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PubMed1992

Development of Health Systems Research and National HSR networking in Zimbabwe.

Health Systems Research (HSR) aims at improving the quality of health care delivery through health managers with a management tool for decision making. Since 1988, over 100 health cadres from provincial and district health teams, central hospitals and municipalities have received training in HSR methodology. This training has resulted in the implementation of 12 research projects with the results being used to solve immediate problems identified. The development of HSR in Zimbabwe has focused on training priority setting for essential health research and the development of infrastructure and local resource groups to sustain the initiative. The HSR unit in conjunction with the Medical Research Council of Zimbabwe (MRCZ) have developed a computerised databank for keeping track of all health and medical research conducted in the country. The databank is a mechanism for co-ordinating and promoting research through minimising duplication of research effort in the dissemination and utilisation of research findings. Prospects for HSR in Zimbabwe are good; further development requires adequate funding, networking of all research groups and a national commitment to build a critical mass of trained health research manpower at all levels.

Decision Support Systems, Management↗
PubMedDate not supplied

Adverse drug reactions reporting at a referral hospital in Zimbabwe.

OBJECTIVES: To establish factors influencing voluntary reporting of adverse drug reactions among health workers. A second objective was to establish the level of awareness on adverse drug reaction reporting and attitudes towards the voluntary adverse drug reaction reporting scheme. DESIGN: Cross sectional descriptive study. SETTING: Parirenyatwa Hospital, a major referral and teaching hospital in Harare, Zimbabwe. SUBJECTS: 200 health professionals randomly selected from various departments. MAIN OUTCOME MEASURES: Number of health workers reporting adverse drug reactions; awareness of the adverse drug reaction reporting scheme. RESULTS: 144 (72%) questionnaires were completed. About half (47.2%) of the respondents did not know how to report an adverse drug reaction and 47.1% were unaware of the existence of a formal adverse drug reaction reporting scheme in Zimbabwe. One fifth (20.1%) of the respondents had reported an adverse drug reaction at some point. Two main factors contributing to under-reporting cited by respondents were the poor feedback from the national reporting centre (59%) and inaccessibility of reporting facilities (45.8%). Beliefs that one should only report an adverse drug reaction if certain of causality (46.5%) and that really serious adverse drug reactions are well documented before a drug is marketed (35.4%) could also account for under reporting. However, 75.7%, viewed adverse drug reaction reporting as a professional obligation. CONCLUSION: Lack of awareness of healthcare professionals to the national (Medicines Control Authority of Zimbabwe) adverse drug reaction voluntary reporting scheme, poor feedback and inaccessibility of reporting facilities are the main factors contributing towards underreporting.

Adult↗
PubMed1990

Survey of the dog population of Zimbabwe and its level of rabies vaccination.

A random sample survey using personal interviews was conducted in Zimbabwe in 1986 to determine the size and structure of the national dog population and its level of rabies vaccination. There was an average of 0.91 dogs per household in Zimbabwe giving an extrapolated total population of 1,308,577 dogs. There was a dog to people ratio of 1:6.5 and an average of 3.4 dogs per square kilometre. The ratio of adult male to female dogs was 0.56:0.44, with 20 per cent of the dog population being less than three months old. In the period 1950 to 1986 there was a 4.7 per cent per annum growth rate of the dog population. In one of the provinces, Manicaland, dogs were found to have an average age of 2.3 years and a life expectancy at birth of 4.6 years. An estimated 40 per cent of the dog population three months old and above had been vaccinated against rabies in 1985/1986. With the rabies incidence in Zimbabwe still unacceptably high this level of vaccination is clearly inadequate and measures designed to increase it are discussed.

Age Factors↗
PubMed1995

Questioning the level of efficacy of the measles vaccine in use in Zimbabwe.

A prospective study was carried out between 1987 and 1989 in the City of Gweru (Zimbabwe) to assess the efficacy of the measles vaccine. The vaccine efficacy assessment was carried out on an epidemiological basis by relating measles transmission in the vaccinated and unvaccinated children aged 10 to 23 months. Measles cases were identified on the basis of a standard case definition and data on occurrence of measles cases was collected through an active surveillance system. Efficacies of 73 pc, 82 pc and 77 pc were calculated for the years 1987, 1988 and 1989 respectively. Over the three year period mean efficacy was found to be 77 pc (95 pc confidence interval 75 to 79 pc). The vaccine efficacies found in this study were lower than 85 pc which is the officially accepted efficacy of the measles vaccine that is in use in Zimbabwe. The low vaccine efficacy found in this study is attributed to the fact that the measles vaccine is applied (at nine months of age) when probably 10 to 20 pc of children still have prenatally acquired maternal antibodies. It is suggested that further studies be carried out in Zimbabwe to enable the country to define the way forward.

Age Distribution↗
PubMed1994

The demographic transition in southern Africa: reviewing the evidence from Botswana and Zimbabwe.

Part, but not all, of the observed decline in the number of children ever born reported in the 1984 CPS and the 1988 DHS in Botswana and Zimbabwe can be attributed to differences in sample composition: women in the 1988 survey appear to be better educated than women of the same cohort in the 1984 survey. Blanc and Rutstein argue that differences in education levels in the pairs of surveys are not significant. However, weighted Kolmogorov-Smirnov statistics, a comparison of average years of schooling, and the proportions of women who complete primary school or attend secondary school all indicate that the differences are, in fact, significant. This is true in both Botswana and Zimbabwe. Blanc and Rutstein also claim that these differences do not account for any of the observed decline in fertility between the surveys of women age 15 to 49. Their methodology follows cohorts of women rather than age-groups and thus cannot possibly address this issue. Furthermore, to interpret their results, response error and respondent education must be uncorrelated: this is a key assumption which is violated by the data. We stand by our conclusions and argue for caution when aggregate statistics from the CPS and the DHS are used to make projections about the course of fertility and population growth in Botswana and Zimbabwe.

Adolescent↗
PubMed1994

Snake bites in Zimbabwe: a clinical study with emphasis on the need for antivenom.

A retrospective analysis of 83 consecutive patients (42 males and 41 females) treated for snake bites at Mpilo Central Hospital between January 1990 and June 1992 is presented. In Zimbabwe poisonous snakes belong to four families; Colubrids (Boomslang), Vipers (Puff Adder), Elapids (Mambas and Cobras) and Atractaspids (Bibron Stilleto snake). The Puff Adder is responsible for three quarters of the bites. Forty eight pc (40/83) of the patients were below 20 years of age (range 1 year 10 months to 72 years). Most bites occurred at night (61 pc) in the rainy season (November to April). The majority of snake bites occurred on the lower limb, 64 pc (53/83), with most of the remainder occurring on the upper limb, 34 pc (28/83). The most common clinical features were; pain (95 pc), swelling (87 pc), tachycardia (20 pc), fever (13 pc) and vomiting (8 pc). This study, carried out at a time when there was no antivenom in stock at Mpilo Hospital, shows a considerable mortality (5 pc, 4/83) and morbidity (37 pc, 31/83) rate from poisonous snake bites in Zimbabwe. These observations highlight the need to maintain adequate stocks of antivenom in the major hospitals in Zimbabwe.

Adolescent↗
PubMed1993

Social pathologies in Zimbabwe.

This paper looks at the trend of social pathologies (diseases and cause of death which are more social in origin than biological) in Zimbabwe over the past decade. The rate of increase was found to be very high, even by international standards. In order to find plausible explanations for this rapid rise, the Zimbabwean situation was compared to two different populations; the Navajo Indians in the United States whose rate of social pathologies was also high and the Island of Mauritius whose level of socio-economic development was similar to that Zimbabwe but whose rate of social pathologies was very low. It was concluded that the reason for the rise in social pathologies in Zimbabwe was due to both socio-economic development and excess alcohol consumption. Efforts to combat social pathologies, however, should first be directed towards the problem of excess alcohol consumption which is more directly related to social pathologies than socioeconomic development.

Adult↗
PubMed1993

Q fever in Zimbabwe. A review of the disease and the results of a serosurvey of humans, cattle, goats and dogs.

Sera from 494 humans, 180 cattle, 180 goats and 27 dogs, collected from different regions of Zimbabwe, were examined by indirect fluorescence for antibodies reactive with phase II Coxiella burnetii antigen. Overall, 37% of humans were reactive at a titre of 1/40 or greater, and there was no evidence of age- or sex-related differences in seroprevalence. A review of clinical and epidemiological features of Q fever is presented in order to alert health workers to this infection, which apparently occurs frequently in Zimbabwe even though clinical cases have not been reported. In animals, serological evidence of Q fever infection was found in 39% of cattle, but only 15% of dogs and 10% of goats. These results suggest that cattle are important reservoirs of C. burnetii in Zimbabwe.

Animals↗
PubMed1996

Retrospective study on the criteria for diagnosis of HIV infection in adults in Zimbabwe.

OBJECTIVE: To review the criteria for diagnosis of HIV infection in adults in order to improve upon the Zimbabwe Adult AIDS case definition. DESIGN: A descriptive study which involved the analysis of "Request fo r HIV Antibody Test" forms which had been submitted by clinicians to Masvingo Public Health Laboratory, between June 1990 and December 1992. SETTING: Masvingo Public Health Laboratory, Zimbabwe. SUBJECTS: 627 adult patients. MAIN OUTCOME MEASURES: HIV seroprevalence; specific, sensitivity and positive predictive values of the Adult AIDS case definition. RESULTS: The HIV seroprevalence in 627 adult patients whose forms had been submitted to Masvingo Public Health Laboratory was 79pc. The criterion for the diagnosis of HIV infection had a very high specificity value of 93pc but low sensitivity of 53pc. The positive predictive value of the case definition was very high (97pc). The positive predictive values of individual symptoms were calculated and only weight loss and persistent generalized lymphodenopathy had high values of 99pc and 72pc respectively. CONCLUSIONS: This study has shown that the criterion used in the diagnosis of HIV infection in Zimbabwe is highly specific but relatively insensitive at identifying seropositive patients. This shows the ability of clinicians to identify HIV positive patients irrespective of the stage of the disease (i.e. HIV related symptoms, AIDS related complex or full blown AIDS). There is also a need for constant monitoring of the clinical manifestations of AIDS patients to keep abreast with newer disease manifestations.

Adult↗
PubMed1997

Evidence of malnutrition having a threshold effect on the risk of childhood diarrhoea in Zimbabwe.

OBJECTIVE: Diarrhoeal disease is a major cause of childhood morbidity and mortality in Zimbabwe. This paper examines the relationship between diarrhoea and malnutrition to determine whether there is a threshold effect in operation. DESIGN: Multivariate analysis of a retrospective survey. SETTING/SUBJECTS: Using a nationally representative sample, the Zimbabwe Demographic and Health Survey, 1994, collected diarrhoeal, anthropometric and socio-economic data for 2,073 children aged 0 to 35 months. RESULTS: Age of the child, residence, and severe stunting and wasting were found to be significant predictors of childhood diarrhoea. However, moderate stunting and wasting failed to show any relationship. CONCLUSIONS: Moderate malnutrition is the main nutritional complaint in Zimbabwe. Thus malnutrition may have a relatively small role in determining the prevalence of childhood diarrhoea. Instead, factors related to exposure--namely sanitation, water supply, population density and hygiene--may be more important. Consequently supplementary feeding programmes should work in tandem with initiatives to reduce exposure if the morbidity burden of children is to be reduced.

Child Nutrition Disorders↗
PubMed1997

Contamination of traditional drinking water sources during a period of extreme drought in the Zvimba communal lands, Zimbabwe.

OBJECTIVES: Diarrhoeal disease is a significant public health concern in Zimbabwe, particularly for the population living in rural settings. The present study was undertaken to investigate the quality of water in a rural area of Zimbabwe during a period of extreme drought. DESIGN AND SETTING: A cross sectional survey study design was used. During the month of July 1995, water samples were collected from various actively used sources in the Zvimba communal lands, Zimbabwe. MAIN OUTCOME MEASURES: The level of contamination was estimated by use of the membrane filtration technique to detect the presence of Escherichia coli. RESULTS: Mean concentrations of E. coli found in boreholes and piped water were 9.3 and zero colonies per 100 ml, respectively. Using standardized criteria to define suitable drinking water quality, borehole and piped sources were determined to be more likely to provide satisfactory drinking water. CONCLUSIONS: Water samples collected from semi-protected and unprotected wells, which serve the majority of the population in the study area, were found to be unsatisfactory for drinking (range from two to 1,960 colonies of E. coli per 100 ml). Included are suggestions on how to efficiently utilize available water.

Cross-Sectional Studies↗
PubMed1998

The distribution of heartwater in the highveld of Zimbabwe, 1980-1997.

Heartwater, the tick-borne disease caused by the rickettsia Cowdria ruminantium has historically been confined to the southern and western lowvelds of Zimbabwe. Since 1986, however, cases of heartwater have been diagnosed with increasing frequency in the central and eastern regions of the previously heartwater-free highveld plateau. During the same period, collections of the two major tick vectors of heartwater in Zimbabwe, Amblyomma hebraeum and Amblyomma variegatum, were made for the first time in these areas, suggesting that spread of these ticks was responsible for the changed distribution of the disease. The factors associated with this spread have not been determined, but increased cattle and wildlife movement and reduced intensity of dipping undoubtedly play important roles. Currently, the distribution of heartwater and its vectors in the highveld is still largely restricted to the central and eastern regions. The northern regions of the highveld appear to be predominantly uninfected, though it is likely that, eventually, heartwater will spread further with considerable impact on livestock production in Zimbabwe.

Animals↗
PubMed1991

Chrysotile asbestos and health in Zimbabwe: I. Analysis of miners and millers compensated for asbestos-related diseases since independence (1980).

Data on the health effects caused by locally mined chrysotile asbestos in Zimbabwe have been very limited. The prevailing local view has been that risk is minimal. In this report we critically reassess the cases of 51 individuals with asbestos exposure who have been compensated by the Central Pneumoconiosis Bureau since independence in 1980. Results demonstrate that the major health risks of exposure reported elsewhere--morbid asbestosis, nonmalignant pleural disease, malignant mesothelioma, and lung cancer--all occur in Zimbabwe, at least among workers in the asbestos mines and mills. It is concluded that further investigation and control measures in the industry are warranted.

Asbestos↗
PubMed2005

Treatment of AIDS-associated Kaposi's sarcoma in Zimbabwe: results of a randomized quality of life focused clinical trial.

Kaposi's sarcoma is currently the most common tumor in Zimbabwe. The purpose of our study is to compare the effectiveness of supportive care vs. 3 intervention approaches, namely oral Etoposide, a 3-drug combination, and radiotherapy using quality of life (QOL) as the primary measure of success. In addition, our study was to determine whether a disease-specific module has greater sensitivity to group differences than a generic QOL questionnaire and to determine the most pragmatic approach to treating epidemic Kaposi's sarcoma (EKS) in Zimbabwe. Histologically confirmed HIV-positive patients with Kaposi's sarcoma were randomized to receive supportive care only or supportive care plus either radiotherapy, oral Etoposide or a 3-drug combination consisting of actinomycin-D, vincristine and bleomycin. No patient received antiretroviral therapy. The primary outcome was QOL measured by the functional living index-cancer (FLI-C) and supplemented by the Kaposi's sarcoma module (KSM). From 1994-1999, 495 EKS patients were accrued, and 470 were evaluable. Of these, 433 are known to be dead, 26 are lost to follow-up and 11 are still alive. The group treated with oral Etoposide had a significantly better QOL than the radiotherapy group for the total FLI-C score (adjusted mean plus standard error at 3-months 89 +/- 3 vs. 76 +/- 3; p = 0.004) and for the hardship (11 +/- 0.4 vs. 9 +/- 0.4; p = 0.001); social (10 +/- 0.4 vs. 8 +/- 0.4; p = 0.001) and nausea (9 +/- 0.4 vs. 8 +/- 0.4; p = 0.002) subscales. In addition, on the physical and psychological subscales, the Etoposide group had a significantly better QOL than the other 3 treatment groups (p < 0.04). The 3-drug combination, supportive care and radiotherapy groups did not differ significantly from each other with respect to the total FLI-C score or its subscales. There were no group differences with respect to survival. Oral Etoposide therapy resulted in better total FLI-C QOL score than radiotherapy. As well, Etoposide resulted in better physical and psychological subscale scores than radiotherapy, 3-drugs and supportive care. Thus, funds permitting, oral Etoposide is a pragmatic approach to treating EKS in an environment where antiretroviral drugs are not universally available. The study underscores the value of undertaking studies in areas of disease prevalence and the necessity of selecting appropriate outcome measures.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Cancer in the African population of Harare, Zimbabwe, 1990-1992.

The data presented from the population-based cancer registry in Harare, Zimbabwe, represent the first information on the incidence of cancer in Southern Africa for almost 20 years. In the African population in Zimbabwe there are several features in common with other countries in sub-Saharan Africa: high rates of liver, prostate and cervix cancer, low rates of large-bowel cancer and breast cancer. Also, as reported from southern and south-eastern Africa, there are relatively high incidence rates of cancers of the oesophagus, bladder and (in men) lung. The AIDS epidemic has given rise to a striking increase in incidence of Kaposi's sarcoma (now the commonest cancer of African men), but there is not much evidence for an increase in incidence of non-Hodgkin lymphomas nor, although rates are very high, of cervical cancer.

Adolescent↗
PubMedDate not supplied

Snake poisoning in rural Zimbabwe--a prospective study.

Over a period of 2 years (January 1991 to December 1992) 274 cases of snake bite were admitted to hospital in the eight provinces of Zimbabwe. Of these patients, 54% were males and 88% belonged to the 6-40-year age group. Five deaths (1.8% of the total cases) were reported. The majority of snake bites (63%) occurred at night (between 6.30 p.m. and midnight) and over 74% took place during the hot rainy season, i.e. between November and April. In over 58% of the cases the victim accidentally stepped on the snake, the snake being cobra in 37%, puff adder in 20% and the black and green mamba in 18% of the cases. Most of the bites occurred on the leg, below the knee. Treatment of snake envenomation consisted mainly of the administration of antibiotics (151 cases), analgesics (144 cases), antivenom tropical snake polyvalent (ATT) (89 cases), antitoxoid tetanus (TT) (61 cases), antihistamines (47 cases) and traditional medicines (43 cases). This study indicates that snake envenomation in rural Zimbabwe is common but fatalities are relatively rare.

Adolescent↗
PubMedDate not supplied

Poisoning in Zimbabwe: a survey of eight major referral hospitals.

A retrospective study of the pattern of poisoning cases admitted to eight major urban referral hospitals in Zimbabwe over a 2-year period (1998-1999 inclusive) was conducted to describe the pattern of poisoning at these centres. There were a total of 2764 hospital admissions due to poisoning, involving a total of 2846 toxic agents. Accidental poisoning (AP) and deliberate self-poisoning (DSP) accounted for 48.9% (1352 cases) and 41.3% (1142 cases), respectively. With AP, the highest number of cases (45.9%) occurred in children below the age of 5 years, with half of these due to chemicals, mainly paraffin. In the DSP group, however, more than 60% of all cases occurred in the 16-25-year age group. In addition, twice as many females as males were admitted for DSP compared with an overall male/female ratio of 1 : 1.2. Pesticides (31.4%) and pharmaceuticals (30.4%) were the most common groups of toxic agents responsible for the hospital admissions. Unknown toxins, natural toxins and pesticides showed the highest mortality rates (15.4%, 8.3% and 6.7%, respectively). Compared with the last major survey of poisoning in Zimbabwe, the pattern of poisoning at referral hospitals has changed over the last decade, with an increase in pesticide and pharmaceutical cases and a marked fall in cases of traditional medicine poisoning. Educational and legislative interventions may be required to address these changes. There is the need also to investigate further the high mortality rates associated with traditional medicine poisoning.

Adolescent↗
PubMed1989

The problem and control of gastrointestinal helminthiases in Zimbabwe.

An overview of the problem of gastrointestinal (GI) helminthiases in Zimbabwe is given in terms of prevalence, distribution, clinical significance of individual parasites and their transmission patterns. Although data on these aspects are incomplete, the available information and the results of studies conducted elsewhere should assist in the planning and implementation of effective helminthiasis intervention strategies. Community-based integrated helminthiasis control measures that include mass chemotherapy, improved sanitation and health education are considered to be the most practical interventions and are being evaluated in Zimbabwe. This community-based approach is cost-effective, as most of the control measures are carried out on a self-help basis. Besides, local voluntary health committees provide consistent community-level surveillance to promote and motivate the population to join in the intervention measures that include improved sanitation and health education, aspects which have broader implications for improved health.

Adolescent↗