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

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Journal of Tuberculosis Research 2015年第4期3卷 126-135页

作者： Meggie Gabida mufuta tshimanga Milton Chemhuru Notion Gombe Donewell Bangure Department of Community Medicine University of Zimbabwe Harare Zimbabwe Provincial Medical Directorate Midlands Province Ministry of Health and Child Welfare Gweru Zimbabwe

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.

关键词： Sputum Smear Positive Treatment Outcome Tuberculosis Kwekwe Zimbabwe

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Evaluation of the Tuberculosis Case Notification System, Mhondoro-Ngezi District, Zimbabwe, 2016

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Open Journal of Epidemiology 2017年第1期7卷 1-9页

作者： Pamela Nyaradzai Magande Daniel Chirundu More Mungati Donewell Bangure Notion Tafara Gombe mufuta tshimanga Department of Community Medicine University of Zimbabwe Harare Zimbabwe Kadoma City Health Department Kadoma City Zimbabwe

Background: Zimbabwe was 17th among 22 tuberculosis (TB) high burdened countries. In Zimbabwe, the TB case notification system tracks data on case detection and treatment. Mhondoro-Ngezi district was reporting less than half provincial case average of 251 cases per 100,000 population per year. Data were always two weeks late. We evaluated the surveillance system and determined reasons for low notification. Methods: A descriptive cross sectional study was conducted using the updated CDC guidelines. Structured questionnaires, notification registers and forms were used to collect data. Epi Info 7 was used to calculate means and frequencies. Results: All 17 facilities providing TB services were selected. Only two of these were diagnostic centres. Of the 41 health workers, 32 (78%) were nurses. All facilities were notifying and 38 (93%) of health workers had notified cases. Notification forms were available at all facilities and were transported to the district office by government vehicles once completed. Ten minutes on average were needed to complete a form and this was easy for 89% health workers. Data were being analysed at facilities by 83% of health workers and 71% took action after analysis. Feedback from district level was being received by 85% of health workers. The reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. Conclusions: The TB case notification system was acceptable, simple, representative and useful. Reasons for low notification included: few diagnostic centres, passive case detection and poor community involvement. As a result of this evaluation, a third diagnostic centre is being set up.

关键词： Tuberculosis Surveillance Mhondoro-Ngezi Zimbabwe

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Prevalence and Factors Associated with Hypertension among Anti-Retroviral Therapy Patients Aged 15 Years and above in Makonde District, Zimbabwe, 2012: An Analytic Cross Sectional Study

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World Journal of Cardiovascular Diseases 2015年第9期5卷 266-277页

作者： Blessing Ruwimbo Mutede Tapiwa Magure Notion Tafara Gombe Donewell Bangure mufuta tshimanga More Mungati Department of Community Medicine University of Zimbabwe Harare Zimbabwe National AIDS Council Zimbabwe Harare Zimbabwe

Background: Anti-retroviral therapy (ART) has reduced morbidity and mortality among HIV-infected individuals over the last years. The increase in survival of HIV patients has contributed to the emergence of other chronic conditions in these individuals, such as hypertension, renal, and cardiovascular disease. Hypertension and HIV infection are both mostly asymptomatic but can lead to fatal and disabling illness. Hypertension among HIV-infected individuals, although not completely elucidated, may be explained by the aging of population, the effect of HIV on vascular tone anti-retroviral therapy and traditional risk factors such as weight gain, smoking, dyslipidemia, and drug abuse. The factors associated with hypertension among ART patients in a predominantly rural setting were studied in this paper. Methods: We conducted an analytical cross sectional study at 13 health facilities in Makonde District a rural district in Mashonaland West Province of Zimbabwe where we systematically selected 393 of 400 ART patients aged 15 years and above. Structured interviewer administered questionnaires were used to collect data on demographic characteristics. Written and informed consent was sought and obtained from all study participants. We obtained parental consent followed by assent from participants younger than 16 years. All enrolled patients had physical measurements done. Chi square test and stratified & logistic regression analysis were done using Epi info version 3.5.1. All calculations were done at 95% confidence interval. Results: Results from 393 participants were analysed. The prevalence and awareness of hypertension were 34.9% and 30% respectively. Only 9.6% were taking medication. Independent risk factors were duration of ART > 2 years (POR 2.23;95%CI: 1.08;4.61), waist to hip ratio (women) > 0.85 (POR 3.45;95%CI: 1.60;5.88), B.M.I > 25 (POR 2.18;95%CI: 1.40;3.8). Protective factors were: Symptomatic HIV disease (POR 0.36;95%CI: 0.14;0.97) and being informally emplo

关键词： ART Patients Prevalence Hypertension Makonde Zimbabwe

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An Evaluation of Prevention of the Mother-to-Child Transmission Program in Murewa District, 2021

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Open Journal of Epidemiology 2022年第3期12卷 300-316页

作者： Hellen Kabaya Bernard Madzima Addmore Chadambuka Mujinga Karakadzai Tsitsi Juru Notion Gombe mufuta tshimanga Department of Primary Health Care Sciences: Family Medicine University of Zimbabwe Global and Public Health Unit Zimbabwe Field Epidemiology Training Program Harare Zimbabwe National AIDS Council of Zimbabwe Harare Zimbabwe Africa Field Epidemiology Network Harare Zimbabwe

Background: Prevention of mother-to-child transmission (PMTCT) program includes a cascade of services given to prevent mother-to-child transmission (MTCT) of HIV in-utero, during delivery and during breastfeeding. Zimbabwe has made tremendous progress in increasing coverage of PMTCT services and reducing MTCT rate. COVID-19 has negatively impacted HIV programs. Murewa was among the districts with the most COVID-19 cases. We evaluated the PMTCT program in Murewa District in the face of COVID-19 challenges. Methods: We assessed inputs, processes, outputs and outcomes of the PMTCT program using the logic model approach. We collected data using interviewer-administered questionnaire, records review, and a checklist to assess availability of inputs, processes carried out and outputs realized from the program. We randomly selected health workers and program recipients. We used Epi info 7 to compute frequencies, means and proportions. Results: Murewa District had 58 health workers in post against an establishment of 92. Seven out of 16 facilities reported having HIV test-kit stockout. Only 4/16 were conducting postnatal clinics. No PMTCT training were conducted. Only 1872/5693 (33%) of HIV consumables including HIV test kits and CD4 count reagents were procured. The reasons reported for low PMTCT coverage in Murewa were fear of contracting COVID-19 at health facilities 33/43 (77%), lack of bus fare 28/43 (65%) and unavailability of medical consumables 26/43 (60%). Conclusion: The PMTCT program in Murewa District failed to meet targets for inputs, processes, and outputs worsened by the impact of the COVID-19 pandemic. The reasons for low PMTCT coverage in Murewa District were reported to be due to fear of contracting COVID-19, unavailability of medical consumables and COVID-19 travelling restrictions. We recommended development of guidelines on provision of PMTCT services amid the COVID-19 pandemic. We gave health education to program recipients on the importance to access

关键词： COVID-19 PMTCT Program Murewa District

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A Comparative Evaluation of the Voluntary Medical Male Circumcision Program for Seke and Goromonzi Districts, Mashonaland East Province, Zimbabwe, 2017

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Open Journal of Preventive Medicine 2017年第7期7卷 138-150页

作者： Hamufare Mugauri Owen Mugurungi Gerald Shambira Tsitsi Juru Notion Tafara Gombe mufuta tshimanga Department of Community Medicine University of Zimbabwe Harare Zimbabwe Ministry of Health and Child Care Harare Zimbabwe

Background: In 2009, Zimbabwe incorporated Voluntary Medical Male Circumcision (VMMC) to a consortium of measures to eliminate HIV transmission by 2030. Seke and Goromonzi districts simultaneously commenced implementing VMMC. These districts have comparable population, geography, and support yet scored varied performances. Cumulatively, (2009-2016) Seke achieved 83% while Goromonzi achieved 15% of set circumcision targets. We compared the performance of the VMMC program in the 2 districts. Methodology: A process evaluation was conducted modelled on a logical framework. Interviewer-administered questionnaires and checklists were used to collect data. Epi info7 was used to generate frequencies and proportions. Results: Three health facilities in Seke and four in Goromonzi were implementing VMMC. Material resources were maintained at three months buffer stock and human resources equitably distributed between the two districts. Additional support (three nurses), from the national army, was received by Seke, and management provided vehicle support for program activities. Goromonzi conducted half of the targeted mobilisations (6/12) and Seke 12/12. Similar amounts of financial support were simultaneously disbursed. Seke circumcised 99.5% (4716) and Goromonzi 48.5% (2372) of annual targets. Adverse reactions were 0.04% (2) for Seke and 2.3% (55) for Goromonzi for same period with no review meetings conducted. Seke participants attributed performance to effective demand creation (22;100%), effective coordination (20;90.9%) and management support (21;95.5%). Goromonzi participants cited delayed payments (20;90.9%), lack of active leadership involvement in planning and execution (14;63.6%) and weak mobilisations (11;50%) to have worked against the program. Conclusion: Effective demand creation and coordination, manpower boost and leadership support enhanced VMMC program performance for Seke and was therefore recommended for Goromonzi. Resource availability did not translate t

关键词： Male Circumcision Adverse Events Comparative Program Evaluation

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

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Open Journal of Epidemiology 2021年第4期11卷 483-500页

作者： Kudzai Patience Takarinda Simon Nyadundu Emmanuel Govha Notion Tafara Gombe Tsitsi Juru tshimanga mufuta Department of Primary Health Care Sciences Global and Public Health Unit University of Zimbabwe Harare Zimbabwe Zimbabwe Ministry of Health and Child Care Provincial Medical Directorate Mutare Zimbabwe African Field Epidemiology Network Harare Zimbabwe

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%). Conclu

关键词： HIV Case-Based Surveillance Recency Testing Electronic Health Record System Mutare Zimbabwe

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Trend Analysis of HIV Testing Services in Zimbabwe, 2007-2016: A Secondary Dataset Analysis

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Open Journal of Epidemiology 2017年第3期7卷 285-297页

作者： Sithabiso Dube Tsitsi Juru T. Magure Gerald Shambira Notion Tafara Gombe mufuta tshimanga Department of Community Medicine University of Zimbabwe Harare Zimbabwe National AIDS Council Harare Zimbabwe

Background: HIV Testing Services (HTS) is a full range of services (e.g. counselling and post-test referrals) that are offered together with HIV testing. It is an important prevention strategy and the gateway to treatment. The national targets in 2016 were to test 1.1 million people of which 54% was achieved. We determined trends of HTS in Zimbabwe from 2007 to 2016. Methods: A secondary dataset analysis was conducted using National Aids Council Core-Output Indicators dataset. Variables captured include total and repeat tests, counselling and referrals. Microsoft excel and Epi Info was used to generate frequencies, percentages and conduct chi square test for trends. Panda-Class Libraries was to attain estimates of HTS uptake till 2020. We used χ2 and p-values for statistical significance. Results: All (10,847.223) records were analysed. HIV tests per year increased from 340,705 in 2007, to 1,974,795 in 2015 (χ2 0.10492, p-value 0.74615). In 2007, 31% (n = 106,884) clients tested positive whilst in 2016 only 7% (n = 121,196) were positive (χ2 0.01166, p-value 0.91402). The 25 - 49 year age-group tested consistently highest throughout the 10year period (χ2 0.0558 p-value 0.813). The 15 - 24 year age-group had the highest yield (11% in 2015). Females (χ2 0.1074, p-value 0.743) consistently tested higher than males (χ2 0.0614, p-value 0.804). From 2007 to 2013 women had higher yields but by September 2016 males had a higher positivity of 8% (p-value χ2 0.658 p-value = 0.417). We estimate that 179,935 people living with HIV will know their status by 2020. Conclusion: HIV tests in Zimbabwe have increased but yield has decreased. Increase in repeat tests may be an indication of exhaustion of particular HTS strategies. Following this analysis it was recommended that HTS utilize various models such as HIV self-test to cater for populations with high yields.

关键词： HIV Testing Services Secondary Dataset

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Evaluation of Perinatal Mortality Surveillance System in the City of Bulawayo, Zimbabwe

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Open Journal of Epidemiology 2021年第2期11卷 124-134页

作者： Munekayi Padingani Gladys Marape Zanele Hwalima Lucia Takundwa Notion Gombe Gerald Shambira Tsitsi Juru mufuta tshimanga Department of Community Medicine University of Zimbabwe Harare Zimbabwe City Health Department Bulawayo City Councils Bulawayo Zimbabwe African Field Epidemiology Network Kampala Uganda

Background: In Zimbabwe, the perinatal mortality surveillance system is based on passive reporting of perinatal deaths using the perinatal death notification forms. Mpilo hospital recorded 74 perinatal deaths from January to September. No death was reported to the city and no perinatal mortality forms were found at the health information section. We aimed to assess the performance of perinatal mortality surveillance system in Bulawayo city. Methods: We conducted a descriptive cross-sectional study in all the maternity centres in Bulawayo City in 2011 using Centers for Disease Control and Prevention guidelines for evaluating public health surveillance systems. We used interviewer-administrated questionnaires to collect data. We used a checklist to assess availability of resources. Perinatal death notification forms were reviewed. Results: We interviewed 67 workers. Knowledge on the system was poor. Eight (12%) were trained in IDSR (Integrated Disease Surveillance Response) and three (4.5%) were inducted on the perinatal mortality surveillance system. Sixty-one (91%) regarded the system as useful. City and private maternity centres were not notifying perinatal deaths due to lack of forms. In central hospitals, delay in notification was due to workload and shortage of trained staff. Conclusion: Poor knowledge on the system, lack of induction and trained staff could have contributed to the non-performance of the system in the City of Bulawayo. Most participants reported the system as useful. Lack of documentation made it difficult to follow up on actions plans.

关键词： Evaluation Perinatal Mortality Surveillance System Maternity Centres Bulawayo City Zimbabwe

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Understanding Health Worker Perspectives on Risk Screening for HIV Testing—A Qualitative Study from Zimbabwe

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Open Journal of Preventive Medicine 2022年第10期12卷 199-212页

作者： Hamufare D. Mugauri Joconiah Chirenda Kudakwashe Takarinda Owen Mugurungi Ishmael Chikondowa Patrick Mantiziba mufuta tshimanga Department of Primary Health-Care Sciences The University of Zimbabwe Harare Zimbabwe Ministry of Health and Child Care AIDS and TB Unit Harare Zimbabwe Organisation for Public Health Interventions and Development (OPHID) Harare Zimbabwe Clinton Health Access Initiative (CHAI) Harare Zimbabwe

Background: Zimbabwe recorded a 55% increase in HIV testing from 2011 to 2018 but with decreasing HIV-testing yields from 20% to 6% respectively as we aim to identify the narrowing gap of undiagnosed people living with HIV. As such adoption of screening tools during targeted HIV testing services improves efficiency by identifying individuals who are likely to test positive. Effective utilization of screening tools requires an understanding of health care worker perception and willingness to use the tools. Methods: We conducted a qualitative study among healthcare workers at 8 selected primary healthcare facilities in Zimbabwe. Interviewer-guided, in-depth interviews were conducted with healthcare workers and their immediate supervisors. Thematic analysis was performed following a framework built around the grounded theory model to describe perspectives that influence the utilization of HIV screening tools and suggestions for improved eligibility screening. Results: Behavioural factors facilitating the utilisation of the screening tool included motivation to adhere to standard practice, awareness of screening in targeting testing, and its ability to manage workload through screening out ineligible clients. This was evident across service delivery levels. Barriers included limited healthcare capacity, confidentiality space, multiple screening tools and opaque screening in/out criteria and the potential of clients not responding to screening questions truthfully. Conclusions: Across geographical and service delivery levels, placing screening tools at HIV testing entry points, healthcare worker knowledge on screening in/out criteria emerged as enablers for correct and consistent utilization. Further, standardizing the tools and adopting a decision aid algorithm would improve the accurate utilisation of screening tools.

关键词： Screening Tool Qualitative HIV Testing Services Health Worker Perspectives Grounded Theory Framework

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Antiretroviral Therapy Discontinuation among Adults Receiving HIV Care in Kadoma City in 2015-2019

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Open Journal of Epidemiology 2022年第2期12卷 134-145页

作者： Godwell Nhidza Daniel Chirundu Tsitsi Patience Juru Emmanuel Govha Notion Gombe Addmore Chadambuka mufuta tshimanga Department of Primary Health Care Sciences Family Medicine/Global and Public Health Unit University of Zimbabwe Harare Zimbabwe Kadoma City Health Department Kadoma Zimbabwe African Field Epidemiology Network Harare Zimbabwe

Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross- sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.***.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate frequencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 (6.1%) discontinued ART, 415/2833 (14.7%) transferred out, 69/2833 (2.4%) died and 2176/2833 (76.8%) were retained on ART. Out of those who discontinued ART, sixty-five percent (112/173) were females. Approximately two-thirds had immunological failure 110/173 (64%). The trend in ART discontinuation decreased over the years but was not statistically significant (R2 = 0.57, p > 0.05). ART discontinuation was independently associated with being Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisana

关键词： ART Discontinuation Secondary Data Analysis HIV Zimbabwe

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