IntroductionIn Zimbabwe the integrated disease surveillance and response guidelines include maternal mortality as a notifiable event reported through the Maternal Mortality Surveillance System (MMSS). A preliminary review of the MMSS data for Mutare district for the period January to June 2014 revealed that there were some discrepancies in cases notified and those captured on the T5 monthly return form. There were also delays in reporting of some maternal deaths. Poor reporting indicated shortcomings in the MMSS in Mutare district and we therefore sought to assess the performance of the maternal mortality surveillance system in Mutare district.MethodsA descriptive cross sectional study was conducted using Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. A total of 64 health workers were enrolled into the study from 19 selected health facilities in Mutare district and 32 maternal death notification forms submitted in 2014 to the provincial office were reviewed to assess the quality of information on the forms. Interviewer administered questionnaires were used to collect information from enrolled health workers, the system's attributes namely usefulness, acceptability, simplicity, stability, data quality, timeliness and completeness were assessed and a checklist was used to assess availability of resources for the implementation of the maternal mortality surveillance. We also determined the cost of reporting each maternal death in Mutare district.ResultsHalf of the study participants gave the correct definition of a maternal death. All health workers participated and were willing to continue participating in the maternal mortality surveillance. Majority of health workers, 79.7% used data generated from the surveillance system and 59.5% found it easy to implement the system. A total of 32 death notification forms were reviewed and of these, 31 forms were forwarded to the national office and all did not reach the national office on time. Average completeness of notification forms was 76.0% and 53.1% of the forms had all the necessary accompanying documents. Reporting each maternal death was estimated to cost $28.65 in Mutare district.ConclusionThe strongest components of the maternal mortality surveillance system in Mutare district were usefulness and acceptability. Timeliness and completeness were the weaker components of the system. The system was found to be simple; however, resources were not adequately available in all health facilities.
IntroductionSevere malaria is a rare life threatening illness. Only a small proportion of patients with clinical malaria progress to this medical emergency. On reviewing 61 malaria death investigation forms submitted to the provincial office in 2014, 22(36%) were children below ten years who succumbed to severe malaria. Mutasa and Nyanga Districts reported 73% of these deaths. This study was conducted to determine factors associated with severe malaria so as to come up with evidence based interventions to prevent severe malaria and associated mortality.MethodsA 1:2 unmatched case control study was conducted. A case was defined as a child 10 years and below, who was admitted at Hauna (Mutasa) or Nyanga District Hospitals between September 2014 and May 2015 with a primary diagnosis of severe malaria. Controls were children of similar age with uncomplicated malaria. Permission to conduct the study was sought and granted by the Medical Research Council of Zimbabwe (Approval number B/874), Joint Research Ethics Committee, Health Studies Office and the Manicaland Directorate Institutional Review Board. Written informed consent was sought from all caregivers of enrolled children. Interviewer administered questionnaires were used to ascertain exposures.ResultsA total of 52 cases and 104 controls were enrolled into the study. The median age of cases was 4 years (Q1=3, Q3=9) and 6 years for controls (Q1=3, Q3=8). The Case Fatality Rate among cases was 28.8%. The independent risk factors for severe malaria were; distance >10km to the nearest health facility [Adjusted Odds Ratio (aOR)=14.35, 95% CI=1.30, 158.81], duration of symptoms before seeking medical care >2 days [aOR=9.03, 95% CI=2.21, 36.93], having comorbidities [aOR=5.38, 95% CI=1.90, 15.19], staying in a house under construction [aOR=4.51, 95%CI=1.80, 11.32] and duration of illness before receiving antimalarial medicines >24 hours [aOR=3.82, 95% CI=1.44, 10.12]. Owning at least one ITN in the household [aOR=0.32, 95% CI=0.11, 0.95] and having a mother as a caregiver [aOR=0.23, 95% CI=0.09, 0.76] were independently protective of severe malaria. Being undernourished [Odds Ratio (OR)=10.13, 95% CI=1.04, 98.49] and being female [OR=0.27, 95% CI=0.08, 0.96] were associated with mortality owing to severe malaria.ConclusionFactors associated with severe malaria and mortality owing to severe malaria identified in this study are consistent with other studies. Caregiver healthcare seeking behaviours, patient related factors and health system related factors are important determinants of severe malaria among children. There is need for regular health education campaigns emphasizing on malaria prevention, signs and symptoms and benefits of seeking medical care immediately for sick children.
IntroductionZimbabwe targets reducing malaria incidence from 22/1000 in 2012 to 10/1000 by 2017, and malaria deaths to near zero by 2017. As the country moves forward with the malaria elimination efforts, it is crucial to monitor trends in malaria morbidity and mortality in the affected areas. In 2013, Manicaland Province contributed 51% of all malaria cases and 35% of all malaria deaths in Zimbabwe. This analysis describes the trends in malaria incidence, case fatality and malaria outpatient workload compared to the general outpatient workload.MethodsWe analyzed routinely captured malaria data in Manicaland Province for the period 2005 to 2014. Epi Info version 7 was used to calculate chi-square trends for significance and Microsoft Excel was used to generate graphs. Permission to analyze the data was sought and granted by the Provincial Medical Directorate Institutional Review Board of Manicaland and the Health Studies office.ResultsMalaria morbidity data for the period 2005-2014 was reviewed and a total of 947,462 cases were confirmed during this period. However, malaria mortality data was only available for the period 2011-2014 and cumulatively 696 deaths were reported. Malaria incidence increased from 4.4/1,000 persons in 2005 to 116.3/1,000 persons in 2014 (p<0.001). The incidence was higher among females compared to males (p-trend<0.001) and among the above five years age group compared to the under-fives (p-trend<0.001). The proportion of all Outpatient Department attendances that were malaria cases increased 30 fold from 0.3% in 2005 to 9.1% in 2014 (p-trend<0.001). The Case Fatality Rate also increased 2-fold from 0.05 in 2011 to 0.1 in 2014 (p-trend<0.001).ConclusionDespite current malaria control strategies, the morbidity and mortality of malaria increased over the period under review. There is need for further strengthening of malaria control interventions to reduce the burden of the disease.
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