High-density Suburbs Of Harare Research Articles

Implementation of an outbreak response vaccination campaign with typhoid conjugate vaccine – Harare, Zimbabwe, 2019

IntroductionTyphoid fever is a public-health problem in Harare, the capital city of Zimbabwe, with seasonal outbreaks occurring annually since 2010. In 2019, the Ministry of Health and Child Care (MOHCC) organized the first typhoid conjugate vaccination campaign in Africa in response to a recurring typhoid outbreak in a large urban setting. MethodAs part of a larger public health response to a typhoid fever outbreak in Harare, Gavi approved in September 2018 a MOHCC request for 340,000 doses of recently prequalified Typbar-TCV to implement a mass vaccination campaign. To select areas for the campaign, typhoid fever surveillance data from January 2016 until June 2018 was reviewed. We collected and analyzed information from the MOHCC and its partners to describe the vaccination campaign planning, implementation, feasibility, administrative coverage and financial costs. ResultsThe campaign was conducted in nine high-density suburbs of Harare over eight days in February–March 2019 and targeted all children aged 6 months–15 years; however, the target age range was extended up to 45 years in one suburb due to the past high attack rate among adults. A total of 318,698 people were vaccinated, resulting in overall administrative coverage of 85.4 percent. More than 750 community volunteers and personnel from the MOHCC and the Ministry of Education were trained and involved in social mobilization and vaccination activities. The MOHCC used a combination of vaccination strategies (i.e., fixed and mobile immunization sites, a creche and school-based strategy, and door-to-door activities). Financial costs were estimated at US$ 2.39 per dose, including the vaccine and vaccination supplies (US$ 0.79 operational costs per dose excluding vaccine and vaccination supplies). ConclusionA mass targeted campaign in densely populated urban areas in Harare, using the recently prequalified typhoid conjugate vaccine, was feasible and achieved a high overall coverage in a short period of time.

Fish from a polluted lake (Lake Chivero, Zimbabwe): a food safety issue of concern

Abstract Objectives A study to determine food safety hazard status of fish products from Lake Chivero was conducted in selected high density suburbs of Harare. Lake water and fish were tested for E. coli O157:H7, total bacterial, fungal counts, mercury (Hg) and aflatoxin B1 (AFB1) to determine contamination levels and assessing human health hazard exposure. Materials and Methods Membrane filtration method was used to determine E. coli O157:H7 viable counts using CHROM agar. Plate count and Potato dextrose agar were used for determination of total viable bacterial and fungal counts. Concentrations of Hg and AFB1 in fish and water were determined by Atomic Absorption Spectrophotometer and High Performance Liquid Chromatography-Mass Spectrometry. A questionnaire survey was conducted on 136 adult fish consumers to determine the fish consumption patterns to assess hazard exposure against international standards. Results Significant levels of microbial contamination above international standards in both fish and water were recorded. Mean E. coli O157:H7 counts were 106 ± 10 (cfu/cm2) in fish and 52 ± 14 (cfu/100ml) in water. Mean Log10 TBC were 8.98 ± 0.26 (cfu/cm2) in fish and 9.05 ± 0.05 (cfu/ml) in water. Mean Log10 TFC were 4.83 ± 0.02 (cfu/cm2) in fish and 4.56 ± 0.03 (cfu/ml) in water. Hg and AFB1 were 0.018 (µg/kg) and 0.025 (µg/kg) in fish and 0.008 (µg/kg) and 0.005 (µg/kg) in water, both with a hazard quotient (HQ) <1 using CODEX STAN 193-1995 of 2015. Conclusion Fish and water are contaminated with E. coli O157:H7, contain bacterial and fungal loads above international food safety guidance levels. Fish were caught already contaminated with pathogens together with toxigenic Hg and carcinogenic AFB1 although their concentration levels are within international food safety toxicological levels. Levels of Hg and AFB1 in water were almost double that of fish, implying bio-accumulation occurred in fish. Thus, fish consumers are exposed to food safety hazards and are at risk of contracting foodborne illnesses from consuming contaminated fish.

Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe.

Consistent domestic hand hygiene can reduce diarrhea-related morbidity and mortality and the spread of other communicable diseases. However, it remains uncertain which technique of handwashing is most effective and practicable during everyday life. The goal of this study is to determine how the handwashing technique, as performed in the daily life by the participants of this case study in Harare, Zimbabwe, influences microbial handwashing effectiveness. Handwashing technique of 173 primary caregivers was observed in their homes and hand rinse samples were collected before and after handwashing. Samples were analyzed for Escherichia coli and total coliform concentrations. Generalized linear models were used to predict fecal hand contamination after washing from observed handwashing technique. Cleaning under fingernails, scrubbing the fingertips, using soap, and drying hands through rubbing on clothes or a clean towel statistically significantly reduced E coli contamination of hands after washing. Tap use, scrubbing fingertips, and rubbing hands on clothes to dry them statistically significantly reduced total coliform contamination. Recommendations for effective and practicable domestic handwashing in Harare, Zimbabwe, should include performing specific handscrubbing steps (ie, cleaning under the fingernails and rubbing the fingertips), and soap and tap use. This calls for further research to develop behavior change interventions that explicitly promote effective handwashing technique at critical times.

Xpert(®) MTB/RIF detection of rifampin resistance and time to treatment initiation in Harare, Zimbabwe.

Patients at elevated risk of drug-resistant tuberculosis (TB) are prioritized for Xpert(®) MTB/RIF testing; however, the clinical usefulness of the test in this population is understudied. From November 2011 to June 2014, consecutive out-patients with a history of previous TB in high-density suburbs of Harare, Zimbabwe, were tested using Xpert, solid and liquid culture, and the microscopic observation drug susceptibility assay. Diagnostic accuracy for rifampin (RMP) resistance and time to initiation of second-line regimens were ascertained. The rpoB gene was sequenced in cases with culture-confirmed RMP resistance and genotypic susceptibility. Among 352 retreatment patients, 71 (20%) were RMP-resistant, 98 (28%) RMP-susceptible, 64 (18%) culture-negative/Xpert-positive, and 119 (34%) culture-negative/Xpert-negative. Xpert had a sensitivity of 86% (95%CI 75-93) and a specificity of 98% (95%CI 92-100) for RMP-resistant TB. The positive predictive value of Xpert-determined RMP resistance for multidrug-resistant TB (MDR-TB) was 82% (95%CI 70-91). Of 71 (83%) participants, 59 initiated treatment with second-line drugs, with a median time to treatment initiation of 18 days (IQR 10-44). The diagnostic accuracy of Xpert for RMP resistance is high, although the predictive value for MDR-TB was lower than anticipated. Xpert allows for faster initiation of second-line treatment than culture-based drug susceptibility testing under programmatic conditions.

Understanding urban poverty in two high-density suburbs of Harare, Zimbabwe

ABSTRACTUrban communities are heterogeneous and averages mask inequities and deprivations among poor and rich urban communities. This article examines the situation of households residing in two low-income, high-density suburbs of Harare, Zimbabwe. The aim of the research was to contextualise urban poverty by looking at selected urban communities and vertically analysing the patterns and determinants of poverty. A household survey was administered to 1000 households and qualitative data were collected through focus group discussions and key informant interviews. The study found high levels of income poverty and also found differences in poverty experiences between the two suburbs. The major proximate determinants of poverty were large family size; low education level of the household head; lack of income from permanent employment; low cash transfers; and short length of residence in the suburb. Increasing household income consumption can be addressed through scaling-up industries, which would result in more quality employment.

Operations of Street Food Vendors and Their Impact on Sustainable Urban Life in High Density Suburbs of Harare, in Zimbabwe

The study sought to investigate the nature and operations of street food vendors including socio-economic features influencing street food vending spatial distribution and its impact on the local environment and urban life within the context of sustainable development. Data were collected through field notes, in-depth personal interviews, direct observations and documentary reviews so as to triangulate the evidence. Sixty semi-structured questionnaires were administered to collect socio-economic and technical data pertaining to street food vending. The study showed that street food vending, far from being a hindrance to progress and sustainable development, is in fact the basis of an alternative street economy which is people friendly and with the necessary institutional and infrastructural support could be both environmental-sensitive and energy conscious. Although street food vending is illegal, it significantly helped to reduce unemployment, increased incomes of vendors and provided urban dwellers with inexpensive and varied indigenous meals. The government should recognise street food industry through legislation and introduction of a code of practice for street food vendors. This would require city council to construct decent shelters and provide essential public utilities such as potable water, electricity and public toilets. What is needed to advance the position of street food vendors is to strengthen their capacities and skills through training, credit, information and infrastructure so as to enhance their competitiveness and productivity. There is need for further research to describe the nature of street vending and quantify the consumption of street foods in Zimbabwe and their economic benefits as well as ways to improve the standards of street food.

Knowledge and attitudes of teachers towards epilepsy in Zimbabwe.

As a preliminary to designing a health education programme on epilepsy for teachers in Zimbabwe, we evaluated the knowledge and attitudes to epilepsy of teachers in Epworth, a poor, high density suburb of Harare, Zimbabwe. All teachers in Epworth were invited to awareness workshops on epilepsy. A questionnaire on knowledge and attitude of epilepsy was distributed to all consenting participants. 165 teachers (Male:Female 1:1.9) responded. Of the respondents 89% had heard or read about epilepsy, while 70.6% had observed an epileptic seizure. Epilepsy was considered hereditary by 34.6%, while 12.6% thought it was a form of insanity. Only 0.6% thought evil spirits were a cause, 22.6% thought that epilepsy was contagious, 82% would allow their child to play with an epileptic child, 76% would marry an epileptic while 55.7% would employ an epileptic. The majority would accommodate an epileptic and teach an epileptic child in class. These positive attitudes towards epilepsy by teachers may be attributed to their higher level of education and may imply that with increasing levels of formal education in the general African population, a more tolerant attitude towards epilepsy can be expected.

From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe

Despite the 15 million children orphaned by AIDS, and fears of sexual vulnerability, little is known about the link between orphanhood and HIV risk. A random sample of 1283 15 to 19-year-old girls in a high-density suburb of Harare was identified in a cross-sectional survey in 2004. A total of 863 agreed to be interviewed and 839 provided a specimen for HIV and herpes simplex virus type-2 (HSV-2) testing. Sexual health outcomes, sexual behaviours and marriage were assessed by type and timing of orphanhood. Half of the participants were single or double orphans. Prevalence of HIV and/or HSV-2 was higher among orphans than non-orphans [17 versus 12%; age-adjusted odds ratio (aOR) = 1.5; 95% confidence interval (CI) 1.0-2.3]. Associations with orphan status were only significant among the 743 never-married participants. In comparison with non-orphaned peers, increased sexual risk (defined as HSV2-positive, HIV-positive or ever pregnant) was seen among maternal orphans (aOR = 3.6; 95% CI, 1.7-7.8), double orphans (aOR = 2.4; 95% CI, 1.2-4.9), and girls who lost their father before age 12 (aOR = 2.1; 95% CI, 0.9-4.8) but not later (aOR = 0.8; 95% CI, 0.3-2.2). Maternal and double orphans were most likely to initiate sex early and to have had multiple partners. Maternal orphans were least likely to have used a condom at first sex, and to have a regular sexual partner. Experience of forced sex was high in all groups. In urban Zimbabwe, female adolescent orphans are at increased risk of HIV and HSV-2 infection. Infection rates vary by type and age of orphanhood, and marital status, and are associated with high-risk sexual behaviours.

Oral interaction and the guided construction of knowledge

This article is grounded in the domain of educational linguistics and focuses on oraldiscourse. Three research questions are addressed: 1. What patterns of interaction currently prevail in the high school classroom? 2. What interaction changes take place in the talk used by teachers and the learner output after raising teacher language awareness? 3. Does negotiation of learning lead to quality output modifications? The aim is to establish current oracy practices in the classroom, and to consider how best to improve practice so as to achieve learning goals at three levels, namely negotiation of meaning, form and content. The study involved investigation of oracy practices by teachers during first year of high school in a high-density suburb of Harare, Zimbabwe. Nine teachers were sampled for the experiment. Of these, six were taken through a programme aimed at developing teacher metalinguistic awareness, while the other three served as the control group. The principal research methodology was audio-taping of lessons, which were later transcribed for analysis. This was carried out, for both groups, at two stages, that is, before intervention and after, and results compared. Results showed that teachers whose language awareness had been raised, used discourse input more effectively than those not exposed. Similarly, learners whose teachers had enhanced language awareness showed evidence of improved ability to negotiate learning better than counterparts. This led to the conclusion that classroom praxis benefits from a conscious enhancement of oracy, since it leads to effective learning. A key recommendation thus evolved, namely, that developing knowledge about oral interaction improves learning results. Such knowledge is beneficial for teacher education.

An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe

In order to design an effective training program for nurses on the management of epilepsy in Zimbabwe, the drug management of epilepsy by community health nurses without prior training in epilepsy management was evaluated. Epilepsy patients in Chitungwiza, a high-density suburb of Harare, were routinely managed at four health clinics run by nurses. The patients also attended a monthly epilepsy support group (ESG) program, which provided them with vocational and social rehabilitative support. Neurologists evaluated the drug therapy of all patients attending this support group program over a 2-year period. The specialist interventions required to drug therapy in patients with inadequate seizure control or drug side effects were noted. A total of 114 epilepsy patients (age range 8–56 years, M:F=1:1.2) were seen, of these 84.2% had generalized seizures, 40.3% of patients had been seizure-free for at least 6 months, 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to on-going drug therapy in 43% of patient consultations. The most important intervention in patients with inadequate seizure control was an increase in drug dose, required in 29% of consultations. Of serum drug level estimations in clinically indicated cases, 58% were below the therapeutic ranges. This tendency to sub-therapeutic dosing with AED amongst nurses implied that a written AED drug therapy protocol specifying optimal maintenance doses and dose increment schedules may be beneficial to the community-based nursing management of epilepsy.

Use of traditional and orthodox health services in urban Zimbabwe.

Health care in Zimbabwe is provided by both orthodox and traditional care providers. With formal medical services under economic strain it is important to understand the extent of consulting with traditional care providers and their effectiveness. A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in two high-density suburbs of Harare, Zimbabwe. Three dependent variables (illness experience, consultation behaviour and choice of care provider) were analysed against a range of sociodemographic, episode-related and outcome measures. More than one-third of the sample had experienced an illness and 83% of these had led to consultation. Medical services were consulted eight times more often than traditional ones. Non-consulting behaviour was associated with lack of money or low perceived significance of problems. Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care. While members of the community appear to recognize physical problems and take them to medical care, traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. The role of traditional medicine in relation to non-specific physical problems and psychological problems is one which deserves further examination from both clinical and administrative perspectives. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.