhoea with death among complicated cases; (b) associations of age at infection, gender of cases and vaccination status of cases with occurrence of either respiratory complications or diarrhoea or death among measles cases. RESULTS: Among cases with respiratory complications, twenty two (29%) had died, while five (5%) had died among those with diarrhoea (OR=7.06,95% CI=2.55-22.35, p<0.001). On rates of respiratory complications among cases, age groups 24-59 and 60+ months were protective by 57% (95% CI=11-79%) and 76% (95% CI=52-88%) respectively compared to the age group <24 months, and vaccination was protective by 42% (95% CI=2-65%) compared to those unvaccinated. Concerning rates of diarrhoea among cases, the age group 60+ months was protective by 80% (95% CI=62-89%) compared to age group <60 months, while vaccination was protective by 64% (95% CI=42-77%) compared to those unvaccinated. With respect to rates of mortality among cases, age was protective by six per cent (95% CI=3-9 %) for every year older. CONCLUSION: It was concluded that: (a) the risk of death was higher in cases with respiratory complications than diarrhoea; (b) the risk of complications and death was inversely related to age at infection and older age groups were protective against occurrence of complications or death; (c) the risk of complications was higher in unvaccinated cases and vaccination was protective against occurrence of complications.