The future of health in Zimbabwe

Bidirectional needs assessment of otolaryngology-head and neck surgery short-term surgical trips in Zimbabwe

Objectives

To describe findings from an otolaryngology-specific needs assessment tool in Zimbabwe.

Methods

Surveys were developed and shared with Low-Middle Income Country (LMIC) hosting institutions in Zimbabwe and to High-Income Country surgical trip participants (HIC). Respondents were otolaryngologists identified online and through professional networks who had participated in a surgical trip.

Results

The most common procedures Zimbabwe otolaryngologists reported treating were adenotonsillectomy (85.7%), chronic rhinosinusitis (71.4%), chronic otitis (57.1%), and head and neck tumor intervention (57.1%). The most common untreatable conditions that host physicians wanted to treat were skull base surgery (71.4%), flap reconstructions (57.1%), and laryngotracheal reconstruction (57.1%). The largest discrepancy between host desires and visiting team offerings were flap reconstruction (57.1%), nasal bone deformities (37.1%), and laryngotracheal reconstruction (17.1%). Perceptions of short-term surgical trips (STST) were recorded for host and visiting teams, and important differences between the public and private sectors of care in Zimbabwe were also identified.

Conclusion

The surveys utilized in this study served as a bidirectional needs assessment of the requirements and care goals of host institutions and visiting teams in Zimbabwe. Differences between public and private sectors of care, particularly regarding infrastructure, resources, and surgical goals, were revealed, and the results can be utilized as part of efforts to maximize efforts within global surgical partnerships.

Level of Evidence

VI.

Clinical characteristics and outcomes of patients admitted with COVID-19 at a public-sector hospital over the first two waves of SARS-CoV-2 infection in Harare, Zimbabwe: A prospective cohort study

BACKGROUND

We investigated the clinical profile, complications, and outcomes of inpatients with COVID-19 at Parirenyatwa Hospital, Harare, across the first two waves of SARS-CoV-2 infection, and factors associated with mortality.

METHODS

We conducted a prospective cohort study on all patients admitted to the COVID-19 unit. Data were extracted from medical records and negative binomial regression with robust standard errors was used to assess the association between sociodemographic and clinical characteristics and mortality. Cox Regression was used for sensitivity analysis.

RESULTS

Of 563 people admitted with COVID-19 between 2 July 2020 and 19 March 2021, 214 (38.0%) died, 340 were discharged and 9 transferred. The median age was 56 (IQR 44-68) years and 53.8% were male. Overall, 38.8% experienced a complication, the most common being acute kidney injury (17.9%) and hyperglycaemia (13.1%). The most common comorbidity was hypertension (41.3%) followed by diabetes (28.6%), HIV (12.1%), cardiovascular disease (10.9%) and chronic kidney disease (7.8%). Among participants who stayed in the ward for more than 1 night, mortality was higher in patients with comorbidity compared to those without any comorbidity (38.7% vs 25.5%, risk ratio (RR) = 1.52 (95% CI 1.11, 2.07), p = 0.008). After adjusting for oxygen saturation, comorbidities, sex and pregnancy, mortality was higher in the second wave than in the first (adjusted RR 1.23, 95% CI 1.00-1.51, p = 0.05). In the second wave 57/161 (35.4%) deaths were attributed to lack of resources, mainly human resources.

CONCLUSION

The mortality rate was high and clinical COVID-19 care needs to pay careful attention to patient monitoring for complications and management of comorbidities. This will require addressing the critical health workforce shortage issues. Prevention of COVID-19 including vaccination particularly among individuals with comorbidities remains a high priority.

The Interface between the State and NGOs in Delivering Health Services in Zimbabwe-A Case of the MSF ART Programme

An over-reliance on donor funding for HIV/AIDS healthcare services remains a concern in Africa. This study, therefore, explores the partnership between the Zimbabwean government and an international non-governmental organisation in delivering HIV/AIDS healthcare services. An interpretivist paradigm and descriptive phenomenological design were used to elicit the opinions, perceptions, and experiences of forty purposively sampled key informants. Thematic analysis was employed using ATLAS.ti version 7.1.4 to analyse the data. The differences in terms of policies, structures, and administrative issues between the partners identified challenges in the implementation of the programme. This was demonstrated through the reversal of the gains attained in prevention, care, and treatment. This raises concerns for increased risk of defaulters, drug resistance, and deaths. Therefore, the partners in this endeavour should negotiate an aligned approach for the efficient delivery of HIV/AIDS healthcare services.

Exploring the perceptions of radiographers pertaining to the provision of quality radiological services in Zimbabwe

INTRODUCTION

Radiology is part of the service industry; therefore, there is a need to understand quality and its associated factors. The cost of poor service quality is a loss of competitive advantage, increased litigation, misdiagnosis, unnecessary radiation exposure, and patient mortality. There has been little research into the factors influencing the quality of radiological services in Zimbabwe. This work, therefore, aimed to explore the radiographer's perceptions of the factors that affect the quality of radiological services at central hospitals in the Harare Metropolitan Province.

METHODS

A qualitative, explorative study applying the SERVQUAL model was carried out. One-on-one interviews with 10 purposively sampled radiographers employed at central hospitals in the Harare Metropolitan Province were conducted. The data were managed by Nvivo 12 (QSR International) and analyzed by framework analysis.

RESULTS

Radiographer's perceptions of the factors that affect the quality of radiological services were categorized by five themes namely; i. Tangibles - the physical appearance of the radiology department and facilities, ii. Reliability and dependability - the ability to perform the promised service dependably and accurately, iii. Responsiveness - the willingness to help patients and provide prompt service, iv. Assurance - the knowledge and courtesy of radiology staff and their ability to inspire trust and confidence, and v. Empathy - caring, the individualized attention the radiology department provides to its patients.

CONCLUSION

Economically viable, well-designed national strategies are needed to prioritize and fund radiology in Zimbabwe and other resource-constrained settings. Recognition of acquired specialist skills by radiographers to halt the exodus and training of radiologists, radiology nurses, medical physicists, and biomedical engineers by local institutions will go a long way in improving the quality of radiological services.

Traditional management of female infertility in Africa: a scoping review protocol

INTRODUCTION

Infertility adversely affects the sexual reproductive health and overall quality of life of people. Recent estimates show that about one in six people (both men and women) experience infertility in their lifetime. This scoping review will, therefore, map the existing evidence on traditional management of female infertility in Africa including the effectiveness of the traditional healthcare systems, to inform policy and practice.

METHODS

The scoping review will be guided by the Arksey and O'Malley framework in conjunction with the Joanna Briggs Institute updated methodological guidance for scoping reviews. A search strategy will be developed, which will target the following databases: PubMed, Scopus, Embase, CINAHL, Google Scholar and Africa-Wide Information including grey literature. The screening of titles, abstracts and full text will be done by two independent reviewers. Data will be extracted, analysed numerically and thematically. The reporting of the scoping review will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.

ETHICS AND DISSEMINATION

This scoping review will not require ethical approval as this is secondary analysis of peer-reviewed articles. The findings of the review will be disseminated on various platforms including conferences, meetings to key stakeholders and in a peer-reviewed journal for wider sharing.

Radiographers' views on the workplace factors that impact their mental health: Findings of a survey at central hospitals in Zimbabwe

BACKGROUND

Delivering high-quality radiography services is an ethical duty that calls for radiographers' dedication and their capacity to handle obstacles to their mental health that arise at work. The purpose of this study was to evaluate the radiographers' views on the workplace factors that impact their mental health in a sample from Harare Metropolitan Province, Zimbabwe.

METHODS

A cross-sectional survey using a structured questionnaire was conducted from 10 August to 10 September 2022. A total of 37 out of 56 radiographers working at central hospitals in Harare Metropolitan Province participated in the survey. Both descriptive and inferential statistics were used in the analysis. Data were analyzed using Stata 13.

RESULTS

Frustration and stress were the most commonly reported feelings among 78.38% and 72.97% of radiographers respectively. Most radiographers agreed that workplace stress influences relationships with family, friends, and coworkers. More than half of the radiographers agreed that workplace stress has forced them to start looking for a new position. A large proportion of radiographers (41.18%) reported that they had no emotional support with only 35.29% reporting that they do have emotional support. When asked to select their top 3 work-related stressors in the last 3 months, 70.27% reported frequent equipment breakdowns, and 67.57% reported poor remuneration. There was no significant difference between diagnostic radiographers and therapy radiographers with respect to stress (Pearson chi-square = 0.57, p = 0.45).

CONCLUSION

Appropriate support mechanisms should be considered to address the issues affecting mental health; as currently this may be a factor leading to the emigration of radiographers.

Should disability-inclusive health be a priority in low-income countries? A case-study from Zimbabwe

The National Disability Policy was launched in Zimbabwe in June 2021 and includes a range of commitments for the provision of disability-inclusive health services and rehabilitation. Fulfilment of these pledges is important, as at least 7% of the population have disabilities, and people with disabilities face greater challenges accessing healthcare services and experience worse health outcomes. However, it will require financial investment which is challenging as the needs of people with disabilities are set against a background of widespread health systems failures in Zimbabwe, exacerbated by the COVID-19 pandemic. Zimbabwe currently faces an epidemic of TB and HIV and a growing burden of non-communicable diseases (NCDs) with a lack of investment, healthcare staff or infrastructure to provide the necessary care. Urgent action is therefore needed to strengthen the health system and 'build back better' after both the pandemic and the regime change. The Zimbabwean government may face the dilemma, common in many low-resource settings, of whether to focus on disability or to wait until the health system has been strengthened for the majority. This paper proposed four complementary arguments why it is important to focus on people with disabilities. First, this focus respects the rights of people with disabilities, including those specified in the new National Disability Policy. Second, it will be challenging to reach the Sustainable Development Goals, including those on health and other global health targets, without including people with disabilities. Third, there is a growing rationale that disability-inclusive health systems will work better for all, and fourth, that they will create cost savings. Everyone will therefore benefit when the health systems are designed for inclusion. In conclusion, a focus on disability may help to strengthen health systems for all as well as helping to achieve human rights and global development goals.

Factors leading to disruptive behaviours at central hospitals in Harare Metropolitan Province: Radiography managers perspectives

BACKGROUND

The negative consequences of disruptive behaviours involving healthcare workers threatens the institution's image, staff morale, finances, and patient safety. While all kinds of health organisations or settings are potentially exposed to disruptive behaviours, some are at higher risk than others because of both environmental and cultural factors. Such risk should be assessed having regard to the specific situation and conditions in which each healthcare organization operates.

AIM

The aim of this study was to explore radiography manager's perspectives on the environmental and cultural factors leading to DBs involving radiographers at central hospitals in Harare Metropolitan Province.

METHODS

An exploratory qualitative study employing in-depth interviews with 11 radiography managers across five departments at three central hospitals selected by criterion purposive sampling was done. The interview data were analysed using Tesch's method of qualitative analysis.

RESULTS

The key environmental and cultural factors identified included three themes: power hierarchy, work environment and reporting framework. Power hierarchy comprised categories, superiority, professional boundaries and representation. The work environment incorporated categories, trust in leadership, burnout and fatigue and remuneration. Lastly, reporting framework included categories, lack of protocol and reporting culture.

CONCLUSION

Radiography managers believe that environmental factors play a bigger role in leading to disruptive behaviours that involve radiographers at central hospitals in Harare Metropolitan Province. This underscores the need for hospital and radiography managers to pay particular emphasis on these when formulating policies and procedures to address these behaviours. Addressing DBs ensures that healthy work environments are promoted which in turn ensures that patients receive optimum and safe care.

IMPLICATIONS FOR PRACTICE

The paper provides an insight into the environmental and cultural dynamics that may trigger disruptive behaviours involving radiographers. This information is invaluable in formulating policies and procedures for addressing these unprofessional behaviours.

Radiography Managers’ Perspectives on the Strategies to Mitigate Disruptive Behaviours: A Qualitative Exploratory Study

Disruptive behaviours (DBs) are not normally in the scope of legal sanctions, notwithstanding their undesirable effects. Hence, many healthcare organizations still have difficulty in dealing with them in an effective manner. Several studies suggest that few organizations have tailor-made policies or procedures for evaluating, proving and mitigating these behaviours. However, evidence shows that mitigating DBs is critical to empowering healthcare workers to focus on providing superior, affordable and safe patient care. The aim of this study was to explore radiography managers’ perspectives on the strategies to mitigate DBs involving radiographers. An exploratory qualitative study employing one-on-one semi-structured in-depth interviews was carried out between March and April 2021. Eleven radiography managers at central hospitals in Harare Metropolitan Province were selected by criterion-purposive sampling. The interview data were analyzed using Tesch’s method of qualitative analysis. The data were first manually coded and then entered into Nvivo (QSR International Version 11) for further analysis. Three themes emerged from the interview data including awareness of DBs, willingness to address DBs, and conflict resolution. Context-specific strategies to mitigate DBs should be identified and implemented to guarantee a healthy work environment for radiographers so that they focus on providing excellent and safe patient care.

Interrupted Access to and Use of Family Planning Among Youth in a Community-Based Service in Zimbabwe During the First Year of the COVID-19 Pandemic

The COVID-19 pandemic has had serious impacts on economic, social, and health systems, and fragile public health systems have become overburdened in many countries, exacerbating existing service delivery challenges. This study describes the impact of the COVID-19 pandemic on family planning services within a community-based integrated HIV and sexual and reproductive health intervention for youth aged 16-24 years being trialled in Zimbabwe (CHIEDZA). It examines the experiences of health providers and clients in relation to how the first year of the pandemic affected access to and use of contraceptives.

A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare

Background: On average, people with disabilities have greater healthcare needs, yet face a range of barriers in accessing care.Objectives: Our objectives were to explore the experiences of people with disabilities in accessing care and identify opportunities for the health system to be designed for inclusion in Zimbabwe.Methods: In-depth qualitative interviews were conducted between May and June 2021 with 24 people with disabilities (identified through purposive sampling) and with 10 key informants from local and national health authorities (identified through expert recommendations). Interviews explored the experience of accessing healthcare prior to the coronavirus disease 2019 (COVID-19) pandemic. Interviews were transcribed, coded and thematically analysed. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform barriers to inclusive healthcare and disparities in outcomes faced by people with disabilities.Results: People with disabilities experienced difficulties accessing health services in Zimbabwe prior to COVID-19. These experiences were shaped by health literacy, self-stigma and affordability of services, which limited demand. Supply of health services was constrained by the perceived poor capacity of health workers to treat people with disabilities and discrimination. Inclusion was facilitated by clinic staff support of people with disabilities’ access to medication through referral to mission hospitals and private clinics, and the lobbying of organisations of people with disabilities.Conclusion: Strategies to promote disability inclusion in healthcare include meaningfully engaging people with disabilities, investing in organisations of people with disabilities, protecting funding for disability inclusion, collecting and analysing disability-disaggregated data and strengthening a twin-track approach to health service provision.

Perceptions of diabetes patients and their caregivers regarding access to medicine in a severely constrained health system: A qualitative study in Harare, Zimbabwe

Nearly half of all sub-Saharan African countries lack operational Diabetes Mellitus policies. This represents an opportunity to build reliable evidence to underpin such policies when they are eventually developed. Representing the interests of those with the experience of living with the condition in national diabetes policies is important, particularly the interests regarding medicine access, a key pillar in diabetes management. One way to achieve this representation is to publish patient perceptions. Patient perspectives are especially valuable in the context of diabetes in Sub-Saharan Africa, where much of the empirical work has focused on clinical and epidemiological questions. We therefore captured the challenges and suggestions around medicine access articulated by a population of diabetes patients and their caregivers. This was a qualitative interpretivist study based on data from focus group discussions with adult diabetes patients and their caregivers. Eight FGDs of 4-13 participants each whose duration averaged 13.35 minutes were conducted. Participants were recruited from diabetes outpatient clinics at two health facilities in Harare. One site was Parirenyatwa Hospital, the largest public referral and teaching hospital in Zimbabwe. The other was a private for-profit facility. Ethics approval was granted by the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: JREC 295/18). Diabetes patients and their caregivers are interested in affordable access to medicines of acceptable form and quality with minimum effort. Yet, they often find themselves privileging one dimension of access over another e.g. prioritising affordability over acceptability. Based on participants' articulations, a sound diabetes policy should: 1. provide for financial and consumer protections, 2. regulate healthcare business practices and medicine prices, 3. provide for a responsive health workforce attentive to patient problems, 4. accord the same importance to diabetes that is accorded to communicable diseases, 5. decentralize diabetes management to lower levels of care, 6. limit wastage, corruption, bad macro-financial governance and a lack of transparency about how funding for health is used, and 7. provide support to strengthen patients' and caregivers' psychosocial networks. A diabetes policy acceptable to patients is one infused with principles of good governance, fairness, inclusiveness and humanity; characterised by: financial protection and price regulation, consumer protection, equity in the attention accorded to different diseases, decentralized service delivery, inclusion of patient voice in political decision-making, a responsive compassionate health workforce, psychosocial support for patients and their caregivers and allocative efficiency and transparency in public expenditure.

Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe

Background

Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care.

Methods

We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model.

Results

Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy.

Conclusions

Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04186-6.

Z Factor: Drama as a tool to tackle mental health stigma: study design and protocol for community and public engagement in rural Zimbabwe

Background: Mental health is slowly gaining global significance as a key health issue, yet the stigma attached to psychosis is still a major problem. There has been little in-depth exploration of sustainable, cost-effective, and replicable community engagement strategies that address mental health myths and stigma, which are major barriers to early health-seeking behaviours. In low-income countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models, perpetuating an environment where mental health conversations are a cultural taboo. Mental health interventions should be accompanied by creative, evidence-based community engagement, ensuring that interventions are suitable for local settings and giving communities a voice in directing their health initiatives.  Methods: Z Factor aimed to engage young adults and their support networks across a variety of socioeconomic groups in a rural district of Zimbabwe through their participation in an inter-ward five-staged drama competition. The focus was on psychosis, with subcategories of initial presentation/detection, seeking help/pathway to care, and the road to recovery/treatment. Each drama group's composition included a young adult and a typical support network seeking treatment from the service provider of choice. Dramas were to act as discussion starters, paving the way toward broader and deeper psychosis treatment discussions among rural communities and gaining insight into service user expectations from health research. Conclusions: Outcomes of the pilot community engagement project will be instrumental in improving understanding community perceptions about psychosis treatment and recovery in rural Zimbabwe and increasing community awareness about psychosis, as well as paving the way for initiating service provider collaboration to promote early detection and encouraging early health-seeking behaviours. The above outcomes will also inform the design of models for more responsive community and public engagement initiatives in similar low resource settings in Zimbabwe and beyond.

Antibiotics, rational drug use and the architecture of global health in Zimbabwe

Rising concerns around antimicrobial resistance (AMR) have led to a renewed push to rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease in conceptualising antibiotic use as individuals behaving '(ir)rationally' and recognition that rising use is emergent of and contributing to wider economic and political challenges. But in between these individual and societal 'drivers' of antibiotic use is an everyday articulation of care through these substances, written-in to the scripts, delivery chains and pedagogics of global healthcare. This article focuses on this everyday 'architecture' that over time and across spaces has knitted-in antibiotics and rhetorics of control that inform current responses to AMR. Based on historically informed ethnographic research in Zimbabwe, we examine points of continuity and change between 20th Century rational drug use (RDU) discourses and contemporary socio-political formations around AMR and antimicrobial stewardship (AMS), paying particular attention to their co-evolution with the process of pharmaceuticalisation. We illustrate how the framework and techniques of RDU were embedded within programmes to increase access to essential medicines and as such complemented the building of one of Africa's strongest postcolonial health systems in Zimbabwe. Whilst 20th Century RDU was focused on securing the health and safety of patients and affordability for systems, AMS programmes aim to secure medicines. Continuous through both RDU and AMS programmes is the persistent rhetoric of 'irrational use'. Health workers in Harare, attuned to the values and language of these programmes, enact in their everyday practice an architecture in which antibiotics have been designed-in. This research illustrates the struggle to optimise antibiotic use within current framings for action. We propose a reconfiguring of the architecture of global health such that frontline prescribers are able to provide 'good' care without necessarily turning to antibiotics. To design-out antibiotic reliance would require attention beyond '(ir)rationality', to the redrafting of blueprints that inscribe practice.

Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe - a theory-driven qualitative study to inform design of a behaviour change intervention

BACKGROUND

Hospital-acquired infection (HAI) is an increasing cause of neonatal morbidity/mortality in low-income settings. Hospital staff behaviours (e.g., hand hygiene) are key contributors to HAI. Understanding the drivers of these can inform interventions to improve infection prevention and control (IPC).

AIM

To explore barriers/facilitators to IPC in a neonatal unit in Harare, Zimbabwe.

METHODS

Interviews were conducted with 15 staff members of neonatal and maternity units alongside ethnographic observations. The interview guide and data analysis were informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model and explored individual, socio-cultural, and organizational barriers/facilitators to IPC. Potential interventions were identified using the Behaviour-Change Wheel.

FINDINGS

Enablers within Capability included awareness of IPC, and within Motivation beliefs that IPC was crucial to one's role, and concerns about consequences of poor IPC. Staff were optimistic that IPC could improve, contingent upon resource availability (Opportunity). Barriers included: limited knowledge of guidelines, no formal feedback on performance (Capability), lack of resources (Opportunity), often leading to improvization and poor habit formation. Further barriers included the unit's hierarchy, e.g., low engagement of cleaners and mothers in IPC, and staff witnessing implementation of poor practices by other team members (Opportunity). Potential interventions could include role-modelling, engaging mothers and staff across cadres, audit and feedback and flexible protocols (adaptable to water/handrub availability).

CONCLUSIONS

Most barriers to IPC fell within Opportunity, whilst most enablers fell under Capability and Motivation. Theory-based investigation provides the basis for systematically identifying and developing interventions to address barriers and enablers to IPC in low-income settings.

Mapping the role of health professionals in peace promotion within an urban complex emergency: the case of Chegutu, Zimbabwe

The study sought to establish the role of health professionals in promoting peace through health care using a case study of Chegutu Urban District in Zimbabwe. The participants were drawn from health professionals employed in three council clinics and were interviewed on their views on programmes that promote peace and end violence. Their narratives were thematically presented. Results revealed that although the participants had ideas on how to promote peace through health care, did health education and assisted victims of violence, their programmes were inhibited by several challenges, predominantly related to the state of the Zimbabwean economy. The study recommended a systematic focus on these challenges so that the health professionals can realize their potential. The study also recommended further research into the impact of village health workers in community peace and the use of a multisectoral approach to managing artisanal violence.

An analysis of the trends, characteristics, scope, and performance of the Zimbabwean pharmacovigilance reporting scheme

We aimed to determine the reporting trends and characteristics of Individual Case Safety Reports (ICSRs) from the Zimbabwean national pharmacovigilance system. ICSRs submitted to VigiBase^TM, the World Health Organisation's ICSR database between January 1993 and December 2017 were retrospectively reviewed with respect to the suspected medicine, System Organ Class (SOC), adverse drug reaction (ADR) type and seriousness, Anatomic Therapeutic Chemical (ATC) group, age, and gender. In total, 4071 ICSRs were submitted to VigiBase^TM from targeted spontaneous reporting (n = 2909; 71.5%), vaccine surveillance (n = 679; 16.7%), and passive spontaneous reporting (n = 483; 11.9%), respectively. The median age, ICSR completeness score and timeliness of reporting were 34.0 years (IQR: 14.0; 43.0), 0.90 (IQR: 0.70; 1.00), and 548.0 days (IQR: 266:1131), respectively. More than half of the ICRS were from female patients (n = 2233; 54.9%). Antiretrovirals, antibiotics, vaccines, and anti‐tubercular medicines were reported in 62.9%, 27.9%, 16.7%, and 13.3% of submitted ICSRs, respectively. The most frequent ADRs involved the skin and subcutaneous systems (n = 1111; 20.5%), nervous system (n = 733; 13.5%), and gastrointestinal disorders system (n = 654; 12.1%). The number of ADRs reported for each patient was significantly related to the reported medicine's ATC category (P = .001. The number of ADRs was significantly related to the use of antiretroviral agents. In conclusion, Zimbabwe has made significant progress in establishing a functional pharmacovigilance system. However, the present system reports on a limited therapeutic spectrum of medicines and potentially underestimates the national ADR burden. Further work is required to strengthen the more sustainable spontaneous reporting system which potentially captures a variety of therapeutic classes.