Trends for Tuberculosis Treatment Outcomes, New Sputum Smear Positive Patients in Kwekwe District, Zimbabwe, 2007-2011: A Cohort Analysis

Introduction: Tuberculosis remains a public health problem in Zimbabwe. Understanding the treatment outcomes is an important proxy indicator on the performance of the tuberculosis program. This study analyzed treatment outcomes of new sputum smear positive tuberculosis patients in Kwekwe district. Materials and Methods: A retrospective records review of new sputum smear positive tuberculosis patients registered in the district tuberculosis register in Kwekwe was conducted. Treatment outcomes were categorized according to the national tuberculosis control program and multivariate logistic regression model was used. P values less than 0.05 were considered statistically significant. Results: From a total of 1115 new sputum smear positive tuberculosis patients, cure rate ranged from 40.8% to 62.8% and death rate of patients decreased from 11 (8.0%) in 2007 to 17 (5.3%) in 2011 (p = 0.016). However, defaulter rate increased from 10 (7.3%) in 2007 to 30 (9.3%) in 2011. In multivariate logistic model, HIV positive tuberculosis patients were more likely to experience (adjusted RR = 1.84, 95% CI: 1.10 - 3.08) unfavorable treatment outcome when compared to negative counterparts. Urban residents were also at risk 1.91 (95% CI: 1.14 - 3.20) unfavorable outcome compared to rural residents. Conclusion: The cure rate was low (ranged from 40.8% to 62.8%) and the defaulter rate needed urgent attention. The district should conduct defaulter tracing and follow up.

Evaluation of Notifiable Disease Surveillance System in Centenary District, Zimbabwe, 2016

Background: Notifiable disease surveillance system (NDSS) data guides immediate action for events of public health importance. In July 2016, 12 patients suspected of typhoid were reported to Centenary District Medical Officer by phone. Following reporting, notification forms (T1) were not submitted to district, hence province did not receive district consolidated report (T2) for the notifications. This implies underreporting of notifiable diseases. Study was conducted to evaluate NDSS in Centenary district. Methods: Using updated Centres for Disease Control and Prevention (CDC) guidelines, descriptive cross sectional study was conducted among health workers sampled from all health facilities in Centenary district. Interviewer administered questionnaire and checklists were used to collect data, assess data quality and resource availability. Epi InfoTM 7 generated frequencies and proportions. Results: We interviewed 50 respondents from 13 health facilities and 64% were females. Health worker knowledge was rated low, 26% knew whom to notify and 40% knew forms are completed in triplicate. Reasons for failure to notify notifiable diseases included, unavailability of reporting forms 32% and lack of reporting guidelines 16%. Ninety-two percent were willing to participate. Four health facilities had at least six standard case definitions. The first two patients were only diagnosed at district level. NDSS information was used to procure antirabies vaccine and implement control measures. Conclusion: NDSS is useful, acceptable, unstable and not sensitive. Failure to notify was mainly due to lack of knowledge on NDSS. We recommend training of health workers and mentoring. Fifteen (IEC) case definitions and reporting guidelines were distributed to five health facilities.

Sexually Transmitted Illnesses in Masvingo Province, 2012-2015: A Secondary Data Analysis

Background: Masvingo province is among the top three provinces with high Genital Ulcer Disease incidence rates in Zimbabwe. There has been no documented evidence to establish the burden and epidemiology of STIs in Masvingo province. We analysed these data to describe trends in STIs from 2012 - 2015. Methods: A retrospective records review of Masvingo STI data set was conducted. We assessed trends in STIs from 2012-2015. Microsoft Excel 2010 software was used to generate bar and linear graphs. Epi info 7TM was used to calculate Chi-square for trends and p values. Results: Most affected age group was 25 - 49 years (incidence rate of 73.9 cases per 1000). The 50 and above age group had a higher incidence rate than the 10 - 24 year age group (27.5 compared to 15.5 cases per 1000). STI incidence was higher in females (31.9 cases per 1000) than in males (20.6 cases per 1000). The most prevalent STIs were vaginal discharge 48,972 (30.7%) and other forms of STIs 35,777 (22.3%). Masvingo district recorded the highest STI incidence rate (34.1 cases per 1000). There was a decline in HIV testing rates from 36 (100%) to 12,190 (64.4%) (p Conclusion: There was a general decline in the STI trends for all age groups. Age group most affected by STIs was the 25 - 49 years with females being more affected. HIV testing services among STI clients declined. We recommend advocacy on safe sexual practices and further research to identify reasons for low uptake of HIV testing services among STI clients.

Evaluation of the Notifiable Diseases Surveillance System in Beitbridge District, Zimbabwe 2015

Back ground: Notifiable Disease Surveillance system serves as an early warning system for public health emergencies. Since January 2013 to August 2014, Beitbridge never submitted T2 forms to the province. Four suspected cases of rabies were reported through the generic report. The electronic District Health Information System 2, T2 forms had not been updated. This discrepancy may imply under reporting of Notifiable Diseases. The study was conducted to evaluate the NDSS in Beitbridge district. Methods: Descriptive cross-sectional study was conducted. Health workers in sampled health facilities were interviewed using questionnaires. Checklists were used to assess resource availability. Epi InfoTM was used to calculate frequencies and proportions. Results: From 11 facilities, 53 respondents were interviewed of which the 59% were females. For Knowledge, 57% recalled at least 9 Notifiable diseases, 11% knew the T1 form required to notify. Respondents willing to participate in the NDSS were 87%. Responsibility to notify was placed other health workers other than themselves by 55% of the respondents. All facilities did not have completed T1 forms. T1 forms were available in 1/11 health facilities. Three outbreaks were reported using the Weekly Disease Surveillance System (WDSS). NDSS information was used for planning and mobilizing resources for indoor residual spraying. It costs an average $12.15 to notify a single case, against $1.50 if it was electronic. Conclusion: NDSS is acceptable, simple, flexible, unstable, not sensitive and useful. Reasons for under reporting were lack of forms, lack of induction and poor knowledge on the NDSS. The cost of operating the NDSS could be reduced if the system is electronic. T1 forms and guidelines for completing the forms should be distributed to all health facilities. On the job training of health workers through tutorials, supervision is recommended.

Evaluation of the HIV Case-Based Surveillance System: A Pilot of the Electronic Health Record System in Mutare District, Zimbabwe, 2021

Background: Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. Methods: We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. Results: The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). Conclusion: The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.

Varicella Outbreak at a Boarding School, Chikomba District, Mashonaland East Province, Zimbabwe, 2019

Background: Varicella is a contagious illness, caused by varicella zoster virus (VZV). It is transmitted via the respiratory route and through contact with the infected person. Fourteen cases of varicella from a boarding school in Chikomba District, Zimbabwe were reported on 14 February 2019. We investigated the outbreak to determine its scope, identify risk factors for transmission and recommend evidence-based control measures. Methods: A 1:2 unmatched case-control study was conducted. A case was a form one student at a boarding school in Chikomba District who developed acute onset of diffuse maculopapulovesicular rash without other apparent cause from 22 January 2019 to 24 February 2019. A control was a form one student at the same boarding school who did not develop the signs and symptoms of varicella during the same period. The diagnosis was based on clinical signs and symptoms. An interviewer-administered questionnaire was used to collect data. Epi info 7TM was used to calculate frequencies, odds ratios and perform logistic regression to control for confounding variables. Results: We recruited 31 cases and 62 controls. Independent risk factors for contracting varicella were classmate contact [AOR 24;(95% CI 4.4 - 83), p Conclusion: A perfect setting for the spread of infection was available in the form of students in a naive community living in close proximity both at class and at dormitories, which lead to the rapid transmission of the virus. Screening and isolation of the infected students controlled the outbreak.