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BACKGROUND: We conducted the first national TB prevalence survey to provide accurate estimates of bacteriologically confirmed pulmonary TB disease among adults aged ≥15 years in 2014.METHODS: A TB symptoms screen and chest X-ray (CXR) were used to identify presumptive TB cases who submitted two sputum samples for smear microscopy, liquid and solid culture. Bacteriological confirmation included acid-fast bacilli smear positivity confirmed using Xpert® MTB/RIF and/or culture. Prevalence estimates were calculated using random effects logistic regression with multiple imputations and inverse probability weighting.RESULTS: Of 43,478 eligible participants, 33,736 (78%) were screened; of these 5,820 (17%) presumptive cases were identified. There were 107 (1.9%) bacteriologically confirmed TB cases, of which 23 (21%) were smear-positive. The adjusted prevalences of smear-positive and bacteriologically confirmed TB disease were respectively 82/100,000 population (95% CI 47-118/100,000) and 344/100,000 (95% CI 268-420/100,000), with an overall all-ages, all-forms TB prevalence of 275/100,000 population (95% CI 217-334/100,000). TB prevalence was higher in males, and age groups 35-44 and ≥65 years. CXR identified 93/107 (87%) cases vs. 39/107 (36%) using the symptom screen.CONCLUSION: Zimbabwe TB disease prevalence has decreased relative to prior estimates, possibly due to increased antiretroviral therapy coverage and successful national TB control strategies. Continued investments in TB diagnostics for improved case detection are required.

Background: Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe., Methods: This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom's cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05., Results: This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50-56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1-2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1-0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05)., Conclusion: This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care., (© 2024. The Author(s).)

Background: Previous studies have shown gender differences in tuberculosis (TB) incidence; however, gender disparity has not been well documented across granular categorizations of anatomic sites affected by TB and in the presence of human immunodeficiency virus (HIV) coinfection, largely due to small sample size for less common TB clinical presentations and lack of detailed clinical data., Methods: The study population included TB cases aged ≥15 years ( n = 41, 266) diagnosed in Harare, Zimbabwe. This cross-sectional study estimated male-to-female ratio (M/F ratio) for (1) age-specific TB incidence, (2) age-specific HIV prevalence among incident TB cases, and (3) 9 types of TB defined by affected anatomic site., Results: Males were at a 53% higher risk of TB compared to females (risk ratio [RR] = 1.53; 95% confidence interval [CI], 1.12-2.09). Based on adjusted odds ratios (aORs) from multinomial logistic regression model, the odds of abdominal TB (aOR = 0.51; 95% CI, .39-.68), TB bones/joints/spine (aOR = 0.63; 95% CI, .45-.90), and "other" extrapulmonary TB sites (aOR = 0.69; 95% CI = .59-.81) versus pulmonary TB were lower among males compared to females. The risk of TB-HIV coinfection among males was 17% (RR = .83; 95% CI, .74-.93) and 8% (RR = 0.92; 95% CI, .88-.95) lower in the 15- to 24-year and 25- to 44-year age groups, respectively., Conclusions: This study revealed a nuanced role of gender across finer categorizations of TB, indicating the need for future research to delineate underlying mechanisms driving gender disparities in TB. The finding that women had a greater likelihood of severe forms of TB and TB-HIV coinfection compared to men has important implications for women's health in TB-HIV high-burden settings., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

HIV positivity yield declined against increasing testing volumes in Zimbabwe, from 20% (1.65 million tests) in 2011 to 6% (3 million tests) in 2018. A screening tool was introduced to aid testers to identify clients likely to obtain a positive diagnosis of HIV. Consequently, testing volumes declined to 2.3 million in 2019 but positivity declined to 5% prompting the evaluation and validation of the tool to improve its precision in predicting positivity yield. A cross-sectional study was conducted. Sixty-four sites were randomly selected where all reporting clients (18+ years) were screened and tested for HIV. Participant responses and test outcomes were documented and uploaded to excel. Multivariable analysis was used to determine the performance of individual, combination questions and screening criteria to achieve >/ = 90% sensitivity for a new screening tool. We evaluated 13 questions among 7,825 participants and obtained 95.7% overall sensitivity, ranging from 3.9% [(95%CI:2.5,5.9) sharing sharp objects] to 86.8% [(95%CI:83.8,89.5) self-perception of risk] for individual questions. A 5-question tool was developed and validated among 2,116 participants. The best combination (self-perception of risk, partner tested positive, history of ill health, last tested >/ = 3months and symptoms of an STI) scored 94.1% (95%CI:89.4,97.1) sensitivity, 18% reduction in testing volumes and 11 Number Needed to Test (NNT). A screening in criteria that combine previously testing >/ = 3 months with a yes to any of the 4 remaining questions was analysed and sensitivity ranged from 89.9% (95%CI:84.4,94.0) for last tested >/ = 3months and sexual partner positive, to 93.5% (95%CI:88.7,96.7) for last tested >/ = 3months and self-perceived risk We successfully developed, evaluated and validated an HIV screening tool. High sensitivity and the fifth reduction in testing volume were acceptable attributes to enhance testing efficiency and effective limited resource utilisation. Screened out clients will be identified through frequent screening and self-testing options., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Mugauri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Childhood tuberculosis (TB) is underserved in resource-constrained endemic areas. Zimbabwe National Tuberculosis Program recommends tuberculosis prevention treatment for children aged <5 years who are close contacts of smear-positive TB cases. The Isoniazid Preventive Therapy (IPT) program performance had never been evaluated since its inception in 2010. We therefore, assessed the IPT program's inputs, processes, outputs, and outcomes. We conducted a process evaluation using the logic model in Kwekwe City. We recruited twenty-seven health care workers from all the five municipal health facilities. Smear-positive guardians of under 5 children, health care workers, and registers were the study population. Data were collected using a questionnaire and checklists and presented as frequencies and proportions. The IPT program met requirements in provision of guidelines (10/10), screening tools (15/15) and on-the-job trainings done in all five health facilities. Isoniazid tablets supply and quarterly budgeting did not meet meeting program requirements. Fifty-nine out of 231 (25.5%) children contacts of sputum-positive TB patients were screened. Fifty-one of the 59 (86.4%) children were initiated on IPT, 42/51 (82.4%) completed the course, one developed TB, 3/51 were still on treatment and 5/51 were lost to follow up. No dropouts and deaths were recorded. Unavailability of drugs was a barrier to the IPT and negatively impacts the TB elimination program. Contact screening was the bottleneck in the successful implementation of the program. Adequate staff and provision of drugs might improve the program. We recommended the recruitment of more healthcare workers and the budget for the program., Competing Interests: The authors declare no competing interests., (Copyright: Nyashadzashe Cosmas Makova et al.)

Introduction: Due to the increasing incidence of diabetes in Zimbabwe, complications such as diabetic foot (DF) are anticipated. Establishing local gaps and needs in DF healthcare is paramount for tailoring management strategies., Aims: To determine the status of DF services in the healthcare system and explore awareness of DF management and practices among registered general nurses (RGNs) in Zimbabwe., Methods: A mixed-methods approach was applied. Thirty-one RGNs from 16 public health facilities in Harare, Zimbabwe attending a DF workshop were administered with a cross-sectional survey instrument and a semi-structured questionnaire. Data collected included presence/absence of DF services and podiatrists in healthcare facilities, healthcare system approaches in DF care and availability of DF training/education programs for RGNs. Analysis was performed using Stata and Nvivo software., Results: No respondents reported availability of podiatrists. Only 1 (3%) of RGNs reported DF screening in primary care. Sixty percent (18) did not know or had never screened for DF. The RGNs reported inadequate DF educational programs/modules in primary care settings., Conclusion: This data highlights a need to improve DF education for RGNs at the frontline of managing PLWD. Understanding the needs for DF services may guide interventions to improve education and awareness programs that are appropriately tailored to local constraints in the health system. The non-communicable diseases director is encouraged to develop DF educational programmes for frontline health care workers., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To investigate determinants of drug resistance and treatment outcomes among patients with drug-resistant tuberculosis (DR-TB)., Design: This was a cross-sectional study on patients diagnosed with DR-TB in Bulawayo and Matabeleland South provinces, 2015., Results: A total of 129 participants were identified. DR-TB patients were 3.4 times more likely to have been treated previously for sensitive TB (95% confidence interval 1.3-9.2). Approximately 88.5% of DR-TB patients were diagnosed before completing the sensitive TB course and another 82.1% developed DR-TB within 6 months of completing sensitive TB treatment. The likelihood diminished with increasing time interval, becoming less likely at >12 months post-treatment. Most DR-TB patients (87.5%) were likely to have resided outside Zimbabwe and to have fallen ill there (85.2%). Overall, hearing loss was the most prevalent (70%) medication side effect experienced. Unfavourable interim treatment outcomes were high for patients <6 months on treatment (prevalence odds ratio 2.7, 95% CI 1.2-6.1), becoming 44% less likely after 18 months (95% CI 1.2-11.4)., Conclusions: The majority of DR-TB patients were diagnosed during sensitive TB treatment, suggesting missed DR-TB diagnosis or inadequate treatment. Delays in starting effective TB regimens negatively affect treatment outcomes. Drug sensitivity testing at diagnosis, patient monitoring, and enhanced adherence counselling are recommended., (© 2022 The Authors.)

Background: Advances in SARS-CoV-2 sequencing have enabled identification of new variants, tracking of its evolution, and monitoring of its spread. We aimed to use whole genome sequencing to describe the molecular epidemiology of the SARS-CoV-2 outbreak and to inform the implementation of effective public health interventions for control in Zimbabwe., Methods: We performed a retrospective study of nasopharyngeal samples collected from nine laboratories in Zimbabwe between March 20 and Oct 16, 2020. Samples were taken as a result of quarantine procedures for international arrivals or to test for infection in people who were symptomatic or close contacts of positive cases. Samples that had a cycle threshold of less than 30 in the diagnostic PCR test were processed for sequencing. We began our analysis in July, 2020 (120 days since the first case), with a follow-up in October, 2020 (at 210 days since the first case). The phylogenetic relationship of the genome sequences within Zimbabwe and global samples was established using maximum likelihood and Bayesian methods., Findings: Of 92 299 nasopharyngeal samples collected during the study period, 8099 were PCR-positive and 328 were available for sequencing, with 156 passing sequence quality control. 83 (53%) of 156 were from female participants. At least 26 independent introductions of SARS-CoV-2 into Zimbabwe in the first 210 days were associated with 12 global lineages. 151 (97%) of 156 had the Asp614Gly mutation in the spike protein. Most cases, 93 (60%), were imported from outside Zimbabwe. Community transmission was reported 6 days after the onset of the outbreak., Interpretation: Initial public health interventions delayed onset of SARS-CoV-2 community transmission after the introduction of the virus from international and regional migration in Zimbabwe. Global whole genome sequence data are essential to reveal major routes of spread and guide intervention strategies., Funding: WHO, Africa CDC, Biotechnology and Biological Sciences Research Council, Medical Research Council, National Institute for Health Research, and Genome Research Limited., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To determine the incidence and major drivers of catastrophic costs among TB-affected households in Zimbabwe., Methods: We conducted a nationally representative health facility-based survey with random cluster sampling among consecutively enrolled drug-susceptible (DS-TB) and drug-resistant TB (DR-TB) patients. Costs incurred and income lost due to TB illness were captured using an interviewer-administered standardised questionnaire. We used multivariable logistic regression to determine the risk factors for experiencing catastrophic costs., Results: A total of 841 patients were enrolled and were weighted to 900 during data analysis. There were 500 (56%) males and 46 (6%) DR-TB patients. Thirty-five (72%) DR-TB patients were HIV co-infected. Overall, 80% (95% CI: 77-82) of TB patients and their households experienced catastrophic costs. The major cost driver pre-TB diagnosis was direct medical costs. Nutritional supplements were the major cost driver post-TB diagnosis, with a median cost of US$360 (IQR: 240-600). Post-TB median diagnosis costs were three times higher among DR-TB (US$1,659 [653-2,787]) than drug DS-TB-affected households (US$537 [204-1,134]). Income loss was five times higher among DR-TB than DS-TB patients. In multivariable analysis, household wealth was the only covariate that remained significantly associated with catastrophic costs: The poorest households had 16 times the odds of incurring catastrophic costs versus the wealthiest households (adjusted odds ratio [aOR: 15.7 95% CI: 7.5-33.1])., Conclusion: The majority of TB-affected households, especially those affected by DR-TB, experienced catastrophic costs. Since the major cost drivers fall outside the healthcare system, multi-sectoral approaches to TB control and linking TB patients to social protection may reduce catastrophic costs., (© 2021 John Wiley & Sons Ltd.)

Introduction: Accurate mapping of spatial heterogeneity in tuberculosis (TB) cases is critical for achieving high impact control as well as guide resource allocation in most developing countries. The main aim of this study was to explore the spatial patterns of TB occurrence at district level in Zimbabwe from 2015 to 2018 using GIS and spatial statistics as a preamble to identifying areas with elevated risk for prioritisation of control and intervention measures., Methods: In this study Getis-Ord Gi* statistics together with SaTscan were used to characterise TB hotspots and clusters in Zimbabwe at district level from 2015 to 2018. GIS software was used to map and visualise the results of cluster analysis., Results: Results show that TB occurrence exhibits spatial heterogeneity across the country. The TB hotspots were detected in the central, western and southern part of the country. These areas are characterised by artisanal mining activities as well as high poverty levels., Conclusions and Recommendations: Results of this study are useful to guide TB control programs and design effective strategies which are important in achieving the United Nations Sustainable Development goals (UNSDGs)., Competing Interests: The authors have declared that no competing interests exist.

Background: Historical neglect of pediatric tuberculosis (TB), compounding the absence of a universally effective vaccine, highlights the importance of successful treatment in combating the global epidemic. Furthermore, compliance with international standards of pediatric TB treatment remains unknown in many high-burden, resource-limited settings., Methods: In this cross-sectional study, using TB surveillance data, we assessed the treatment outcomes among 853 pediatric TB cases (<15 years old), a study sample that represented all the pediatric TB cases with treatment outcome records in Harare, Zimbabwe during 2013-2017. We also identified factors associated with treatment outcome by multivariate logistic regression., Results: Of these 853 analyzed cases, 57% were either cured or had completed treatment. In a model accounting for confounding variables, hospital center and pretreatment sputum smear were associated with unfavorable treatment outcome. Cases from Beatrice Road Infectious Disease Hospital were four times as likely to have an unfavorable outcome compared with those from Wilkins Infectious Disease Hospital (adjusted odds ration [aOR]: 4.0; 95% CI 2.9-5.5). Children whose pretreatment sputum smear was positive were 2.4 times as likely to have an unfavorable outcome as those who were negative (aOR: 2.4; 95% CI 1.7-3.6)., Conclusion: Pediatric TB case management needs to be improved, especially among those with a positive pretreatment sputum smear. Efforts to address TB treatment outcome disparities between clinical settings in high-burden settings, such as Harare, Zimbabwe, are essential in improving global TB control., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Although effective treatment for malaria is now available, approximately half of the global population remain at risk of the disease particularly in developing countries. To design effective malaria control strategies there is need to understand the pattern of malaria heterogeneity in an area. Therefore, the main objective of this study was to explore the spatial and spatio-temporal pattern of malaria cases in Zimbabwe based on malaria data aggregated at district level from 2011 to 2016., Methods: Geographical information system (GIS) and spatial scan statistic were applied on passive malaria data collected from health facilities and aggregated at district level to detect existence of spatial clusters. The global Moran's I test was used to infer the presence of spatial autocorrelation while the purely spatial retrospective analyses were performed to detect the spatial clusters of malaria cases with high rates based on the discrete Poisson model. Furthermore, space-time clusters with high rates were detected through the retrospective space-time analysis based on the discrete Poisson model., Results: Results showed that there is significant positive spatial autocorrelation in malaria cases in the study area. In addition, malaria exhibits spatial heterogeneity as evidenced by the existence of statistically significant (P < 0.05) spatial and space-time clusters of malaria in specific geographic regions. The detected primary clusters persisted in the eastern region of the study area over the six year study period while the temporal pattern of malaria reflected the seasonality of the disease where clusters were detected within particular months of the year., Conclusions: Geographic regions characterised by clusters of high rates were identified as malaria high risk areas. The results of this study could be useful in prioritizing resource allocation in high-risk areas for malaria control and elimination particularly in resource limited settings such as Zimbabwe. The results of this study are also useful to guide further investigation into the possible determinants of persistence of high clusters of malaria cases in particular geographic regions which is useful in reducing malaria burden in such areas.

Country-specific interventions targeting high-risk groups are necessary for a global reduction in Tuberculosis (TB)/HIV burden. We analyzed the data of 13,802 TB cases diagnosed in Harare, Zimbabwe, during 2013-2017. Pearson's chi-square tests and multivariate logistic regression models were used to identify patient characteristics significantly associated with TB/HIV coinfection. Of the 13,802 TB cases analyzed, 9,725 (70.5%) were HIV positive. A significantly higher odds of having TB/HIV coinfection diagnosis was found among females, patients aged 25-64 years, previously treated cases, and acid-fast bacillus sputum smear-negative cases. Compared with nondisseminated pulmonary TB, miliary TB (adjusted odds ratio [aOR]: 1.469, 95% CI: 1.071, 2.015) and TB meningitis (aOR: 1.715, 95% CI: 1.074, 2.736) both had a significantly higher odds for TB/HIV coinfection, whereas pleural TB (aOR 0.420, 95% CI: 0.354, 0.497) and all other extrapulmonary TB (EPTB) (aOR: 0.606, 95% CI: 0.516 0.712) were significantly less likely to have TB/HIV coinfection. The risk for TB/HIV coinfection varied significantly by patients' sociodemographic and clinical characteristics in Harare. Our finding that different forms of EPTB have different relationships with HIV coinfection has extended the knowledge base about clinical markers for TB/HIV coinfection which can lead to a greater public health impact on eliminating TB/HIV infection.

Introduction: The contribution of high tuberculosis (TB) transmission pockets in propagating area-wide transmission has not been adequately described in Zimbabwe. This study aimed to describe the presence of hotspot transmission of TB cases in Harare city from 2011 to 2012 using geospatial techniques., Methods: Anonymised TB patient data stored in an electronic database at Harare City Health department was analysed using geospatial methods. Confirmed TB cases were mapped using geographic information system (GIS). Global Moran's I and Anselin Local Moran's I (LISA) were used to assess clustering and the local Getis-Ord Gi* was used to estimate hotspot phenomenon of TB cases in Harare City for the period between 2011 and 2012., Results: A total of 12,702 TB cases were accessed and mapped on the Harare City map. In both 2011 and 2012, ninety (90%) of cases were new and had a high human immunodeficiency virus (HIV)/TB co-infection rate of 72% across all suburbs. Tuberculosis prevalence was highest in the Southern district in both 2011 and 2012. There were pockets of spatial distribution of TB prevalence across West South West, Southern, Western, South Western and Eastern health districts. TB hot spot occurrence was restricted to the West South West, parts of South Western, Western health districts. West South West district had an increased peri-urban population with inadequate social services including health facilities. These conditions were conducive for increased intensity of TB occurrence, a probable indication of high transmission especially in the presence of high HIV co-infection., Conclusions and Recommendations: Increased TB transmission was limited to a health district with high informal internal migrants with limited health services in Harare City. To minimise spread of TB into greater Harare, there is need to improve access to TB services in the peri-urban areas., Competing Interests: The authors have declared that no competing interests exist.

Objective: To determine the prevalence of resistance to rifampicin alone; rifampicin and isoniazid, and second-line anti-TB drugs among sputum smear-positive tuberculosis patients in Zimbabwe., Design: A health facility-based cross-sectional survey., Results: In total, 1114 (87.6%) new and 158 (12.4%) retreatment TB patients were enrolled. MTB was confirmed by Xpert MTB/RIF among 1184 (93%) smear-positive sputum samples. There were 64 samples with Xpert MTB/RIF-determined rifampicin resistance. However, two were rifampicin susceptible on phenotypic drug susceptibility testing. The prevalence of RR-TB was [4.0% (95% CI, 2.9, 5.4%), n=42/1043) and 14.2% (95% CI, 8.9, 21.1%; n=20/141) among new and retreatment patients, respectively. The prevalence of MDR-TB was 2.0% (95% CI, 1.3, 3.1%) and 6.4% (95% CI, 2.4, 10.3%) among new and retreatment TB patients, respectively. Risk factors for RR-TB included prior TB treatment, self-reported HIV infection, travel outside Zimbabwe for ≥one month (univariate), and age <15 years. Having at least a secondary education was protective against RR-TB., Conclusion: The prevalence of MDR-TB in Zimbabwe has remained stable since the 1994 subnational survey. However, the prevalence of rifampicin mono-resistance was double that of MDR-TB., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Biobanking of Mycobacterium tuberculosis (Mtb) sputum samples for future research activities recommends the use of -70°C or -80°C freezers. Infrastructure for biobanking is not readily available in the majority of low-income countries. This study aimed to assess the recovery rate of Mtb isolates stored at room temperature for more than 6 years in Zimbabwe., Methods: Census samples of all confirmed rifampicin-resistant/multidrug-resistant tuberculosis isolates that were stored in mycobacterial growth indicator tubes (MGITs) at room temperature from 2011 to 2016 were identified and retrieved. The samples were subcultured on MGIT and 7H10 solid media for the extraction of genomic deoxyribonucleic acid using the phenol/chloroform method followed by precipitation with isopropanol., Results: A total of 248/400 (62%) isolates were successfully recovered. Recovery rates increased with declining time since the last culture, with 51% for samples stored for 6 years which increased to 77% for those stored for 1 year. The isolates that grew but were contaminated during the first subculture at the National Microbiology Reference Laboratory in Harare could not be recovered through decontamination because of limited resources. Decontamination was only possible during the second culture at the University of Stellenbosch., Conclusion: Storage of Mtb isolates at room temperature is a viable option in low-income countries where currently recommended biobanking procedures may not be available. This low-cost biobanking will facilitate research activities years later as new questions arise. Standard infection prevention and control when handling Mtb samples stored under room temperature for long periods is strongly recommended as these bacteria remain viable longer than previously reported., Competing Interests: None

Pediatric tuberculosis (TB) represents a major barrier to reducing global TB mortality, especially in countries confronting dual TB and human immunodeficiency virus (HIV) epidemics. Our study aimed to characterize pediatric TB epidemiology in the high-burden setting of Harare, Zimbabwe, both to fill the current knowledge gap around the epidemiology of pediatric TB and to indicate areas for future research and interventions. We analyzed de-identified data of 1,051 pediatric TB cases (0-14 years) found among a total of 11,607 TB cases reported in Harare, Zimbabwe, during 2011-2012. We performed Pearson's χ 2 test and multivariate logistic regression analysis to characterize pediatric TB and to assess predictors of HIV coinfection. Pediatric TB cases accounted for 9.1% of all TB cases reported during 2011-2012. Approximately 50% of pediatric TB cases were children younger than 5 years. Almost 60% of the under-5 age group were male, whereas almost 60% of the 10-14 age group were female. The overall HIV coinfection rate was 58.3%. Odds for HIV coinfection was higher for the 5-9 age group (adjusted odds ratio [AOR]: 2.77, 95% confidence interval [CI]: 1.97-3.94), the 10-14 group (AOR: 3.57, 95% CI: 2.52-5.11), retreatment cases (AOR: 6.17, 95% CI: 2.13, 26.16), and pulmonary TB cases (AOR: 2.39, 95% CI: 1.52, 3.75). In conclusion, our study generated evidence that pediatric TB, compounded by HIV coinfection, significantly impacts children in high-burden settings. The findings of our study indicate a critical need for targeted interventions.

Background: Tuberculosis (TB) has remained one of the major public health problems in Zimbabwe with an estimated incidence rate of 552 per 100,000 persons in 2013. The aim of this study was to describe the trends in acid-fast bacilli (AFB) sputum-smear positive (SSP) TB overall and within subpopulations for the period during 2008-2011 in Zimbabwe. Results of this study will contribute towards the evaluation and implementation of targeted TB control interventions., Methods: A cross-sectional study design was used to analyze 40, 110 SSP TB patient records routinely collected during 2008-2011. Incidence trends of SSP TB were described by province, sex, and age group. A Mantel-Haenszel Chi Statistic was calculated to compare each provincial SSP TB notification rate to the national SSP TB notification rate., Results: SSP TB notification rates were higher in the two main urban provinces, the western provinces and Manicaland. The 25-44 year age group accounted for the largest proportion of notified SSP TB. However, the 55-64 year and 65+ age groups had SSP TB notification rates in 2011 higher than the 2008 value. Finally, the average SSP TB notification rate in males was 23% higher than in females., Conclusion: The findings of this study suggest that TB control has successfully decreased the notification rate of SSP TB in Zimbabwe during 2008-2011. However, the disproportionate distribution of SSP TB among different regions and subpopulations of the country highlights the need for more targeted interventions to accelerate the decline of TB in Zimbabwe.

Background: Failure to thrive (FTT) is a sign of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. We assessed TB and HIV prevalence in children with FTT at one clinic in Botswana., Methods: In July 2010, we screened all children attending a 'Well Child' clinic for FTT. Children with FTT were referred to a paediatrician who: (i) assessed causes of FTT, (ii) evaluated for HIV and TB and (iii) reviewed the patient chart for evaluations for TB and HIV., Results: Of 919 children screened, 176 (19%) had FTT. One hundred eighteen (67%) children saw a paediatrician, and of these, 95 (81%) completed the TB evaluation. TB was newly diagnosed in 6 of 95 (6%). At review, HIV status was known in 23 of 118 (19%). Ninety-five had an unknown HIV status. Forty-five (47%) tested for HIV; all tested HIV-negative., Conclusion: TB and HIV screening among children with FTT diagnosed TB in 6% of cases completing an evaluation, but no new HIV infections.

Objective: A beverage manufacturing company reported 59.3% increase in occupational injuries between 2006 and 2007. Factors associated with occupational injuries at this company in Harare were characterized, described the injuries, identified the hazards and control measures in place., Design: An analytical cross sectional study was conducted., Setting: Two plants of a beverage manufacturing company in Harare., Subjects: We interviewed randomly selected workers at the 2 plants of the company, Main Outcome Measures: Prevalence of occupational injuries, Factors associated with injury, occupational hazards, control measures, Results: Of 392 workers interviewed, 53.3% reported having had a work-related injury. Twenty-six percent had not reported the injuries. Independent risk factors were: working in packaging department OR = 3.64 (95% CI: 2.25-5.88), having sleep disorder OR = 2.26 (95% CI: 1.21-4.22) and 7 day working week without rest OR = 1.88 (95% CI: 1.01-3.47). Hazards identified were noise, broken bottles, unguarded machines and coal dust. High risk areas were automated. Common injuries were cuts/lacerations (70.8%) and the most affected parts being the fingers 27.3% (57/209) and the hands 17.2% (36/209). Most injuries (74.8%) occurred in the packaging department due to breaking bottles., Conclusion: Prevalence of occupational injuries is high. We recommended regular machinery maintenance to minimize bottle breakages, reduction in working time and supply of adequate personal protective clothing.

Objectives: To determine behaviour factors for contracting human cutaneous anthrax among residents of Musadzi area., Design: We conducted a matched case-control study for age, sex, and village., Setting: A rural community in Musadzi area of Gokwe North district., Subjects: We interviewed 35 cases and 35 controls. A case was defined as any resident/visitor of Musadzi, diagnosed with anthrax between 9 September and 10 November 2004. A control was any resident who had not been diagnosed with anthrax and had no lesions suggestive ofanthrax on day of the interview., Main Outcome Measures: Behaviour factors associated with contracting anthrax., Results: In September 2004, cattle were reported to be dying in Musadzi area. Bacillus anthracis was positively identified in a blood smear from some of the carcasses. The attack rate among humans was 5%. Risk factors associated with contracting anthrax were: skinning of animals that had died from unknown causes AOR=3.8 (95% CI:1.3-10.7); preparation of the meat for cooking (AOR=3.1 (95% CI:1.16-8-4); preparation of the meat for drying AOR=2.7 (95% CI: 1.0081-7.4); belonging to a religious or ethnic sect that allow handling of meat from animals that had died from unknown causes (AOR=5.2 (95% CI: 1.8-14.8)., Conclusion: The human anthrax outbreak was secondary to an anthrax epizootic occurring in cattle. The Ministry of Health activated the local zoonotic committee, carried out anthrax awareness campaigns, supervised the destruction of carcasses, disinfected potentially contaminated sites and introduced a participatory health education tool on anthrax. The veterinary department quarantined and vaccinated cattle.

Objective: To examine the prevalence, patterns and reasons for disclosure of HIV status among people living with HIV/AIDS., Design: Adescriptive cross sectional survey., Setting: FamilyAIDS Support Organisation (FASO), Mutare, Zimbabwe., Subjects: A random selection of members of FASO attending clinic or meetings., Outcome Measures: Disclosure of HIV seropositivity to sexual partner, to one or more family members, to health care workers and to the wider public., Results: There was 79%, 72% and 70% disclosure to the family, health workers and to sexual partners respectively. While public disclosure was 23%, more people wanted to disclose but did not get an opportunity. Main reasons for disclosure to family were to obtain psychosocial and material support; to the public it was to give HIV/AIDS a face; and to the sexual partner it was to have safer sex. Knowing one's HIV status for a year or longer was significantly associated with disclosure to family, sexual partner and the public. Females were significantly more likely to disclose to family members compared to males (p=0.004). People in abusive relationships were significantly less likely to disclose to sexual partners (OR=0.17, p=0.039)., Conclusion: Though disclosure rates were generally high, attention must be given to the small number of people engaging in high-risk behaviour, and disclosure counseling needs to be enhanced. Domestic violence hindered disclosure and we advise that it must be prevented.

Objective: To describe treatment outcomes of patients on anti-retrovirals at six months of treatment., Study Design: We conducted pre-intervention post intervention surveys using a pretest-post test design., Setting: Khami Municipal Clinic, Bulawayo., Subjects: We interviewed consecutive patients eligible to receive antiretroviral drugs (ARVs). All patients had a history of TB treatment and a CD4 count less than 200 cells/mm., Main Outcome Measures: Mean change in CD4 count, weight, body mass index, and Karnofsky performance measured before and at six months ofantiretroviral treatment., Results: 72 subjects were interviewed at baseline, their median age was 38 years (Q1, 32 years, Q3, 43 years). Of these, 17 (24%) died before six months of treatment. Three (4%) defaulted treatment follow up. A total of 52 respondents were alive and interviewed at six months though only 50, had repeat CD4 counts at six months. Among the 50 survivors, the mean CD4 count at six months was significantly higher than at baseline (p = 0.0003). There was a 4.2 point statistical significant increase in the mean weight from baseline (p = 0.0005). Similarly, the mean Body Mass Index (BMI) significantly increased by 1.5 kg/m2 from baseline, (p = 0.001). The mean Karnofsky performance increased from 89% at baseline to 95% at six months (p = 0004). The researchers noted that patients on TB treatment were being deferred antiretroviral therapy until they completed TB treatment., Conclusion: The Khami project bears testimony that even in a resource poor setting; treatment of HIV/AIDS with antiretroviral drugs is feasible. We recommend early treatment initiation for those on TB treatment in line with national guidelines.

Introduction: During 2001-2002, a total of 97 occupational injuries occurred among workers in the cleansing section of the Bulawayo, Zimbabwe, City Council's Health Services Department. This report describes a study that was conducted to describe the nature of these injuries and determine the associated risk factors., Methods: A retrospective, descriptive cross-sectional survey was conducted concerning occupational injuries incurred by workers in the cleansing section during 2001-2002. A total of 153 workers who had been in the section as of January 1, 2001, and 23 senior managers and section supervisors were interviewed, the occupational injury register was reviewed, and a walk-through survey was conducted to estimate risk factors., Results: The occupational injury register indicated that during the study period, 62 workers sustained 67 injuries, including one that was fatal. Of these 67 injuries, 27 (40%) involved workers who sustained cuts inside a box-type refuse removal truck, and 11 (16%) involved workers who had sprained ankles and wrists as a result of improper lifting. Workers aged 18-25 years were more likely to incur an injury than workers aged >25 years. Working as a bin loader and not having received preemployment training were associated with injuries. None of the bin loaders had received preemployment training. Hazards identified during the walk-through survey included use of small jacks in workshops, contact with biologic and chemical materials on trucks and landfill sites, and poor use of protective clothing. Supervisors cited worker negligence as the main cause of injury, whereas 72 (84%) workers cited lack of adequate protective clothing as a source of injury, and eleven (7%) workers cited use of inappropriate equipment., Conclusion: On the basis of the modifiable risk factors for injury identified in this study, the Bulawayo City Council drafted a new health and safety training manual. New recruits now receive training before starting work on refuse collection trucks.

Objectives: To review the evidence of association between malaria and HIV/AIDS co-infection for purposes of developing strategies for malaria control., Design: Desktop review of literature., Setting: Harare, Zimbabwe., Main Outcome Measures: Response to treatment, development of severe malaria, malarial immunological response in HIV/AIDS positive people and incidence of malaria in HIV/AIDS positive individuals., Results: HIV-1 infection increases the incidence of Plasmodium falciparum parasitaemia and is associated with the development of severe malaria, commonly anaemia, cerebral malaria and high parasite density (OR = 2.56; 95% CI = 1.53 to 4.29; p < 0.001). The efficacy of chloroquine and sulphadoxine-pyrimethamine in reducing placental malaria in HIV-1 positive pregnant women was impaired compared to HIV-1 negative pregnant women. However, the situation in non-gravid HIV-1 positive people as regards efficacy of chloroquine and sulphadoxine-pyrimethamine prophylaxis is not known. Also not known is the relationship between malaria parasitaemia without symptoms and HIV-1 infection, the results of which may provide useful information regarding malaria control and prevention in HIV-1 positive people., Conclusions: HIV-1 positive people staying in malaria endemic areas are at risk of developing severe malaria. Malaria prevention using insecticide-treated bednets and indoor residual house spraying may be the best available options for these people. Chloroquine and sulphadoxine-pyrimethamine prophylaxis require further studies to verify their efficacy, in the presence of HIV-1/AIDS infection.