The impact of an inadequate municipal water system on the residents of Chinhoyi town, Zimbabwe

OBJECTIVE: To assess the use and impact of the water reticulation system in Chinhoyi on its residents. DESIGN: Cross sectional and case series studies. SETTING: Chinhoyi town. SUBJECTS: 600 Chinhoyi residents. MAIN OUTCOME MEASURES: Practices and perceptions of Chinhoyi residents on the water system, and distribution of water-related diseases per area of residence. RESULTS: Out of 600 respondents, 565 (99.3%) had access to piped water and 558 (98.0%) to flush toilets. Breakdowns of water supply and functioning of toilet facility were reported by 308 (77.0%) and 110 (28.0%) respondents in the previous six months, respectively. Main complaints of Chinhoyi residents were about low water quality (36.2%), inadequate sewage system (31.3%) and environmental pollution (26.5%). Cases of water-related diseases were not associated with natural water bodies. CONCLUSIONS: Chinhoyi residents have good access to the municipal water and an adequate sanitation system. However, low quality of the water, frequent system breakdowns and the degradation and loss of amenity of the environment impair their quality of life.     

Risk awareness of HIV/AIDS among commercial farm workers in Zimbabwe

OBJECTIVE: To determine levels of perceived risk of HIV infection and the determinants of these perceptions among commercial farm workers. DESIGN: Cross sectional. SETTING: Commercial farms in Manicaland, Mashonaland Central, Mashonaland West and Mashonaland East provinces of Zimbabwe. SUBJECTS: 406 male and 411 female adults. MAIN OUTCOME MEASURES: Perceived risk of HIV infection. RESULTS: Out of 33 female respondents aged less than 20 years, 19 (57.6%) reported that they had no chance of acquiring the HIV infection. The majority (15) of these 19 teenagers indicated that they had no chance of being HIV infected because they had sex only with their spouses. Of the respondents aged 20 years or more, 235 (64.6%) males and 182 (55.3%) females reported that they had no chance of being HIV infected (OR = 1.47, 95% CI 1.07 to 2.02, p = 0.016). Most males (57.0%) and females (59.9%) of age 20 years or more said that they had no chance of being HIV infected because they had sex with only their spouses. Among the respondents of age 20 years or more who indicated they had a moderate to high chance of being infected or were already infected, 35 (33.3%) of the males reported that they had multiple partners and 41 (40.6%) of the females reported that their spouses had multiple partners. CONCLUSION: In general, despite high seroprevalence rates in Zimbabwe, many individuals do not perceive themselves at risk. Future health education intervention studies should seek to increase the general perception of low risk so that adequate precaution can be taken against being infected.     

Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe

OBJECTIVE: To determine the association between HIV infection and progression of Plasmodium falciparum malaria illness in Hurungwe district, Zimbabwe. DESIGN: Prospective cohort. SETTING: Hurungwe Rural Hospital in Mashonaland West Province, Zimbabwe. SUBJECTS: Blood slide positive P. falciparum malaria patients. MAIN OUTCOME MEASURES: Development of severe and complicated malaria. RESULTS: A total of 659 clinical malaria cases were investigated and 237 (36.0%) confirmed cases entered the study. The total HIV positive malaria patients were 82 (34.6%) of confirmed cases or 12.4% of the total clinical cases. The case fatality rate was 5.9% (14 deaths) in the confirmed cases and 11 of these deaths were HIV positive. The commonly reported complications were high parasite count of 2% or more (38.5%), anaemia (29.0%), cerebral malaria (23.1%), low blood pressure (8.3%) and renal failure (1.2%). The HIV positive cases which developed severe and complicated malaria were 72, 30.4% of the sample studied or 55.8% of the total severe and complicated cases. The mode of transport to the nearest health centre was the only confounding factor identified during the analysis. After adjusting for this confounding factor, the risk of developing severe and complicated malaria was 2.35 (95% CI 1.85 to 2.98) times more in the HIV positive malaria patients than in HIV negative patients. CONCLUSION: We conclude that HIV infection is significantly associated with the development of severe and complicated malaria. There is need for future studies to determine whether HIV positive malaria patients require different management protocol from HIV negative malaria patients.     

Field Epidemiology Training Programmes in Africa - Where are the Graduates?

Background  

The current shortage of human resources for health threatens the attainment of the Millennium Development Goals. There is currently limited published evidence of health-related training programmes in Africa that have produced graduates, who remain and work in their countries after graduation. However, anecdotal evidence suggests that the majority of graduates of field epidemiology training programmes (FETPs) in Africa stay on to work in their home countries--many as valuable resources to overstretched health systems.     

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background

Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.

Objective

To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.

Methods

A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls.

Results

Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42–20.85), relationships less than one year, OR= 9.33 (95% CI 3.53–24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64–16.25) and paying for sex OR= 23.65 (95% CI 6.23–89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02–6.04) and relationships less than one year OR=3.19 (95% CI 1.41–7.23).Significant differences in attitudes were evident among cases and controls.

Conclusion

Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.     

Knowledge and practices of family planning in Zimbabwe

OBJECTIVE: To assess the level of knowledge and use of family planning in Zimbabwe. DESIGN: Cross sectional study. SETTING: All eight provinces and two major cities in Zimbabwe. SUBJECTS: Women of child bearing age (15 to 49 years, 6,083 respondents). MAIN OUTCOME MEASURES: Number of live births, knowledge of contraceptive methods, previous, current and intention for future use of contraceptives, method related problems. RESULTS: The contraceptive prevalence rate was 59.6% (CI 95% 58.4 to 60.9). The median number of live births was two (Q1 = 1, Q3 = 4) among all women, and seven (Q1 = 6, Q3 = 8) among women aged 40 to 49 years. Of 6,083 women interviewed, 5,849 (96.2%) knew at least one method of modern family planning, and 4,743 (78.0%) had ever used contraceptive in their life. Health concerns were the main reason for both discontinuation (28.5%) and postponement (22.8%) of contraceptive use. CONCLUSIONS: As compared to the 1991 Mother and Child Health Survey, knowledge and coverage of family planning services have improved further, and the introduction of injectable contraceptives has proved a success. Areas which need attention include the groups with high parity that remain under served, the low knowledge and use of condoms as a contraceptive, and the high level of health concerns among current and potential users.