Biomedical subjects

M Tshimanga

Publications and source records attributed to M Tshimanga.

14 recordsLinked to original sources

PubMed2006

Occupational injuries among workers in the cleansing section of the City Council's Health Services Department--Bulawayo, Zimbabwe, 2001-2002.

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.

Accidents, Occupational↗

PubMed2001

Factors associated with measles complications in Gweru, Zimbabwe.

OBJECTIVE: To investigate factors associated with complications or death among measles cases. DESIGN: A cross-sectional study. SETTING: Health facilities in the city of Gweru, Zimbabwe. SUBJECTS: Six hundred and thirty seven measles cases randomly selected from measles surveillance data. MAIN OUTCOME MEASURES: (a) Associations of respiratory complications and diarrhoea with death among complicated cases; (b) associations of age at infection, gender of cases and vaccination status of cases with occurrence of either respiratory complications or diarrhoea or death among measles cases. RESULTS: Among cases with respiratory complications, twenty two (29%) had died, while five (5%) had died among those with diarrhoea (OR=7.06,95% CI=2.55-22.35, p<0.001). On rates of respiratory complications among cases, age groups 24-59 and 60+ months were protective by 57% (95% CI=11-79%) and 76% (95% CI=52-88%) respectively compared to the age group <24 months, and vaccination was protective by 42% (95% CI=2-65%) compared to those unvaccinated. Concerning rates of diarrhoea among cases, the age group 60+ months was protective by 80% (95% CI=62-89%) compared to age group <60 months, while vaccination was protective by 64% (95% CI=42-77%) compared to those unvaccinated. With respect to rates of mortality among cases, age was protective by six per cent (95% CI=3-9 %) for every year older. CONCLUSION: It was concluded that: (a) the risk of death was higher in cases with respiratory complications than diarrhoea; (b) the risk of complications and death was inversely related to age at infection and older age groups were protective against occurrence of complications or death; (c) the risk of complications was higher in unvaccinated cases and vaccination was protective against occurrence of complications.

Age Factors↗

PubMed2000

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.

Adult↗

PubMed2000

An outbreak of dysentery in a rural district of Zimbabwe: the role of personal hygiene at public gatherings.

OBJECTIVES: To characterize the nature and extent of the outbreak; to determine the risk factors associated with contracting shigellosis; and to institute disease control and preventive measures. DESIGN: Case control study. SETTING: Nyaure Ward, Goromonzi District, Mashonaland East Province, Zimbabwe. SUBJECTS: 52 cases and 52 controls. A case was defined as any resident of Nyaure Ward who presented with bloody diarrhoea (three or more loose stools/day) between 25 July and 25 October 1997. MAIN OUTCOME MEASURES: Frequencies of symptoms, types of treatment received, risk factors for contracting the illness. RESULTS: The median age was 17 (Q1 = 8, Q3 = 30) years for cases and 19 (Q1 = 7, Q3 = 28) years for controls. Prominent symptoms were abdominal cramps (96.2%), malaise and fever (92.3%), nausea and vomiting (50.0%). The median duration of diarrhoea was 13 (Q1 = 6, Q3 = 14) days. Eighteen (34.6%) cases were admitted and of these five were referred to a central hospital and two of them complicated with haemolytic uraemic syndrome. The case fatality rate was 1.6%. Twenty four(46.1%) of the cases had Shigella dysenteriae type I, sensitive to Nalidixic acid, Kanamycin, and Doxycycline but resistant to Metronidazole, isolated from the stool specimen. Water samples did not yield any pathogens. Significant risk factors associated with contracting dysentery were shared hand washing in the same standing water at gatherings[OR = 8.47, 95% CI: (2.43-31.33)] or within homes[OR = 60.43, 95% CI: (15.73 to 256.00)]. The use of Blair toilets was a protective factor[OR = 0.03, 95% CI: (0.01 to 0.11)]. CONCLUSION: The epidemiologic evidence implicated contamination of water used for shared hand washing before meals as the source of the infection. The common practice of shared hand washing in standing water should be discouraged at all gatherings and within households to avoid future outbreaks.

Case-Control Studies↗

PubMed1999

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.

Adolescent↗

PubMed1999

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.

Attitude to Health↗

PubMed1999

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.

Adolescent↗

PubMed1999

Post natal maternal morbidity patterns in mothers delivering in Gweru City (Midlands province).

OBJECTIVES: To determine morbid conditions suffered by mothers during the first six weeks post delivery and risk factors associated with them in Gweru district. DESIGN: A cross sectional survey. SETTING: Gweru district hospital, Monomotapa, Mkoba 1 and Mkoba polyclinic. SUBJECTS: A consecutive sample of 201 mothers residing in Gweru district who delivered in these facilities during the month of June 1997. MAIN OUTCOME MEASURES: Morbid conditions, magnitude and the risk factors. RESULTS: During follow up checks on recruited mothers, turn up rates were 82% and 63% at two and six weeks respectively. Fifty eight percent (58%) of the mothers reported at least one morbid condition within the first 24 hours post delivery and pain was a dominant feature. At two weeks, 56% of those who turned up predominantly presented with sepsis in areas of the reproductive tract. The figure fell to 35% among mothers who turned up at six weeks and a mixture of pain and sepsis were the predominant complaints. Episiotomies caused a lot of pain post operatively and the risk of subsequent sepsis was high, (OR: 9; 95% CI: 1.16 < OR < 69.7; p = 0.020). Statistically significant associations were found between backache and multiparity (OR: 1.89; 95% CI: 1 < OR < 3.4; p = 0.040) and also between Caesarian section and some morbid conditions (OR: 4.14; p = 0.002; 95% CI 2.05 < OR < 10.91). The prevalence rate of HIV was 29.4%. HIV positivity was associated with marriage below the age of 19 years (OR: 2.4; 95% CI 1.21 < OR < 3.8; p = 0.024). There was no association between HIV serostatus and maternal morbidity. Use of traditional medication during pregnancy was reported by 42% of mothers, but it did not have any immediately observable intrapartum of post partum effects. Similarly the place of delivery was not associated with post natal maternal morbidity. CONCLUSION: The first two weeks post delivery were the most critical for the mother in terms of post natal maternal morbidity. Sepsis associated pain was the predominant condition. To improve the effectiveness of post natal care, a review within the first two weeks post delivery is an essential intervention, in addition to the routine six weeks check.

Adult↗

PubMed1998

Challenges posed by changes in measles transmission patterns.

OBJECTIVE: To quantify changes in measles transmission patterns. DESIGN: Analysis of measles surveillance data. SUBJECTS: All measles cases identified in 1988. MAIN OUTCOME MEASURES: Proportion of cases in age group 60 to 119 months, proportions of vaccinated and unvaccinated cases in age group 60 to 119 months, and occurrence of cases in schools. RESULTS: Measles vaccination coverage was 91%. Incidence rate of measles was 205 per 100,000 population. The age group 60 to 119 months accounted for 49% of all reported cases and 68% of cases in this age group were vaccinated. There were measles epidemics in schools and these were associated with occurrence of secondary cases in younger siblings in the community. Case fatality rate and mortality rate were 0.4% and one per 100,000 population respectively. CONCLUSION: High measles transmission in children of school going age could spill into the community through generation of secondary cases among younger siblings and this could result in high morbidity and mortality in this vulnerable group. It is recommended that either revaccination at school entry or mass vaccination campaigns be carried out in affected age groups at schools to reduce occurrence of epidemics.

Age Distribution↗

PubMed1998

Consultations at central hospitals: reasons and outcome of referrals from urban clinics in Bulawayo, Zimbabwe.

OBJECTIVE: To quantify the main reasons for referral from urban primary health care clinics to central hospitals and to assess the outcome of such referrals in Bulawayo. DESIGN: Descriptive cross sectional study. SETTING: Mpilo Central Hospital, a quaternary level hospital and referral centre for urban clinics. SUBJECTS: 914 patients referred by urban clinics who attended the hospital in April and May 1995. MAIN OUTCOME MEASURES: Frequency of referrals by referrer, reasons for referral, outcome of referrals, diagnosis of admitted referrals. RESULTS: Of 914 referrals studied, 863 (94%) were made by registered general nurses and 51 (6%) by medical officers. Four hundred and forty four (49%) referrals made by registered general nurses were for doctors to establish the diagnosis, and 341 (37%) were for treatment or operation. The other referrals were for specialists to take over management, for advice on management and referral back to the clinic, and for the hospital to carry out specific tests. Of all referrals, 844 (92%) were consulted by generalist medical officers (GMOs), and only 70 (8%) by specialists. A total of 148 (16%) patients were admitted. Of these, 84 (57%) were females and 47% of admissions were aged 15 years or more. Nine (18%) of 51 referrals made by medical officers were admitted compared to 139 (16%) of 863 by registered general nurses. The rate of admission was not different by referrer (p = 0.7). CONCLUSIONS: The main reasons for referral from urban clinics to central hospitals are for doctors to either establish the diagnosis or provide treatment. There is scope for reducing the number of referrals made primarily for these reasons if a secondary or tertiary level of care institution is availed to Bulawayo and/or if clinic operations are reorganized to make medical officers' advice more accessible to registered general nurses during working hours.

Adolescent↗

PubMed1997

Measles complications: the importance of their management in reducing mortality attributed to measles.

OBJECTIVE: To determine the effect of rates of complications among cases and management of complicated cases on measles case fatality rates. DESIGN: Measles disease surveillance. SETTING: City of Gweru, Department of Health. SUBJECTS: Children aged zero to 15 years. MAIN OUTCOME MEASURES: Case fatality rates. RESULTS: Measles case fatality rates declined from 47.6 in 1967 to zero in 1989. Between 1967 and 1978 respiratory infections were the predominant complications (66.5%), while after 1979 diarrhoea was the predominant complications (60.6%). A significant partial correlation coefficient was observed between rates of mortality among complicated cases and case fatality rates (r = 0.89, df = 20, p < 0.001). CONCLUSION: Good management of complicated cases may have contributed towards the decline in measles case fatality rates.

Adolescent↗

PubMed1997

The health information system in the City of Bulawayo, Zimbabwe: how good is it?

OBJECTIVE: To evaluate the operations and attributes of the outpatient diseases (OPD) surveillance system in the City of Bulawayo. DESIGN: Cross sectional and descriptive study. The system's attributes were evaluated using Centres for Disease Control and Prevention (CDC) evaluation guidelines. We also held focus group discussions with health personnel regarding the use of collected data. SETTING: 6 of 17 health care clinics in Bulawayo, the second largest city in Zimbabwe. SUBJECTS: 34 health personnel were interviewed. MAIN OUTCOME MEASURES: Knowledge of the system's operations, and attributes of the system. RESULTS: Data providers interviewed and all those who participated in Focus Group Discussions (FGDs) had good knowledge of the system's operations. The system is complex. It reports on 94 health events, of which only six (6%) have standard case definitions. All 17 clinics participated in this surveillance. However, of 54 returns studied, 67% were incomplete, and 69% were sent in after the deadline. The system has no plans on how data should be analyzed, used and disseminated. CONCLUSIONS: The CODROPA system is potentially useful in detecting trends of diseases. However, the long delay between data collection and data analysis does not allow for early detection of epidemics and clusters of diseases may be missed. A simpler and less time consuming surveillance system should be started to improve the system's attributes particularly, timeliness of reporting and acceptability of the system to those who have or need to participate.

Ambulatory Care↗

PubMed1997

Comparison of protection afforded by single measles vaccination and late revaccination schedules.

An intervention study compared the protection afforded vaccinees by single measles vaccination and late revaccination schedules in 1990-94. During the intervention a single revaccination (after initial vaccination at nine months of age) was applied to children at any point in time between 12 and 23 months of age. Cases of measles aged 10-23 months were identified through an active surveillance system and in this period 5, 11 and 11 cases of revaccinated, single vaccination and unvaccinated children were identified. Measles incidence rates were 392.2-415.6 (mean = 405.6, SD = 6.7), 75.4-112.1 (median = 91.7, SD = 13.3) and 12.8-15.2 (mean = 13.9, DS = 0.99) per 100,000 population in children who were unvaccinated, with single vaccination and revaccinated respectively. Relative risk of contracting measles in children who were unvaccinated or with single vaccination was 26.5-32.5 (mean = 29.4, SD = 2.3) and 5.8-8.8 (mean = 6.8, SD = 1.2) respectively compared with revaccinated children. Vaccine efficacies that were determined were 73-81% (mean = 77.2, SD = 2.9) and 96.2-96.9% (mean = 96.6, SD = 0.27) for single vaccination and late revaccination schedules respectively. It was concluded that late revaccination affords vaccinees better protection than single vaccination through improvement in vaccine.

Age Factors↗

PubMed1997

Using epidemiologic tools to control an outbreak of diarrhoea in a textile factory, Bulawayo, Zimbabwe.

Dysentery is endemic in Zimbabwe. More than 260,000 cases and a case fatality of four per thousand were reported in 1993. In late July 1994, the Health Services Department in Bulawayo was informed of two cases of Shigella dysenteriae type I at a textile factory that employs 138 workers. Workers were interviewed at the factory regarding the date of the onset of illness, symptoms, food consumed, and treatment received. Factory water supply, cooking, and sanitary facilities were inspected. Stool and water samples were obtained for analysis. A case was defined as an employee presenting with diarrhoea with onset from July 24 to August 25, 1994. Of the 99 workers on day and evening shifts, 75 (75%) were interviewed. Thirty eight workers met the case definition (Attack Rate 51%). Common symptoms were abdominal cramps (71%), and blood in stools (37%); median duration of diarrhoea was 11 days (range 5 to 32 days). Thirty seven (64%) of 58 workers who drank borehole water were ill compared to one (6%) of the 17 who did not (RR = 10.8, 95% CI = 1.6-73). No food items consumed were significantly associated with the illness. Two different shigella species (2 sonnei and 2 boydii) were isolated from five (13%) of 38 stool specimens. Water samples from the two boreholes yielded numerous faecal coliforms. Neither borehole was registered as required by the municipal bylaws, which also forbid use of borehole water for drinking. The epidemiologic and laboratory evidence implicate contaminated borehole water as the most likely cause of this outbreak. Enforcement of municipal bylaws on drilling, registration and use of boreholes is essential to avoid further outbreaks of waterborne diseases.

Disease Outbreaks↗