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Noble C, Mooney C, Makasi R, Ntozini R, Majo FD, Church JA, Tavengwa NV, Prendergast AJ, Humphrey JH, Manges A, Mangwadu G, Maluccio JA, Mbuya MNN, Moulton LH, Stoltzfus RJ, Tielsch JM, Smith LE, Chasokela C, Chigumira A, Heylar W, Hwena P, Kembo G, Mutasa B, Mutasa K, Rambanepasi P, Sauramba V, Van Der Keilen F, Zambezi C, Chidhanguro D, Chigodora D, Chipanga JF, Gerema G, Magara T, Mandava M, Mavhudzi T, Mazhanga C, Muzaradope G, Mwapaura MT, Phiri S, Tengende A, Banda C, Chasekwa B, Chidamba L, Chidawanyika T, Chikwindi E, Chingaona LK, Chiorera CK, Dandadzi A, Govha M, Gumbo H, Gwanzura KT, Kasaru S, Matsika AM, Maunze D, Mazarura E, Mpofu E, Mushonga J, Mushore TE, Muzira T, Nembaware N, Nkiwane S, Nyamwino P, Rukobo SD, Runodamoto T, Seremwe S, Simango P, Tome J, Tsenesa B, Amadu U, Bangira B, Chiveza D, Hove P, Jombe HA, Kujenga D, Madhuyu L, Mandina-Makoni P, Maramba N, Maregere B, Marumani E, Masakadze E, Mazula P, Munyanyi C, Musanhu G, Mushanawani RC, Mutsando S, Nazare F, Nyarambi M, Nzuda W, Sigauke T, Solomon M, Tavengwa T, Biri F, Chafanza M, Chaitezvi C, Chauke T, Chidzomba C, Dadirai T, Fundira C, Gambiza AC, Godzongere T, Kuona M, Mafuratidze T, Mapurisa I, Mashedze T, Moyo N, Musariri C, Mushambadope M, Mutsonziwa TR, Muzondo A, Mwareka R, Nyamupfukudza J, Saidi B, Sakuhwehwe T, Sikalima G, Tembe J, Chekera TE, Chihombe O, Chikombingo M, Chirinda T, Chivizhe A, Hove R, Kufa R, Machikopa TF, Mandaza W, Mandongwe L, Manhiyo F, Manyaga E, Mapuranga P, Matimba FS, Matonhodze P, Mhuri S, Mike J, Ncube B, Nderecha WTS, Noah M, Nyamadzawo C, Penda J, Saidi A, Shonhayi S, Simon C, Tichagwa M, Chamakono R, Chauke A, Gatsi AF, Hwena B, Jawi H, Kaisa B, Kamutanho S, Kaswa T, Kayeruza P, Lunga J, Magogo N, Manyeruke D, Mazani P, Mhuriyengwe F, Mlambo F, Moyo S, Mpofu T, Mugava M, Mukungwa Y, Muroyiwa F, Mushonga E, Nyekete S, Rinashe T, Sibanda K, Chemhuru M, Chikunya J, Chikwavaire VF, Chikwiriro C, Chimusoro A, Chinyama J, Gwinji G, Hoko-Sibanda N, Kandawasvika R, Madzimure T, Maponga B, Mapuranga A, Marembo J, Matsunge L, Maunga S, Muchekeza M, Muti M, Nyamana M, Azhuda E, Bhoroma U, Biriyadi A, Chafota E, Chakwizira A, Chamhamiwa A, Champion T, Chazuza S, Chikwira B, Chingozho C, Chitabwa A, Dhurumba A, Furidzirai A, Gandanga A, Gukuta C, Macheche B, Marihwi B, Masike B, Mutangandura E, Mutodza B, Mutsindikwa A, Mwale A, Ndhlovu R, Nduna N, Nyamandi C, Ruvata E, Sithole B, Urayai R, Vengesa B, Zorounye M, Bamule M, Bande M, Chahuruva K, Chidumba L, Chigove Z, Chiguri K, Chikuni S, Chikwanda R, Chimbi T, Chingozho M, Chinhamo O, Chinokuramba R, Chinyoka C, Chipenzi X, Chipute R, Chiribhani G, Chitsinga M, Chiwanga C, Chiza A, Chombe F, Denhere M, Dhamba E, Dhamba M, Dube J, Dzimbanhete F, Dzingai G, Fusira S, Gonese M, Gota J, Gumure K, Gwaidza P, Gwangwava M, Gwara W, Gwauya M, Gwiba M, Hamauswa J, Hlasera S, Hlukani E, Hotera J, Jakwa L, Jangara G, Janyure M, Jari C, Juru D, Kapuma T, Konzai P, Mabhodha M, Maburutse S, Macheka C, Machigaya T, Machingauta F, Machokoto E, Madhumba E, Madziise L, Madziva C, Madzivire M, Mafukise M, Maganga M, Maganga S, Mageja E, Mahanya M, Mahaso E, Mahleka S, Makanhiwa P, Makarudze M, Makeche C, Makopa N, Makumbe R, Mandire M, Mandiyanike E, Mangena E, Mangiro F, Mangwadu A, Mangwengwe T, Manhidza J, Manhovo F, Manono I, Mapako S, Mapfumo E, Mapfumo T, Mapuka J, Masama D, Masenge G, Mashasha M, Mashivire V, Matunhu M, Mavhoro P, Mawuka G, Mazango I, Mazhata N, Mazuva D, Mazuva M, Mbinda F, Mborera J, Mfiri U, Mhandu F, Mhike C, Mhike T, Mhuka A, Midzi J, Moyo S, Mpundu M, Msindo NM, Msindo D, Mtisi C, Muchemwa G, Mujere N, Mukaro E, Muketiwa K, Mungoi S, Munzava E, Muoki R, Mupura H, Murerwa E, Murisi C, Muroyiwa L, Muruvi M, Musemwa N, Mushure C, Mutero J, Mutero P, Mutumbu P, Mutya C, Muzanango L, Muzembi M, Muzungunye D, Mwazha V, Ncube T, Ndava T, Ndlovu N, Nehowa P, Ngara D, Nguruve L, Nhigo P, Nkiwane S, Nyanyai L, Nzombe J, Office E, Paul B, Pavari S, Ranganai S, Ratisai S, Rugara M, Rusere P, Sakala J, Sango P, Shava S, Shekede M, Shizha C, Sibanda T, Tapambwa N, Tembo J, Tinago N, Tinago V, Toindepi T, Tovigepi J, Tuhwe M, Tumbo K, Zaranyika T, Zaru T, Zimidzi K, Zindo M, Zindonda M, Zinhumwe N, Zishiri L, Ziyambi E, Zvinowanda J, Bepete E, Chiwira C, Chuma N, Fari A, Gavi S, Gunha V, Hakunandava F, Huku C, Hungwe G, Maduke G, Manyewe E, Mapfumo T, Marufu I, Mashiri C, Mazenge S, Mbinda E, Mhuri A, Muguti C, Munemo L, Musindo L, Ngada L, Nyembe D, Taruvinga R, Tobaiwa E, Banda S, Chaipa J, Chakaza P, Chandigere M, Changunduma A, Chibi C, Chidyagwai O, Chidza E, Chigatse N, Chikoto L, Chingware V, Chinhamo J, Chinhoro M, Chiripamberi A, Chitavati E, Chitiga R, Chivanga N, Chivese T, Chizema F, Dera S, Dhliwayo A, Dhononga P, Dimingo E, Dziyani M, Fambi T, Gambagamba L, Gandiyari S, Gomo C, Gore S, Gundani J, Gundani R, Gwarima L, Gwaringa C, Gwenya S, Hamilton R, Hlabano A, Hofisi E, Hofisi F, Hungwe S, Hwacha S, Hwara A, Jogwe R, Kanikani A, Kuchicha L, Kutsira M, Kuziyamisa K, Kuziyamisa M, Kwangware B, Lozani P, Mabuto J, Mabuto V, Mabvurwa L, Machacha R, Machaya C, Madembo R, Madya S, Madzingira S, Mafa L, Mafuta F, Mafuta J, Mahara A, Mahonye S, Maisva A, Makara A, Makover M, Mambongo E, Mambure M, Mandizvidza E, Mangena G, Manjengwa E, Manomano J, Mapfumo M, Mapfurire A, Maphosa L, Mapundo J, Mare D, Marecha F, Marecha S, Mashiri C, Masiya M, Masuku T, Masvimbo P, Matambo S, Matarise G, Matinanga L, Matizanadzo J, Maunganidze M, Mawere B, Mawire C, Mazvanya Y, Mbasera M, Mbono M, Mhakayakora C, Mhlanga N, Mhosva B, Moyo N, Moyo O, Moyo R, Mpakami C, Mpedzisi R, Mpofu E, Mpofu E, Mtetwa M, Muchakachi J, Mudadada T, Mudzingwa K, Mugwira M, Mukarati T, Munana A, Munazo J, Munyeki O, Mupfeka P, Murangandi G, Muranganwa M, Murenjekwa J, Muringo N, Mushaninga T, Mutaja F, Mutanha D, Mutemeri P, Mutero B, Muteya E, Muvembi S, Muzenda T, Mwenjota A, Ncube S, Ndabambi T, Ndava N, Ndlovu E, Nene E, Ngazimbi E, Ngwalati A, Nyama T, Nzembe A, Pabwaungana E, Phiri S, Pukuta R, Rambanapasi M, Rera T, Samanga V, Shirichena S, Shoko C, Shonhe M, Shuro C, Sibanda J, Sibangani E, Sibangani N, Sibindi N, Sitotombe M, Siwawa P, Tagwirei M, Taruvinga P, Tavagwisa A, Tete E, Tete Y, Thandiwe E, Tibugari A, Timothy S, Tongogara R, Tshuma L, Tsikira M, Tumba C, Watinaye R, Zhiradzango E, Zimunya E, Zinengwa L, Ziupfu M, Ziyambe J. Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial. BMC Pregnancy Childbirth 2022; 22:981. [PMID: 36585673 PMCID: PMC9805263 DOI: 10.1186/s12884-022-05282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. METHODS This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. RESULTS Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. CONCLUSIONS Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov, number NCT01824940.
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Affiliation(s)
- Christie Noble
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK
| | - Ciaran Mooney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beechill House, 42 Beechill Rd, Belfast, BT8 7RL UK
| | - Rachel Makasi
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Florence D. Majo
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - James A. Church
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Naume V. Tavengwa
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Andrew J. Prendergast
- grid.4868.20000 0001 2171 1133Blizard Institute, Queen Mary University of London, London, UK ,grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jean H. Humphrey
- grid.493148.3Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe ,grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Poncin M, Marembo J, Chitando P, Sreenivasan N, Makwara I, Machekanyanga Z, Nyabyenda W, Mukeredzi I, Munyanyi M, Hidle A, Chingwena F, Chigwena C, Atuhebwe P, Matzger H, Chigerwe R, Shaum A, Date K, Garone D, Chonzi P, Barak J, Phiri I, Rupfutse M, Masunda K, Gasasira A, Manangazira P. Implementation of an outbreak response vaccination campaign with typhoid conjugate vaccine – Harare, Zimbabwe, 2019. Vaccine X 2022; 12:100201. [PMID: 35983519 PMCID: PMC9379662 DOI: 10.1016/j.jvacx.2022.100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/07/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Typhoid fever is a public-health problem in Harare, the capital city of Zimbabwe, with seasonal outbreaks occurring annually since 2010. In 2019, the Ministry of Health and Child Care (MOHCC) organized the first typhoid conjugate vaccination campaign in Africa in response to a recurring typhoid outbreak in a large urban setting. Method As part of a larger public health response to a typhoid fever outbreak in Harare, Gavi approved in September 2018 a MOHCC request for 340,000 doses of recently prequalified Typbar-TCV to implement a mass vaccination campaign. To select areas for the campaign, typhoid fever surveillance data from January 2016 until June 2018 was reviewed. We collected and analyzed information from the MOHCC and its partners to describe the vaccination campaign planning, implementation, feasibility, administrative coverage and financial costs. Results The campaign was conducted in nine high-density suburbs of Harare over eight days in February–March 2019 and targeted all children aged 6 months–15 years; however, the target age range was extended up to 45 years in one suburb due to the past high attack rate among adults. A total of 318,698 people were vaccinated, resulting in overall administrative coverage of 85.4 percent. More than 750 community volunteers and personnel from the MOHCC and the Ministry of Education were trained and involved in social mobilization and vaccination activities. The MOHCC used a combination of vaccination strategies (i.e., fixed and mobile immunization sites, a creche and school-based strategy, and door-to-door activities). Financial costs were estimated at US$ 2.39 per dose, including the vaccine and vaccination supplies (US$ 0.79 operational costs per dose excluding vaccine and vaccination supplies). Conclusion A mass targeted campaign in densely populated urban areas in Harare, using the recently prequalified typhoid conjugate vaccine, was feasible and achieved a high overall coverage in a short period of time.
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Affiliation(s)
- M. Poncin
- World Health Organization, Geneva, Switzerland
- Corresponding author at: Square Clair-Matin 44, 1213 Petit Lancy, Switzerland.
| | - J. Marembo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Chitando
- Harare City Health Department, Harare, Zimbabwe
| | - N. Sreenivasan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - I. Makwara
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - M. Munyanyi
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - C. Chigwena
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Atuhebwe
- World Health Organization, Brazzaville, Republic of the Congo
| | - H. Matzger
- World Health Organization, Geneva, Switzerland
| | - R. Chigerwe
- Harare City Health Department, Harare, Zimbabwe
| | | | - K. Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - D. Garone
- Médecins Sans Frontières, Brussels, Belgium
| | - P. Chonzi
- Harare City Health Department, Harare, Zimbabwe
| | - J. Barak
- United Nations Children's Fund, Harare, Zimbabwe
| | - I. Phiri
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - K. Masunda
- Harare City Health Department, Harare, Zimbabwe
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