Public Health

Malaria continues to be a major public health problem in Sub-Saharan Africa despite efforts that have been made to prevent and control the disease for many decades. The knowledge on prediction and occurrence of the disease that communities acquired over the years has not been seriously considered in control programmes. This article reports on studies that aimed to integrate indigenous knowledge systems (IKS) on malaria into the malaria control programme in Gwanda District, Zimbabwe. The studies were conducted over a 3-year period. Data were collected using participatory rural appraisals, key informant interviews, household interviews and workshops in three wards (11, 15 and 18) with the highest malaria incidence in Gwanda District. Disease livelihoods calendars produced by the community showed their knowledge on the relationship between malaria, temperature and rainfall, and thus an understanding of malaria as a hazard. Volunteer IKS experts willing to record the indigenous environm...

A tuberculosis model which incorporates treatment of infectives and chemoprophylaxis is presented. The model assumes that latently infected individuals develop active disease as a result of endogenous re-activation, exogenous re-infection and disease relapse, though a small fraction is assumed to develop active disease soon after infection. We start by formulating and analyzing a TB model without any intervention strategy that we extend to incorporate chemoprophylaxis and treatment of infectives. The epidemic thresholds known as reproduction numbers and equilibria for the models are determined, and stabilities analyzed. The reproduction numbers for the models are compared to assess the possible community benefits achieved by treatment of infectives, chemoprophylaxis and a holistic approach of these intervention strategies. The study shows that treatment of infectives is more effective in the first years of implementation (approximately 10 years) as treatment results in clearing active TB immediately and there after chemoprophylaxis will do better in controlling the number of infectives due to reduced progression to active TB.

The treatment and control of tuberculosis (TB) can only be achieved through effective chemotherapy. Patient compliance is one of the main obstacles that need to be overcome by TB control programmes in order to effectively control tuberculosis. A better understanding of the various factors accounting for treatment default could help in the achievement of better compliance from patients.The objective of this study, which was carried out in Gwanda District of Zimbabwe, was to determine the possible reasons for treatment interruption among TB patients in order to suggest ways of improving adherence to treatment.In this study both quantitative and qualitative methods of data collection were used. A semi-structured questionnaire was administered to 100 patients and records of 40 defaulters were reviewed. Complementary data was gathered through focus group discussions.The results of this study revealed that there is a good knowledge about the signs and symptoms of TB. However the associati...

As well as being institutes of learning, universities play a more important national role in Africa than in other regions by housing the bulk of the continents research capability and technical expertise, and can be the only national institutions with the skills, equipment and mandate to generate new knowledge through research and dissemination. With the tendency for women to be based in the lower levels of the educational field, and their low representation in higher education and research institutions, they often have limited opportunities to participate in the generation of knowledge. This is as important as ever in the field of environmental health in Africa and in turn affects the achievement of the Millennium Development Goals. The Africa Academy for Environmental Health (AAEH) identified gaps in gender equity in HEIs, and through funding from the Association of African Universities undertook an 18 month programme with a network of 16 HEIs in 13 countries in 3 regions of Afric...

Community-based early warning systems involve community driven collection and analysis of information that enable warning messages to help a community to react to a hazard and reduce the resulting loss or harm. Most early warning systems are designed at the national or global level. Local communities’ capacity to predict weather conditions using indigenous knowledge has been demonstrated in studies focusing on climate change and agriculture in some African countries. This review was motivated by successes made in non-disease specific community-based early warning systems with a view to identify opportunities for developing similar systems for malaria. This article reviewed the existing community-based early warning systems documented in literature. The types of disasters that are addressed by these systems and the methodologies utilised in the development of the systems were identified. The review showed that most of the documented community-based early warning systems focus on natu...

This paper discusses indigenous environmental indicators for the occurrence of malaria in ward 11, 15 and 18 of Gwanda district, Zimbabwe. The study was inspired by the successes of use of indigenous knowledge systems in community based early warning systems for natural disasters. To our knowledge, no study has examined the relationship between malaria epidemics and climatic factors in Gwanda district. The aim of the study was to determine the environmental indicators for the occurrence of malaria. Twenty eight key informants from the 3 wards were studied. Questionnaires, focus group discussions and PRA sessions were used to collect data. Content analysis was used to analyse the data. The local name for malaria was 'uqhuqho' literally meaning a fever. The disease is also called, "umkhuhlane wemiyane" and is derived from the association between malaria and mosquitoes. The findings of our study reveal that trends in malaria incidence are perceived to positively correlate with variations in both temperature and rainfall, although factors other than climate seem to play an important role too. Plant phenology and insects are the commonly used indicators in malaria prediction in the study villages. Other indicators for malaria prediction included the perceived noise emanating from mountains, referred to as "roaring of mountains" and certain behaviours exhibited by ostriches. The results of the present study highlight the importance of using climatic information in the analysis of malaria surveillance data, and this knowledge can be integrated into the conventional health system to develop a community based malaria forecasting system.

Although there has been a decline in the number of malaria cases in Zimbabwe since 2010, the disease remains the biggest public health threat in the country. Gwanda district, located in Matabeleland South Province of Zimbabwe has progressed to the malaria pre-elimination phase. The aim of this study was to determine the spatial distribution of malaria incidence at ward level for improving the planning and implementation of malaria elimination in the district. The Poisson purely spatial model was used to detect malaria clusters and their properties, including relative risk and significance levels at ward level. The geographically weighted Poisson regression (GWPR) model was used to explore the potential role and significance of environmental variables [rainfall, minimum and maximum temperature, altitude, Enhanced Vegetation Index (EVI), Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), rural/urban] and malaria control strategies [indoor residual...

Hand hygiene is one of the most effective and efficient ways of controlling faecal–oral diseases. However, little is known about the predictors of hand hygiene behaviours among school children. A predesigned checklist guide was used to observe hygiene behaviours of 460 pupils from four rural schools in Shamva South district, Zimbabwe. A pretested questionnaire was administered to obtain demographic data of the observed school children. Membership of a Water, Sanitation and Hygiene (WASH) club, age, gender and the level of education were associated with hand hygiene practices (p < 0.05). The findings indicated that investing in hand hygiene behaviour change processes among school children using the promotion, formation, resuscitation and empowerment of WASH clubs in schools is important in disease prevention among communities in developing countries.

Background: Although sub-Saharan African countries have rolled out massive HIV treatment and care programmes, there is little evidence of these having embraced key population groups particularly female sex workers. Due to the criminalisation of sex work in countries like Zimbabwe, research on HIV and its impact on this group is sparse. The absence of an enabling environment has hindered access to HIV care and treatment services for female sex workers. Objectives: To gain an in-depth understanding of the experiences of female sex workers accessing HIV care and treatment services to enhance programming and planning for this key population group. Methods: This study was qualitative and phenomenological. Data saturation determined the sample size of 20 participants. Data was collected using in-depth interviews that were audio recorded, transcribed, and subjected to thematic content anal- ysis. Results: Our findings demonstrate varying dynamics between the private and public sector HIV c...

Background Zoonoses are a major threat to human health. Worldwide, rabies is responsible for approximately 59 000 deaths annually. In Zimbabwe, rabies is one of the top 5 priority diseases and it is notifiable. It is estimated that rabies causes 410 human deaths per year in the country. Murewa district recorded 938 dog bite cases and 4suspected rabies deaths between January 2017 and July 2018, overshooting the threshold of zero rabies cases. Of the 938dog bite cases reported in the district, 263 were reported in Ward 30 and these included all the 4suspected rabies deaths reported in the district. This necessitated a study to assess risk factors for contracting rabies in Ward 30, Murewa. Methodology/ Principal findings A descriptive cross sectional survey was used for a retrospective analysis of a group of dog bite cases reported at Murewa Hospital, in Ward 30. Purposive sampling was used to select dog bite cases and snowball sampling was used to locate unvaccinated dogs and areas wi...

Introduction Significant progress has been made with respect to the initiation of children on antiretroviral therapy (ART) in Southern Africa including Swaziland, however retention of these children in care poses a major challenge. The aim of the study was to assess retention to care in children testing HIV positive taking into account the number of return child welfare care (CWC) visits the child made. Methods A retrospective cross sectional study and was conducted at 4 facilities in Swaziland. All children who were HIV infected from 0 to 18 months were identified using the child welfare register (CWC). Infant characteristics were obtained from the child welfare register and early infant diagnosis logbooks. Proportion of patients retained in care were calculated at three, six, nine and twelve months. Results Of the 32 HIV positive children identified tested between December 2014 up to July 2016, sixty eight percent (n = 22) of the children that tested HIV positive were retained at ...