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PubMed1999

Current estimates of and future projections for adult deaths attributed to HIV infection in Zimbabwe.

OBJECTIVE: Estimates of HIV prevalence in 1995 among all adults in Zimbabwe range between about 18% and 24%. The objective of this study was to estimate, for Zimbabwe, the impact of HIV infection on adult mortality, by age and gender, between 1995 and the year 2000. METHODS: For this analysis, we used 1992 census data to estimate the number of non-HIV-related deaths, and a short-term projection model to estimate the number of deaths attributed to HIV infection in 1995 and the year 2000. RESULTS: It was estimated that between 52% and 60% of all adult deaths in 1995 were attributed to HIV infection, and between 69% and 76% in both males and females in the group between 20 and 39 years of age. The estimated adult mortality rate per 1000 increased from 9.8 in 1987 (based on census data) to between 20.6 and 24.3 in 1995. For the year 2000, it was projected that between 66% and 73% of all adult deaths would be attributed to HIV infection, and between 81% and 86% in those aged 20 to 39 years. The estimated adult mortality rate in the year 2000 increased to between 29.1/1000 and 36.6/1000. Even if all transmission was assumed to cease after 1995, it was projected that >60% of adult deaths would be attributed to HIV in the year 2000. Adult population growth is projected to decrease to between 0.3% and 1.0% in the year 2000. CONCLUSION: Results suggest that the impact of HIV infection on mortality in Zimbabwe is already severe and will continue to increase. Efforts to reduce numbers of new HIV infections today will serve to reduce the future burden of mortality, particularly in the longer term.

Adolescent↗
PubMed2007

Gender differences in AIDS-associated Kaposi sarcoma in Harare, Zimbabwe.

Reasons for gender-related differences in the risk of AIDS-related Kaposi sarcoma (AIDS-KS) are unknown. Four hundred thirty-eight male and 166 female AIDS-KS patients were evaluated in Harare, Zimbabwe. Female patients were younger than male patients in this study (median of 33 vs. 38 years; P < 0.001), mirroring the epidemiology of AIDS in Zimbabwe. In a multivariate model adjusted for CD4 T-cell count, age, prior radiation treatment, and chemotherapy, women were more likely to report fever, diaphoresis, or weight loss (odds ratio = 1.7, 95% confidence interval: 1.1 to 2.7; P = 0.009). These findings suggest an increased severity of KS or other unidentified infections among women with AIDS-KS in Zimbabwe.

AIDS-Related Opportunistic Infections↗
PubMed1998

Rabies in Zimbabwe: reservoir dogs and the implications for disease control.

Using detailed field study observations of the side-striped jackal (Canis adustus) and a simple stochastic model of the transmission dynamics of the virus and host demography, we discuss the epidemiology of rabies virus infection in the jackal population of Zimbabwe. Of the two jackal species in Zimbabwe, the other being the black-backed jackal (Canis mesomelas), the bulk of notified rabies cases are in side-striped jackals. Specifically, we show that the side-striped jackal population itself does not seem able to support rabies infection endemically, i.e. without frequent reintroduction from outside sources of infection. We argue that this is probably because the overall average jackal population density is too low to maintain the chain of infection. This study suggests that the disease is regularly introduced to jackals by rabid dogs from populations associated with human settlements. Given the rapidly rising dog population in Zimbabwe, estimates are derived of the future incidence of jackal rabies based on different dog-vaccination scenarios.

Animals↗
PubMed2004

An analysis of genetic differentiation among assortatively mating Drosophila melanogaster in Zimbabwe.

African Drosophila melanogaster populations, and those from Zimbabwe in particular, have attracted much interest recently. African flies differ genetically from 'cosmopolitan' populations and were found to exhibit discriminative mating behaviour against individuals from 'cosmopolitan' populations. It has therefore been proposed that Zimbabwean and some other African populations are in an 'incipient stage of speciation'. However, whether the mating behaviour is an effective barrier against gene flow from other populations, and whether intra-population genetic differentiation has already evolved in sympatry is not known. Here, we took a population-based approach to test whether the well-characterized mating type differences have resulted in a genome-wide differentiation at the population level. Using 122 polymorphic microsatellite loci mapping to the third chromosome, we demonstrate a significant genetic differentiation between Zimbabwean flies differing in their mating behaviour. We also provide evidence to suggest that this difference is unlikely to be attributable to population structure within Zimbabwe. However, the analysis of individual microsatellite loci did not indicate more loci differentiating these two groups than expected by chance. Our data suggest that the 'Z'-'M' mating behaviour is strong enough to result in a small but significant genetic differentiation. Thus, future studies based on a larger population sample of flies characterized for their mating behaviour and using more markers are expected to provide more information on the genetic basis of the mating traits in the Zimbabwe flies.

Animals↗
PubMed2000

Evaluation of a human papillomavirus assay in cervical screening in Zimbabwe.

OBJECTIVE: To determine the utility of an assay for high risk genital human papillomavirus (HPV) in cervical screening in Zimbabwe, Africa. DESIGN: Cross-sectional study. SETTING: Harare, Zimbabwe. POPULATION: Zimbabwe women (n = 2,140), 25 to 55 years old, recruited in clinics in Chitungwiza and Greater Harare. METHODS: Genital specimens were assessed for HPV, using the HPV DNA test Hybrid Capture II (probe B). Further assessment of the women was conducted using colposcopy and biopsy as indicated. High grade squamous intraepithelial lesions were diagnosed in 215 women. Colposcopy and/or biopsy showed low grade lesions in 346 women. RESULTS: The overall prevalences were: 42 x 7% for HPV, 10% for high grade squamous intraepithelial lesions and 16% for low grade lesions. Prevalence for HPV decreased significantly with increase in age (P for trend < 0 x 0001) and increased significantly with increasing disease severity, from 35% in normal women, to 53% in women with low grade lesions and 81% in women with high grade lesions (P for trend < 0 x 001). In specimens positive for HPV, the amount was 14-fold higher in women with high grade lesions compared with normal women. In screening for high grade lesions the assay for HPV had a sensitivity of 81% (CI 75%-86%); sensitivity for low grade lesions was 64% (CI 60%-68%). Specificity was 62% (CI 59%-64%) for high grade lesions and 65% (CI 62%-67%) for low grade lesions. The positive predictive value was 19% (CI 17%-22%) for high grade lesions and 39% (CI 36%-42%) for low grade lesions. CONCLUSION: For high grade squamous intraepithelial lesions the sensitivity of the Hybrid Capture II HPV DNA test was high, but the specificity was relatively low. The test may therefore be most useful in conjunction with other screening tests.

Adult↗
PubMed2006

Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Haiti.

OBJECTIVE: To determine whether observed changes in HIV prevalence in countries with generalised HIV epidemics are associated with changes in sexual risk behaviour. METHODS: A mathematical model was developed to explore the relation between prevalence recorded at antenatal clinics (ANCs) and the pattern of incidence of infection throughout the population. To create a null model a range of assumptions about sexual behaviour, natural history of infection, and sampling biases in ANC populations were explored to determine which factors maximised declines in prevalence in the absence of behaviour change. Modelled prevalence, where possible based on locally collected behavioural data, was compared with the observed prevalence data in urban Haiti, urban Kenya, urban Cote d'Ivoire, Malawi, Zimbabwe, Rwanda, Uganda, and urban Ethiopia. RESULTS: Recent downturns in prevalence observed in urban Kenya, Zimbabwe, and urban Haiti, like Uganda before them, could only be replicated in the model through reductions in risk associated with changes in behaviour. In contrast, prevalence trends in urban Cote d'Ivoire, Malawi, urban Ethiopia, and Rwanda show no signs of changed sexual behaviour. CONCLUSIONS: Changes in patterns of HIV prevalence in urban Kenya, Zimbabwe, and urban Haiti are quite recent and caution is required because of doubts over the accuracy and representativeness of these estimates. Nonetheless, the observed changes are consistent with behaviour change and not the natural course of the HIV epidemic.

Adolescent↗
PubMed2006

HIV prevalence and trends from data in Zimbabwe, 1997-2004.

BACKGROUND: This paper brings together data from a variety of reports to provide a basis for assessing future steps for responding to and monitoring the HIV epidemic in Zimbabwe. METHOD: Data reported from four antenatal clinic (ANC) surveys conducted between 2000 and 2004, two small local studies in Zimbabwe conducted from 1997 through 2003, four general population surveys from 1999 through 2003, and service statistics covering 1990 through 2004 were used to describe recent trends in HIV prevalence and incidence, behaviour change, and programme provision. RESULTS: HIV prevalence among pregnant women attending ANCs declined substantially from 32.1% in 2000 to 23.9% in 2004. The local studies confirmed the decline in prevalence. However, prevalence continued to be high. Sexual behaviour data from surveys suggests a reduction in sexual experience before age 15 years among both males and females age 15-19 years, and in the proportions of males and females aged 15-29 years reporting non-regular sexual partners in the past 12 months. Reported condom use with non-regular partners has been high since 1999. Condom distribution and HIV counseling and testing increased from 2000 to 2004. DISCUSSION: On the basis of examination of data from a variety of sources, the recent decrease in HIV prevalence may be related to recent reductions in early-age sexual activity and non-regular sexual partnerships and increases in condom use. Comparison of data from sentinel surveillance systems, population based serosurveys, local studies, and service statistics provide increased confidence that a decline in HIV prevalence in Zimbabwe is actually happening in the population.

Adolescent↗
PubMed2006

Acceptability of heat treating breast milk to prevent mother-to-child transmission of human immunodeficiency virus in Zimbabwe: a qualitative study.

Although heat treatment of human milk is an official infant-feeding recommendation for human immunodeficiency virus (HIV)-positive mothers in Zimbabwe, its implementation has not been adequately addressed, because knowledge about the safety of this method is rudimentary and its acceptability is poorly understood. To address this knowledge gap, the authors conducted focus group discussions among mothers, grandmothers, midwives, and husbands in various regions of Zimbabwe. Although the practice of heat treating expressed human milk was initially met with skepticism because of potential obstacles, including time constraints and social and cultural stigma, a pattern of opinion reversal emerged in all groups. By the end of each discussion, participants believed that, given its affordability and its potential to protect infants from HIV infection, heat-treated human milk may be a feasible infant-feeding option for HIV-positive mothers in Zimbabwe. These findings merit further investigation so that appropriate behavioral strategies can be designed.

Adolescent↗
PubMed2005

Screening for psychological morbidity in HIV-infected and HIV-uninfected pregnant women using community counselors in Zimbabwe.

OBJECTIVE: To examine the prevalence of psychological morbidity in HIV-infected and uninfected pregnant women seeking antenatal care in Zimbabwe. METHODS: Pregnant women were screened for psychological morbidity at the initial antenatal care visit using the 14-item Shona Symptom Questionnaire (SSQ) before voluntary HIV counseling and testing (VCT). The primary outcome measure was "cases," as determined by a SSQ score of >or= 8. Demographic characteristics and HIV status were compared between cases and noncases to determine the risk factors for psychological morbidity. RESULTS: Of the 437 participants, psychological morbidity was detected in 73 (17%) women before undergoing VCT. Risk factors for psychological morbidity included having a spouse older than 35 years of age. HIV infection by itself was not a risk factor for psychological morbidity for women. CONCLUSIONS: There is a high burden of psychological morbidity among pregnant women in Zimbabwe. Mental health services should be integrated into antenatal care to improve psychological health for all women in Zimbabwe.

Adolescent↗
PubMed1992

Psychometric properties of the revised UCLA Loneliness Scale and two short-form measures of loneliness in Zimbabwe.

The cross-cultural reliability in Zimbabwe of the Revised University of California at Los Angeles (UCLA) Loneliness Scale and two short forms of the Revised UCLA Loneliness Scale were investigated. Subjects comprised a sample of 1,354 adolescents and another sample of 754 adults. The reliability of the Revised UCLA Loneliness Scale was acceptable. The internal consistency of an eight-item short form of the Revised UCLA Loneliness Scale was adequate, but the reliability of a four-item short form was low. Factor analysis of the Revised UCLA Loneliness Scale, which yielded two factors similar to those reported in North America by Zakahi and Duran (1982) supported the construct validity of the Revised UCLA Loneliness Scale in Zimbabwe. The Revised UCLA Loneliness Scale and the eight-item short form were highly correlated, but this association was spuriously elevated by the fact the eight-item short form is part of the full scale. Factor analysis of the eight-item short form suggested that this scale does not consistently reflect the factor structure of the full scale. We concluded that the Revised UCLA Loneliness Scale possesses acceptable reliability and factorial validity in Zimbabwe and that the eight-item version is superior to the four-item form of the Revised UCLA Loneliness Scale as a short loneliness measure. However, additional refinements may be needed to further improve the eight-item short version.

Adolescent↗
PubMed1999

Survey of Trichinella spp. infection in pigs from commercial piggeries in Zimbabwe.

Trichinella spp. infection has never been reported among domestic pigs in Zimbabwe. Given that Trichinella spp. occurs in a sylvatic cycle in Zimbabwe and particularly in the light of the recent notification of the presence of the infection in farmed crocodiles, a survey was undertaken to evaluate the present epidemiological situation on commercial pig farms. Carcasses of 7,446 fattener pigs (average 11.7% [+/- 0.2%] of those slaughtered from each farm) were investigated by artificial digestion of pooled diaphragm muscle samples. These carcasses originated from 70 commercial piggeries and were selected by stratification on a farm basis from 63,602 pigs slaughtered during the survey period. No Trichinella spp. larvae were found in any of the 7,446 diaphragm muscle samples. The results demonstrated no evidence of Trichinella spp. infection within the pig population of the commercial piggeries in Zimbabwe.

Abattoirs↗
PubMed2000

A nation in pain: why the HIV/AIDS epidemic is out of control in Zimbabwe.

There has been a dramatic increase in the number of people living with HIV and the number who have died of AIDS-related diseases in Zimbabwe since the early 1990s. This increase has caused shock waves and panic in Zimbabwe and in the entire southern African region. Understanding the factors that have given rise to and sustained patterns of sexual behavior that allow HIV to be transmitted easily and quickly among the general populace is of paramount importance if HIV/AIDS prevention campaigns are to be better formulated and to be effective in this part of sub-Saharan Africa. This article makes a contribution to those studies that seek to examine socioeconomic, cultural, political, and psychological factors determining high-risk sexual behaviors leading to heterosexual HIV infection in the African context. The author contends that the focus of HIV/AIDS prevention programs should be on a myriad of socioeconomic, cultural, political, and behavioral factors instead of just on women and prostitutes--groups that have the least negotiating power within the context of sex and reproduction in a patriarchal society such as Zimbabwe. The author also points out many important areas that have been omitted in the study of HIV transmission and AIDS in Africa.

Adolescent↗
PubMed2005

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.

Abortion, Induced↗
PubMed2004

Susceptibility of 7 freshwater gastropod species in Zimbabwe to infection with Gastrodiscus aegyptiacus (Cobbold, 1876) Looss, 1896.

Gastrodiscosis outbreaks due to Gastrodiscus aegyptiacus were recorded in horses in the vicinity of Harare, Zimbabwe, in the absence of Bulinus forskalii, B. senegalensis and Cleopatra sp. which are considered to be the only intermediate host snails. This suggested the possibility of other snail species acting as intermediate hosts in the life cycle of the trematode. A study was carried out to determine the susceptibility of 7 freshwater snail species to infection with G. aegyptiacus. First generation (F-1) of 5 freshwater pulmonate snail species, Bulinus tropicus, Bulinus globosus, Biomphalaria pfeifferi, Helisoma dyuri and Physa acuta that were bred in the laboratory, and 2 prosobranch snail species, Melanoides tuberculata and Cleopatra sp. that were collected from the field were used in this study. Data pertaining to mortalities and cercariae shedding were recorded throughout the experimental period. The prosobranch snails, M. tuberculata and Cleopatra sp. were susceptible to G. aegyptiacus with a minimum prepatent period of 45 days and 54 days, respectively. Bulinus tropicus, P. acuta and H. duryi were susceptible as evidenced by the presence of different generations of rediae and mature cercariae on dissection at 59 days post-infection although attempts to induce the snails to shed from 28 days post-infection did not produce cercariae. Bulinus globosus and Bio. pfeifferi were refractory to infection. The results revealed the ability of G. aegyptiacus to infect M. tuberculata, Cleopatara sp., B. tropicus, P. acuta and H. duryi under experimental conditions and this may explain the recorded outbreaks of gastrodiscosis in equine populations in Zimbabwe in the absence of the known intermediate hosts. Bulinus tropicus is considered as the most likely major intermediate host of G. aegyptiacus because of its wide distribution in Zimbabwe and is well adapted to a wide variety of environments.

Animals↗
PubMed1999

Adolescent drug use in Zimbabwe assessed by their teachers.

OBJECTIVES: To obtain secondary school teachers' assessment of adolescent drug use in Zimbabwe. Secondly, to compare this assessment with some of the results from student drug use surveys undertaken in 1990 and 1994. DESIGN: Cross sectional. SETTING: 17 secondary schools in Harare, Mashonaland East and West and Matabeleland North Provinces (including Bulawayo). SUBJECTS: 442 secondary school teachers, of whom half were males. MAIN OUTCOME MEASURES: Teachers' assessment of how serious a problem adolescent drug use is in Zimbabwe in general and at the teachers' own school. Secondly, whether adolescent drug use is currently on the increase or decrease. RESULTS: The teachers assessed alcohol use as the most serious drug problem among secondary school students in Zimbabwe, followed in descending order by cannabis, tobacco, inhalants and other drugs. Drug use was considered less serious at the teachers' own school as compared to the assessment of the general situation. Student drug use is largely stable or increasing moderately. Alcohol appears to be increasing the most. Although partly corresponding with previous studies, the situation was assessed as more serious than what appeared from the student drug use surveys in 1990 and 1994. The largest gap between teachers' assessment and students' self-reported drug use was found for cannabis and inhalants. CONCLUSIONS: The study among teachers concur to some extent with results from previous studies among students. There are, however, variations in the assessment of drug use among secondary school students that do not correspond completely with the picture drawn by previous student surveys. It is argued that some of the variation in the assessment may in part be explained by sociocultural and normative differences between different sociocultural segments of Zimbabwean society.

Adolescent↗
PubMed1999

Identification of a serogroup bataviae Leptospira strain isolated from an ox in Zimbabwe.

A strain belonging to the genus Leptospira serogroup Bataviae, isolated from an ox at slaughter in Zimbabwe, was identified by using cross-agglutinin absorption, the monoclonal antibody, restriction fragment length polymorphism, and polymerase chain reaction analyses. Results of both serological tests used showed that the isolate (strain SBF 37) was antigenically similar to reference strain Paidjan and therefore belongs to serovar paidjan. Strain SBF 37 was, however, genetically different from strain Paidjan since their chromosomal DNA had different restriction fragment length polymorphism patterns. The Zimbabwe paidjan strain was identified as belonging to the species Leptospira kirschneri while strain Paidjan reacted as a member of one of the non-kirschneri species in the polymerase chain reaction. The Zimbabwe isolate therefore belongs to Leptospira kirschneri serovar paidjan.

Animals↗
PubMed2000

Evaluation of a commercially available ELISA kit for detection of antibodies to Anaplasma marginale and Anaplasma centrale in cattle in Australia and Zimbabwe.

A newly available competitive inhibition ELISA kit for the serological diagnosis of anaplasmosis was evaluated in Australia and Zimbabwe. In Australia the performance of the test was compared with the card agglutination test (CAT). The assay was evaluated using negative sera collected from Anaplasma-free herds, positive sera from experimentally infected cattle and sera from Anaplasma marginale-endemic herds. The sensitivity and specificity of the ELISA in Australia were 100 % and 83,3 %, respectively, and the sensitivity and specificity of the CAT were both 100%. The agreement between the ELISA and CAT in the sera from endemic herds was 86,4 % (kappa = 0,718). The specificity of the ELISA in Zimbabwe was 100%. No meaningful estimate of sensitivity was possible in Zimbabwe because few known positive sera were available for testing, but all eight known positive sera that were available were clearly positive. We conclude that the ELISA is a useful alternative to the CAT for epidemiological studies. The ELISA kits have advantages over the CAT in that the ELISA is more robust and reagents are better standardized, but the kits are expensive.

Agglutination Tests↗
PubMed1997

Health official emphasizes increase in malaria, AIDS, and TB incidence. International (Zimbabwe).

Zimbabwe has recorded more than 255,000 cases of malaria since the rainy season began last November, 1996. Almost 500 infected people have died of the disease. The death toll from malaria during the same period a year ago was 200; in all, over 2000 people died of malaria in 1996. The increase in disease incidence is attributed to the especially wet rainy season Zimbabwe is experiencing this year. Conditions are favorable for the disease-carrying mosquitoes to breed. Timothy Stamps, Zimbabwe's Minister of Health and Child Welfare, announced these figures at the Medic Africa 1997 exhibition held in Harare on April 16, 1997. According to an article by Segun Adeyemi, a Panafrican News Agency correspondent, Stamps told "some of the continent's top scientists attending [the exhibition] that the health challenges facing African and other developing countries [remain] as daunting as ever." HIV/AIDS research updates also were presented at the exhibition, a 3-day international medical event which includes conferences and seminars presented primarily by research scientists. According to Adeyemi, Stamps told his audience that "the HIV/AIDS pandemic continues to decimate critical human resources and overwhelm the health care system with no respite in sight." "Coupled with that," Adeyemi wrote, "was the vengeful return of tuberculosis, which had since become more difficult to treat and cure. The disease had hitherto been brought under control through immunization and multi-drug therapy."

Africa↗