Disease In Zimbabwe Research Articles

Plants used for the management of paediatric ailments in Zimbabwe: A narrative review

Background: Children are susceptible to various types of infections and diseases because of their low and weakened immune system. In various communities throughout the world, medicinal plants have historically been used to treat and manage paediatric diseases and ailments.Aim: The current study was aimed at identifying and analysing medicinal plants used traditionally to treat and manage paediatric diseases in Zimbabwe.Setting: This review provides an overview of medicinal plants used to manage paediatric ailments in Zimbabwe.Method: Ethnobotanical information on medicinal plants used to treat and manage paediatric diseases in Zimbabwe was obtained using online databases such as Scopus, JSTOR, PubMed, Google Scholar and Science Direct.Results: A total of 178 taxa belonging to 64 families have been documented as traditional medicines for paediatric diseases and ailments in Zimbabwe. Cryptolepis oblongifolia, Asparagus spp., Dichrostachys cinerea, Fadogia ancylantha, Inula glomerata, Lannea edulis and Strychnos spinosa are the most popular medicinal plants with four to five use reports each. Medicinal plants are used to treat and manage 41 childhood medical conditions in Zimbabwe.Conclusion: Baseline data provided in this study can be used for future ethnopharmacological research focusing on chemical, pharmacological and toxicological evaluations of the documented species.Contribution: This study contributes to the existing literature about medicinal plants used to treat and manage paediatric diseases, and such data can be used to develop new health-promoting products for children and also pharmaceutical products that can be used to reduce child or infant mortality rate.

Plant species from the Euphorbiaceae (spurge) family used for medicinal purposes in Zimbabwe: A review

The present review was aimed at documenting medicinal uses of species of the Euphorbiaceae family in Zimbabwe. Literature was collected from online databases such as BioMed Central, Web of Science, Springerlink, Google Scholar, Scielo, PubMed, Science Direct, ACS Publications, Scopus and JSTOR. This study showed that 29 species are used to manage human and animal diseases in Zimbabwe. These species are used against 49 medical conditions, mainly as ethnoveterinary medicine (21 use reports), and traditional medicine against respiratory (23 use reports), gastro-intestinal (14 use reports), male reproductive (11 use reports), antenatal and postpartum (10 use reports each) and sexually transmitted infections (9 use reports). Acalypha brachiata, Bridelia cathartica, B. mollis, Crotonmegalobotrys, Euphorbia ingens, E. matabelensis, Flueggea virosa, Monadenium lugardiae, Pseudolachnostylis maprouneifolia, Ricinus communisand Spirostachys africanahave the highest number of medicinal uses. There is need to unravel the therapeutic potential of the family through further ethnopharmacological research.

The nexus between Gender-based Violence and the COVID-19 pandemic in Zimbabwe: A case study of the Johane Marange Apostolic Church

The outbreak of the COVID-19 pandemic greatly affected humanity, including inter alia working schedules, public life, and public health systems. Johane Marange Apostolic Church (JMAC) Women’s religious life in Zimbabwe was not spared the effects of the coronavirus. This pandemic affected women in various religious practices, and one of them is being subjected to gender-based violence (GBV). Throughout the intermittent lockdown phases, the COVID-19 pandemic exacerbated the already existing gender discrepancies, with far-reaching implications for women. The closure of informal businesses, which was the major source of income for most JMAC women resulted in the shortages of food on the table. The shortages of food supplies resulted in unprecedented conflicts in the home, and women suffered the most. This study interrogates how the outbreak of the COVID-19 pandemic exacerbated the problem of GBV, especially for ordinary women. The article adopts the social conflict perspective as a theoretical lens for examining how women in the JMAC became more susceptible to GBV, perpetrated by their male counterparts during the peak of the COVID-19 pandemic in Zimbabwe. The article concludes by proposing ways for curbing some of the patriarchal-endowed beliefs and practices which intensified the suffering of JMAC women during the peak of the coronavirus disease in Zimbabwe.

Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial.

Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. PRR1-10.2196/47512.

Medicinal uses of the Asteraceae family in Zimbabwe: A historical and ecological perspective

Background: Several plant species belonging to the Asteraceae family are widely used as sources of traditional medicines. The current study was aimed at providing a systematic review of ethnomedicinal, phytochemical and pharmacological properties of Asteraceae species used as sources of traditional medicines in Zimbabwe. Methods: Information related to the ethnomedicinal, phytochemical and pharmacological properties of Asteraceae species was systematically collected using relevant keywords from online databases such as BioMed Central, Web of Science, Springerlink, Google Scholar, Scielo, PubMed, Science Direct, ACS Publications, Scopus and JSTOR, books, dissertations, theses, scientific reports and herbarium specimens. Results: This study showed that 50 species are traditionally used to manage human and animal diseases in Zimbabwe. These species are used as traditional medicines against 51 medical conditions, mainly used in the treatment of gastro-intestinal problems (34 use reports) and respiratory problems (28 use reports). Aspilia pluriseta, Baccharoides adoensis, Bidens pilosa, Brachylaena discolor var. rotundata, Dicoma anomala, Erythrocephalum zambesianum, Gymnanthemum amygdalinum, G. coloratum, Helichrysum caespititium, Inula glomerata, Laggera crispata, Linzia glabra, Lopholaena coriifolia, Schkuhria pinnata, Senecio coronatus, S. latifolius and Tagetes minuta have the highest number of medicinal uses. Majority of the documented species are characterized by flavonoids (46.0%), terpenoids (44.0%), tannins (40.0%), alkaloids (34.0%), saponins (26.0%), essential oils (24.0%) and glycosides (20.0%). Conclusions: Further phytochemical and pharmacological studies would be of great interest for assessment of ethnopharmacological properties of Asteraceae species used as sources of traditional medicines. Keywords: Asteraceae, Compositae, herbal medicine, indigenous knowledge, natural compounds, Zimbabwe

Medicinal Uses of the Fabaceae Family in Zimbabwe: A Review

The current study is aimed at providing a systematic review of the ethnomedicinal, phytochemical and pharmacological properties of Fabaceae species used as sources of traditional medicinies in Zimbabwe. Fabaceae is one of the well-known plant families of ethnopharmacological importance. Of the approximately 665 species of the Fabaceae family occurring in Zimbabwe, about 101 are used for medicinal purposes. Many communities in the country, mainly in peri-urban, rural and marginalized areas with limited access to healthcare facilities, rely on traditional medicines as their primary healthcare. The study reviewed research studies undertaken on Zimbabwe's Fabaceae species during 1959 to 2022. Information was gathered from literature sourced from Google Scholar, Science Direct, Scopus, PubMed, books, dissertations, theses and scientific reports. This study showed that 101 species are traditionally used to manage human and animal diseases in Zimbabwe. The genera with the highest number of medicinal uses are Indigofera, Senna, Albizia, Rhynchosia and Vachellia. Species of these genera are used as traditional medicines against 134 medical conditions, mainly gastrointestinal conditions, female reproductive conditions, respiratory conditions and sexually transmitted infections. Shrubs (39.0%), trees (37.0%) and herbs (18.0%) are the primary sources of traditional medicines, while roots (80.2%), leaves (36.6%), bark (27.7%) and fruits (8.9%) are the most widely used plant parts. Many of Zimbabwe's Fabaceae species used as sources of traditional medicines have been assessed for their phytochemical and pharmacological properties, corroborating their medicinal uses. However, there is a need to unravel the therapeutic potential of the family through further ethnopharmacological research focusing on toxicological studies, in vitro and in vivo models, biochemical assays and pharmacokinetic studies.

Medicinal plants used against poultry diseases in Zimbabwe: A systematic review

The current study was aimed at documenting ethnoveterinary medicines (EVMs) used against poultry diseases in Zimbabwe and local ecological knowledge (LEK) associated with the docu¬mented plant species. Information related to EVMs used against poultry diseases in Zimbabwe was systematically collected using relevant keywords from online databases such as BioMed Central, Web of Science, SpringerLink, Google Scholar, Scielo, PubMed, Science Direct, ACS Publications, Scopus and JSTOR, books, dissertations, theses, and scientific reports. This study showed that 69 species are traditionally used to manage poultry diseases in Zimbabwe. Most of the plant species (79.01%) that are used in poultry treatment and management are wild and 29.0% are exotic, cultivated, or naturalized. These species are used against 22 medical conditions, mainly in the treatment and management of coccidiosis, Newcastle, cough, diarrhea, wounds, and ectopar¬asites. Adenia gummifera, Aloe arborescens, Aloe chabaudii, Aloe greatheadii, Actaea spicata, Bobgunnia madagascariensis, Capsicum annuum, Capsicum frutescens, Cynanchum viminale, and Erythrina abyssinica have the highest number of EVM uses. This review highlights the importance of EVMs for the healthcare of poultry in Zimbabwe. Therefore, detailed ethnopharmacological evaluations of the species focusing on their phytochemistry, pharmacological properties, toxico¬logical evaluations, in vivo and clinical research investigations are recommended.

Christian women bearing the brunt of burden during the peak of the COVID-19 pandemic in Zimbabwe: A social gender justice perspective

The outbreak of the COVID-19 pandemic in 2019 brought untold suffering to Christian women as they are the custodians of the families. A considerable number of people have succumbed to the COVID-19 pandemic globally. The hardest hit were women in hospitals, villages and families, owing to the fact that they looked after the sick. During lockdowns, the COVID-19 pandemic exacerbated the already existing gender disparities, with far-reaching implications to Christian women. The closure of offices and educational institutions, the emerging norm of working from home and online education, the lack of services of domestic workers and the need to perform unpaid chores in the household has increased. In this context, the focus of this study is to interrogate how the onslaught of the COVID-19 pandemic posed as an agonizing burden to the Zimbabwean Christian women and the girl child from a social gender justice perspective. The paper argues that Christian women were on the receiving end during the peak of the pandemic, owing to a plethora of factors, notably: there were no resources in clinics; there was no protection when looking after patients; thus, resulting in the higher risk of contracting coronavirus disease. The study is informed by insights from a social gender justice perspective to examine how Christian women were burdened during the COVID-19 pandemic in Zimbabwe. It could be concluded that Christian women suffered most during the coronavirus disease in Zimbabwe when they looked after the sick; ultimately resorting to the indigenous herbal medicines as a cure to COVID-19 when there was no conventional medicine. Utilizing the lens of the social gender justice framework, this study examines how the onslaught of the COVID-19 pandemic posed an unbearable burden, particularly to the Christian women and the girl child in Zimbabwe from. This article contributes to the ongoing academic discussions emphasizing the need for Christian women to be empowered in order to better equipped to fight for their rights globally.

Medicinal plants used for the management of respiratory diseases in Zimbabwe: Review and perspectives potential management of COVID-19

Respiratory diseases have in the recent past become a health concern globally. More than 523 million cases of coronavirus disease (COVID19), a recent respiratory diseases have been reported, leaving more than 6 million deaths worldwide since the start of the pandemic. In Zimbabwe, respiratory infections have largely been managed using traditional (herbal) medicines, due to their low cost and ease of accessibility. This review highlights the plants’ toxicological and pharmacological evaluation studies explored. It seeks to document plants that have been traditionally used in Zimbabwe to treat respiratory ailments within and beyond the past four decades. Extensive literature review based on published papers and abstracts retrieved from the online bibliographic databases, books, book chapters, scientific reports and theses available at Universities in Zimbabwe, were used in this study. From the study, there were at least 58 plant families comprising 160 medicinal plants widely distributed throughout the country. The Fabaceae family had the highest number of medicinal plant species, with a total of 21 species. A total of 12 respiratory ailments were reportedly treatable using the identified plants. From a total of 160 plants, colds were reportedly treatable with 56, pneumonia 53, coughs 34, chest pain and related conditions 29, asthma 25, tuberculosis and spots in lungs 22, unspecified respiratory conditions 20, influenza 13, bronchial problems 12, dyspnoea 7, sore throat and infections 5 and sinus clearing 1 plant. The study identified potential medicinal plants that can be utilised in future to manage respiratory infections.

Trends in Airborne Chrysotile Asbestos Fibre Concentrations in Asbestos Cement Manufacturing Factories in Zimbabwe from 1996 to 2016.

Zimbabwe has two major factories that have been manufacturing chrysotile asbestos cement products since the 1940s. Exposure monitoring of airborne fibres has been ongoing since the early 1990s. This study examines trends in personal exposure chrysotile asbestos fibre concentrations for the period 1996–2016. Close to 3000 historical personal exposure measurements extracted from paper records in the two factories were analysed for trends in exposure. Exposure over time was characterised according to three time periods and calendar years. Mean personal exposure chrysotile asbestos fibre concentrations generally showed a downward trend over the years in both factories. Exposure data showed that over the observed period 57% and 50% of mean personal exposure chrysotile asbestos fibre concentrations in the Harare and Bulawayo factories, respectively, were above the OEL, with overexposure being exhibited before 2008. Overall, personal exposure asbestos fibre concentrations in the factories dropped from 0.15 f/mL in 1996 to 0.05–0.06 f/mL in 2016—a decrease of 60–67%. These results can be used in future epidemiological studies, and in predicting the occurrence of asbestos-related diseases in Zimbabwe.

Epidemiological transition and the dual burden of communicable and noncommunicable diseases in Zimbabwe

Background: The epidemiological transition model, coined by Abdel Omran in 1971, building on the demographic transition theory developed by Frank Notestein in 1945, has been largely credited for describing epidemiological situations both globally and nationally in many parts of the world. However, owing to its origins in the United States of America (USA), scholars critique the model's applicability to various geographical, socioeconomic, and epidemiological contexts, which are diversely different from the USA and vary from region to region. It was imperative to test the applicability of this model in sub-Saharan Africa (SSA), particularly Zimbabwe to ascertain versatility in describing epidemiological transitions, predicting population health status and whether the assumption of a shift from communicable diseases (CDs) to noncommunicable diseases (NCDs) could be confirmed in a low-income developing nation focusing on Zimbabwe. Methods: The study was a retrospective document review case study, using the existing framework of the epidemiological transition model, as a guiding principle, applying the model to describe the demographic and epidemiological circumstances prevailing within Zimbabwe. The researcher reviewed, compared, analyzed, and described the existing literature on population dynamics and epidemiological profile of the country for the period 1990–2020. Results: The epidemiological transition model attempts to describe the changes in epidemiological circumstances both at national and global scales. The model presumes a shift in CDs to NCDs. However, many scholars question the applicability of the model to diverse contexts, particularly within the SSA context. The Zimbabwean case was considered in light to its rising population growth, dual burden characterized by a high burden of communicable and rising NCDs. Findings from this study indicate that NCDs are on the rise in Zimbabwe. However, owing to a high burden of CDs, a dual disease burden model is the best fit to explain the epidemiological transition currently obtaining within Zimbabwe. Conclusions: Consequentially, funding streams targeting CDs should take heed of the currently obtaining epidemiological situation in the country and respond by challenging funding to public health interventions with a view to address the rising NCDs. Further, public health authorities should craft Public health policies that create supporting environments conducive for the populace to fight NCDs. Informed by the Ottawa charter, reorientation of health services to ensure more health systems responsiveness in the face of emerging NCDs is imperative. In addition, developing interpersonal skills for individuals to be able to act against NCD's risk behaviors and factors is key; at the same time, strengthening community action by capacitating community health workers to address risk behaviors and factors associated with NCDs at community level is imperative. Finally, the inadequacy of the epidemiological transition model inadvertently challenges epidemiologists to step up efforts to review, refine, and extend the model to suit SSA countries like Zimbabwe and elsewhere countries in similar circumstances.

Determining the burden of fungal infections in Zimbabwe

Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and ‘at-risk’ populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.

Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe.

BackgroundChronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD.MethodsParticipants included Zimbabwean C-PHIV, aged 6–16, who were either newly diagnosed and cART-naive, or on cART for >6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated.ResultsC-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL.ConclusionsIn this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation.

Is syndromic data from rural poultry farmers a viable poultry disease reporting tool and means of identifying likely farmer responses to poultry disease incursion?

Syndromic surveillance is a well described tool used in developed countries for alerting authorities to livestock disease incursions. However, little work has been done to evaluate whether this could be a viable tool in countries where disease reporting infrastructure and resources is poor. Consequently, a syndrome-based questionnaire study in Eastern Zambia was designed to gather data on previous encounters farmers had with poultry diseases, as well as control measures they use to mitigate them. Descriptive statistics and logistic regression were used to analyse the data.Farmers reported an overall annual disease incidence in rural poultry for eastern Zambia of 31% (90% CI 29–32%). Occurrence of poultry disease in the last 12 months was associated with use of middlemen to purchase poultry products (p = 0.05, OR = 7.87), poultry products sold or given away from the farm (p = 0.01, OR = 1.92), farmers experiencing a period with more trade of poultry and its products (p = 0.04, OR = 1.70), presence of wild birds near the farm or village (p = 0.00, OR = 2.47) and poultry diseases being reported from neighbouring farms or villages (p = 0.00, OR = 3.12). The study also tentatively identified three poultry diseases (Newcastle Disease, Gumboro Disease and Fowl Pox) from the thirty-four disease syndromes provided by farmers. Farmers reported an incidence of 27% for Newcastle Disease in 2014. When compared with the state veterinary services data which reported Newcastle Disease incidence at 9% in 2014, it seems syndromic data obtained from farmers may be more sensitive in identifying disease incursion.Thirty-six remedies and strategies farmers use to treat and control these diseases were revealed. The main control strategy for identified diseases was vaccination and the main treatment was unspecified herbs, which warrants further investigation and presents an opportunity for further research in ethno-veterinary medicine. More still, this study identified chilli, Aloe Vera, garlic onion, moringa, and ash as traditional remedies that are commonly being used in Eastern Zambia, and which are also used to treat poultry diseases in Zimbabwe and Botswana. Only fourteen remedies described are conventionally accepted by veterinarians as remedies and disease control measures for poultry diseases.This study shows that syndromic data obtained from farmers is a useful disease reporting tool and could be used as an effective means of alerting authorities to disease incursion. In addition, it shows that these data may give a more accurate estimate of incidence for certain diseases than current surveillance methods and could be useful in assessing significant risk factors associated with disease occurrence.

Legislation, Vulnerability and Disaster Risk Management of Waterborne Diseases in Zimbabwe

Legislation, Vulnerability and Disaster Risk Management of Waterborne Diseases in Zimbabwe

To what extent do prescribing practices for hypertension in the private sector in Zimbabwe follow the national treatment guidelines? An analysis of insurance medical claims

BackgroundHypertension is the most prevalent cardiovascular disease in Zimbabwe. The prevalence of Hypertension in the country is above 30% regardless of the cut off used. Currently, majority of patients in Zimbabwe seek health care from the private sector due to limited government funding for the public health sector. However, Standard treatment guidelines for hypertension are only available in the public sector and are optional in the private sector. This study assesses compliance of private sector prescribing to Standard Treatment guidelines for hypertension.MethodsWe reviewed hypertension prescription claims to a private health insurance company in Zimbabwe for the period Jan 1-Dec 31 2015. We used the last prescription claimed in the year on the assumption that it represented the patient’s current treatment. Prescription data was analyzed by comparing medicines prescribed to those recommended in the Zimbabwe 7th Essential Medicines List and Standard Treatment Guidelines 2015. We used Microsoft Excel© 2010 to conduct the analysis.ResultsA total of 1019 prescriptions were reviewed. Most patients were either on mono or dual therapy (76%). The mostly prescribed class of antihypertensive as first line were Angiotensin Converting Enzyme Inhibitors /Angiotensin Receptor Blockers. Regardless of whether they were being used as first, second or third line this class of antihypertensives emerged as the most prescribed (639 times). Only 358 (35%) prescriptions were compliant with standard treatment guidelines; the rest (661) did not meet several criteria. Areas of non-compliance included use of second line medicines as first line, failure to consider patient characteristics when prescribing, use of contraindicated medicines for certain patients, clinically significant interactions among prescribed medicines and illogical combinations that predispose patients to toxicity.ConclusionThe poor compliance to standard treatment guidelines observed in our study indicates need to improve prescription practices for Hypertension in the private sector in Zimbabwe for its cost-effective management among the covered patients. However, further investigation is needed to understand the drivers of the prescribing habits and the non-compliance to the Essential Medicines List and Standard Treatment guidelines observed. This will enable design of appropriate educational, managerial and economic interventions to improve compliance.

Burden attributable to Cardiometabolic Diseases in Zimbabwe: a retrospective cross-sectional study of national mortality data.

BackgroundCardiometabolic diseases (CMDs) are an important cause of mortality worldwide and the burden associated with them is increasing in Sub-Saharan Africa. The tracking of mortality helps support evidence based health policy and priority setting. Given the growing prevalence of non-communicable diseases in Zimbabwe, a study was designed to determine the mortality attributable to CMDs in Zimbabwe.MethodsThe study design was a retrospective cross-sectional analysis of national mortality from 1996 to 2007, collated by the Ministry of Health and Child Welfare in Zimbabwe. We employed generalized additive models to flexibly estimate the trend of the CMD mortality and a logistic regression model was used to find significant factors (cause of death according to the death certificate) of the CMD mortality and predict CMD mortality to 2040.ResultsCMDs accounted for 8.13 % (95 % CI: 8.08 % - 8.18 %) of all deaths during 1996 to 2007 (p = 0.005). During the study period CMD mortality rate increased by 29.4 % (95 % CI: 19.9 % - 41.1 %). The association between gender and CMD mortality indicated female mortality was higher for diabetes (p < 0.001), hypertensive disease (p < 0.001), CVD (p < 0.001) and pulmonary disease (p < 0.001), while male mortality was higher for ischaemic (p = 0.010) and urinary diseases (p < 0.001). There was no gender difference for endocrine disease (p = 0.893). Overall, females have 1.65 % higher mortality than males (p < 0.001). CMD mortality is predicted to increase from 9.6 % (95 % CI: 8.0 % - 11.1 %) in 2015 to 13.7 % (95 % CI: 10.2 % - 17.2 %) in 2040 for males, and from 11.6 % (95 % CI: 10.2 % - 12.9 %) in 2015 to 16.2 % (95 % CI: 13.1 % - 19.3 %) in 2040 in females.ConclusionThe findings of this study indicate a growing prevalence of CMDs and related mortality in Zimbabwe. Health policy decisions and cost-effective preventive strategies to reduce the burden of CMDs are urgently required.

Bayesian spatial analysis of childhood diseases in Zimbabwe.

BackgroundMany sub-Saharan countries are confronted with persistently high levels of childhood morbidity and mortality because of the impact of a range of demographic, biological and social factors or situational events that directly precipitate ill health. In particular, under-five morbidity and mortality have increased in recent decades due to childhood diarrhoea, cough and fever. Understanding the geographic distribution of such diseases and their relationships to potential risk factors can be invaluable for cost effective intervention.MethodsBayesian semi-parametric regression models were used to quantify the spatial risk of childhood diarrhoea, fever and cough, as well as associations between childhood diseases and a range of factors, after accounting for spatial correlation between neighbouring areas. Such semi-parametric regression models allow joint analysis of non-linear effects of continuous covariates, spatially structured variation, unstructured heterogeneity, and other fixed effects on childhood diseases. Modelling and inference made use of the fully Bayesian approach via Markov Chain Monte Carlo (MCMC) simulation techniques. The analysis was based on data derived from the 1999, 2005/6 and 2010/11 Zimbabwe Demographic and Health Surveys (ZDHS).Results and conclusionsThe results suggest that until recently, sex of child had little or no significant association with childhood diseases. However, a higher proportion of male than female children within a given province had a significant association with childhood cough, fever and diarrhoea. Compared to their counterparts in rural areas, children raised in an urban setting had less exposure to cough, fever and diarrhoea across all the survey years with the exception of diarrhoea in 2010. In addition, the link between sanitation, parental education, antenatal care, vaccination and childhood diseases was found to be both intuitive and counterintuitive. Results also showed marked geographical differences in the prevalence of childhood diarrhoea, fever and cough. Across all the survey years Manicaland province reported the highest cases of childhood diseases. There is also clear evidence of significant high prevalence of childhood diseases in Mashonaland than in Matabeleland provinces.

006.6 High prevalence of chlamydia and gonorrhoea among patients with genital ulcer disease in zimbabwe: potential implications for syndromic management

Background Syndromic management of genital ulcer disease (GUD) as recommended by the Zimbabwe Ministry of Health and Child Care, includes antibiotics against Treponema pallidum (TP: benzathine penicillin), Haemophilus ducreyi (HD: erythromycin), and herpes simplex virus (HSV: acyclovir). However, these medications are not recommended to treat co-infections with Neisseria gonorrhoeae (NG: ceftriaxone or kanamycin) and Chlamydia trachomatis (CT: doxycycline or azithromycin) and, unless a person with GUD is simultaneously diagnosed with genital discharge syndromes (GDS), NG and CT co-infections will not be treated according to guidelines. Methods In an ongoing study, we enrolled men and women with GDS or GUD syndromes in 6 clinics with high STI prevalence in Zimbabwe. In addition to testing ulcer secretions for TP, HD, and HSV by multiplex polymerase chain reaction (National Institute of Communicable Diseases, Johanneburg), all patients had urine (males) or vaginal swabs (females) tested for NG and CT by nucleic acid amplification (GeneXpert ® ). Results To date, 302 patients have been enrolled for whom testing is complete, including 106 GUD and 196 GDS patients. NG and/or CT infections were present in 19/52 (36.5%) female GUD patients and 13/54 (24.1%) male GUD patients, compared to 26/96 (27.1%) female GDS patients and 68/100 (68.0%) male GDS patients. Of 32 GUD patients infected with NG (N = 24) and/or CT (N = 17), including 9 dual infections, only 4/18 (22%) of women and 4/14 (29%) of men met objective criteria for simultaneous GDS syndromic management. Conclusion In our study, urethral or vaginal GC and/or CT infections were present in 30% of patients with GUD, of whom three quarters would not have been treated according to recommended syndromic treatment guidelines for sexually transmitted infections. Our study methods and findings should be relevant for Zimbabwe and other countries that are using a syndromic approach to STI control.

Distribution of schistosomiasis and soil transmitted helminthiasis in Zimbabwe: towards a national plan of action for control and elimination.

BackgroundSchistosomiasis and STH are among the list of neglected tropical diseases considered for control by the WHO. Although both diseases are endemic in Zimbabwe, no nationwide control interventions have been implemented. For this reason in 2009 the Zimbabwe Ministry of Health and Child Care included the two diseases in the 2009–2013 National Health Strategy highlighting the importance of understanding the distribution and burden of the diseases as a prerequisite for elimination interventions. It is against this background that a national survey was conducted.MethodologyA countrywide cross-sectional survey was carried out in 280 primary schools in 68 districts between September 2010 and August 2011. Schistosoma haematobium was diagnosed using the urine filtration technique. Schistosoma mansoni and STH (hookworms, Trichuris trichiura, Ascaris lumbricoides) were diagnosed using both the Kato Katz and formol ether concentration techniques.Main findingsSchistosomiasis was more prevalent country-wide (22.7%) than STH (5.5%). The prevalence of S. haematobium was 18.0% while that of S. mansoni was 7.2%. Hookworms were the most common STH with a prevalence of 3.2% followed by A. lumbricoides and T. trichiura with prevalence of 2.5% and 0.1%, respectively. The prevalence of heavy infection intensity as defined by WHO for any schistosome species was 5.8% (range 0%–18.3% in districts). Only light to moderate infection intensities were observed for STH species. The distribution of schistosomiasis and STH varied significantly between provinces, districts and schools (p<0.001). Overall, the prevalence of co-infection with schistosomiasis and STH was 1.5%. The actual co-endemicity of schistosomiasis and STH was observed in 43 (63.2%) of the 68 districts screened.Conclusion and recommendationsThis study provided comprehensive baseline data on the distribution of schistosomiasis and STH that formed the basis for initiating a national control and elimination programme for these two neglected tropical diseases in Zimbabwe.