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

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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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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COVID-19 Vaccine Breakthrough Infections and Associated Factors in Kwekwe City, Zimbabwe, 2021

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Open Journal of Epidemiology 2022年第2期12卷 170-184页

作者： Nyashadzashe Cosmas Makova Mary Muchekeza Addmore Chadambuka Emmanuel Govha Tsitsi Patience Juru notion Tafara gombe Mufuta Tshimanga Department of Primary Health Care Sciences University of Zimbabwe Harare Zimbabwe Kwekwe City Council Department of Health Kwekwe Zimbabwe African Field Epidemiology Network Harare Zimbabwe

Background: To break the spread of COVID-19, people must adopt preven-tive health measures such as vaccination. A vaccine breakthrough infection is the detection of SARS-CoV-2 RNA or antigen in a specimen collected from a person ≥ 14 days after receipt of all recommended vaccine doses. Kwekwe City experienced an increase in breakthrough cases from one case (12 June 2021) to 39 cases (7 July 2021). The study was conducted to determine factors associated with breakthrough infections. Methods: We conducted an un-matched 1:2 case-control study. A case is defined as a patient who had two doses of a COVID-19 vaccine and had a positive SARS-CoV-2 antigen/PCR test at least two weeks after the date of receiving the second dose of the vac-cine in Kwekwe City from June 12, 2021. An interviewer-administered ques-tionnaire was used to collect data. We used the Epi Info software to generate means, frequencies, and proportions, to calculate measures of associations that include odds ratios. Results: Fifty-four cases in the records met the case definition for breakthrough infections, and two had died giving a case fatality rate of 3.7%. Fifty-one of the remaining 52 cases and 102 controls were re-cruited. Being within the age of 55 - 64 years (aOR = 12.22;95% CI (1.15 - 129.81) and being unemployed (aOR = 0.26;95% CI (0.07 - 0.93) were the independent factors associated with breakthrough infection. The median dura-tion in days between getting the second dose of the vaccine and getting tested was 57.0 (Q1 = 33;Q3 = 81) and 46 (Q1 = 33;Q3 = 64) for cases and controls respectively. There were significant differences in overall knowledge, controls had good knowledge compared to cases (p = 0.01). Conclusion: Individuals who were within the 55 - 64 years age group were more likely to have break-through infections. Those who had breakthrough infections had overall poor knowledge of COVID-19. Non-pharmacological interventions such as mask-wearing

关键词： Breakthrough Infections COVID-19 Kwekwe

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

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Open Journal of Epidemiology 2022年第4期12卷 492-504页

作者： Govha Emmanuel Nyika Howard Simukai Tirivanhu Zizhou notion Tafara gombe Addmore Chadambuka Tsitsi Patience Juru Mufuta Tshimanga Department of Community Medicine University of Zimbabwe Harare Zimbabwe AIDS and TB Unit Ministry of Health and Child Care Harare Zimbabwe Mashonaland East Provincial Medical Directorate Ministry of Health and Child Care Marondera Zimbabwe African Field Epidemiology Network Harare Zimbabwe

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.

关键词： Varicella Outbreak Risk Factors High School Chikomba

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HIV Self-Testing Kits Uptake in Mashonaland West Province, Zimbabwe, 2019-2020: A Secondary Data Analysis

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World Journal of AIDS 2022年第1期12卷 20-31页

作者： Tendai Hlabangana Owen Mugurungi Howard Nyika Emmanuel Govha Tsitsi Patience Juru notion Tafara gombe Addmore Chadambuka Mufuta Tshimanga Department of Family Medicine Global and Public Health Unit University of Zimbabwe Harare Zimbabwe AIDS and TB Unit Directorate Harare Zimbabwe African Field Epidemiology Network Harare Zimbabwe

Background: Human Immuno-Deficiency Virus Self-Testing (HIVST) is a process where an individual who wants to know their HIV status collects a specimen, performs a test and interprets the result by themselves. HIVST data from the Zimbabwe AIDS and TB Program (ATP) directorate showed that between 2019-2020, only 31% of the target HIVST kits were distributed in the country. Mashonaland West Province was one of the least performing provinces in meeting targets for HIVST kits distribution. Gaps in the implementation of the HIVST in the province ultimately affect the nationwide scaleup of targeted testing, a key enabler in achieving HIV epidemic control. We analyzed HIVST trends in Mashonaland West Province to inform HIV testing services programming. Methods: We conducted a cross-sectional study using HIVST secondary data obtained from the District Health Information Software 2 (DHIS2) electronic database. We conducted regression analysis for trends using Epi Info 7.2 and tables, bar graphs, pie charts and linear graphs were used for data presentation. Results: A total of 31,070 clients accessed HIVST kits in Mashonaland West Province from 2019-2020. A slightly higher proportion (50.4% and 51.7%) of females as compared to males accessed HIVST kits in 2019 and 2020 respectively. Overall, an increase in the trend of HIVST kits uptake was recorded (males R2 = 0.3945, p-value = 0.003 and females R2 = 0.4739, p-value = 0.001). There was generally a decline in the trend of community-based distribution of HIVST kits from the third quarter of 2019 throughout 2020 (R2 = 0.2441, p-value = 0.006). Primary distribution of HIVST kits remained the dominant method of distribution, constituting more than half of the kits distributed in both 2019 (67%) and 2020 (86%). Conclusion: Mashonaland West Province was mainly utilising facility-based distribution model for HIVST over the community-based distribution model. We recommended training more community-base

关键词： HIV Self-Testing Analysis Secondary Data

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An Evaluation of the Adverse Events Following Voluntary Medical Male Circumcision Surveillance System in Zvimba District, Zimbabwe, 2020

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World Journal of AIDS 2022年第1期12卷 1-19页

作者： Tendai Hlabangana Owen Mugurungi Emmanuel Govha Tsitsi P. Juru notion T. gombe Addmore Chadambuka Maurice Omondi Mufuta Tshimanga Department of Family Medicine Global and Public Health Unit University of Zimbabwe Harare Zimbabwe AIDS and TB Programmes Directorate Harare Zimbabwe African Field Epidemiology Network Harare Zimbabwe African Field Epidemiology Network Nairobi Kenya

Background: The Adverse Events following Voluntary Medical Male Circumcision Surveillance System (VMMC AESS) serves to identify adverse events (AEs) for safe provision of VMMC. In 2019, Zvimba District reported two adverse events out of 542 circumcisions translating to a 0.4% AE rate against an acceptable threshold of 2% and this is suggestive of underreporting. We evaluated the system to verify existence of underreporting of AEs, assess the surveillance system attributes and evaluate data quality. Methods: A descriptive cross-sectional study was conducted using the updated Center for Disease Control (CDC) guidelines for surveillance system evaluation. We proportionately sampled VMMC client intake records and purposively selected health workers involved in the VMMC programme into the study. An interviewer-administered questionnaire was used to collect data from 14 - 30 December 2020 on knowledge of the VMMC AESS among health care workers and surveillance system attributes. We used a checklist to check for data quality. Data were analysed using Epi Info 7 statistical software. Results: Of the 31 health workers that participated in the study, 21 (68%) had fair knowledge of the surveillance system. Out of 384 records reviewed, 104 had missing data on AE monitoring days 7 and 42. Sixteen (52%) of participants regarded filling AE reporting forms as difficult and the process as time-consuming. The surveillance system was not representative as only two out of eight facilities were conducting outreaches in hard-to-reach areas. Conclusion: There was possible underreporting of adverse events as about a quarter of reviewed records had missing data on AE monitoring days and the system’s performance was threatened by poor data quality and unavailability of reporting forms. The system was rendered acceptable though unstable, not representative and not simple and the health workers were not making use of the surveillance system. We recommended retraining on the surveillance system

关键词： Surveillance Adverse Events System Circumcision Evaluation

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Secondary Data Analysis of Tuberculosis Deaths in Bulawayo Province, Zimbabwe, 2016-2019

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Open Journal of Epidemiology 2022年第1期12卷 57-67页

作者： Tshebukani Mzingaye Moyo Edwin Sibanda notion Tafara gombe Tsitsi Patience Juru Emmanuel Govha Maurice Omondi Addmore Chadambuka Mufuta Tshimanga Department of Primary Health Care Sciences Global and Public Health University of Zimbabwe Harare Zimbabwe Bulawayo City Council Department of Health Bulawayo Zimbabwe African Field Epidemiology Network Harare Zimbabwe African Field Epidemiology Network Nairobi Kenya

Background: Tuberculosis is a leading cause of death globally, and the third leading cause of death in Zimbabwe. Death from any cause following a diag-nosis of tuberculosis is classified as a tuberculosis death. Bulawayo Province reported high tuberculosis death rates from 15.3% in 2016 to 14.2% in 2019 against a threshold of 5%. We analyzed tuberculosis deaths for Bulawayo Province to characterize patients dying and to make recommendations for im-proving treatment outcomes for susceptible tuberculosis cases. Methods: A descriptive cross-sectional study was conducted. We analyzed all (N = 469) records of tuberculosis deaths from 19/19 Bulawayo tuberculosis diagnosing centers from 01 January 2016 to 31 December 2019. Microsoft® Excel 2007 was used to generate graphs and Stata® version 17 was used to conduct chi-square tests for trends. Results: Males accounted for 278/469 (59.3%) of the deaths. The median age of death was 40 years (Q1 = 33: Q3 = 51). The proportion of TB deaths increased from 63/114 (55%) in 2016 to 57/90 (63%) in 2019 for males (p Conclusion: High death rates particularly in the intensive phase, could be attributed to sub-optimal clinical care. Tuberculosis programs should work towards adopting differentiated care models for tuberculosis patients and developing algorithms for patients at high risk of death.

关键词： Tuberculosis Death Secondary Data Analysis Bulawayo Province Zimbabwe

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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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Uptake of Cervical Cancer Screening among Women Attending Health Facilities in the City of Bulawayo, 2012

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Open Journal of Epidemiology 2018年第3期8卷 153-163页

作者： Munekayi Padingani Gladys Marape Zanele Hwalima notion gombe Ms T. Juru Department of Community Medicine University of Zimbabwe Harare Zimbabwe City Health Department Bulawayo City Council Bulawayo Zimbabwe

Introduction: In Zimbabwe, where cervical cancer is the leading female malignancy, no systematic cervical screening program has been introduced. However, selective or opportunistic screening has been performed since the late 1980s. The Ministry of Health and Child Care is relying on screening, which allows early detection of pre-cancerous cells and diagnosis at early stages but many women are not going for the test and no studies have been done to find out why. This study investigated the women’s perception about cervical cancer and its screening using health belief model (HBM) in Bulawayo, where they are two new screening clinics. Methods: We conducted an analytic cross-sectional study. Women from 18 years and above attending health facilities were included in the study. Interviewer administrated questionnaire was used to determine the proportion of screened women and elicit their perception about cervical cancer and its screening. Epi-info version 3.3.2 was used to do bivariate and multivariate analysis. Results: Two hundred women were recruited into the study. The proportion of women who had cervical cancer screening was 52 (26%). Pap smear only had 35 (17.5%) had VIAC only, 13 (6.5%) and Pap smear and VIAC had 4 (2%). Knowledge of cervical cancer and its screening was poor among participants. In multivariate analysis, awareness of cervical cancer screening [adjusted OR 42.05 (95% CI 5.63 - 314.04)] was associated with the uptake of cervical cancer screening and perceiving that having multiple sexual partners[adjusted OR 0.33 (95% CI 0.12 - 0.88)] was independently associated to the uptake of cervical cancer screening. Conclusion: This study demonstrated that lack of awareness of cervical cancer screening is a barrier to the uptake of the screening. Perceiving multiple sexual partners was associated to the uptake of cervical cancer screening. It is therefore necessary to increase awareness in Bulawayo City and educate the community about other risk factors.

关键词： Cervical Cancer Screening VIAC Pap Smear Bulawayo City

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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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