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Midzi N, Mutsaka-Makuvaza MJ, Charimari LS, Mangwiro P, Manengureni T, Mugadza G. Understanding facilitators and barriers to COVID-19 vaccination in the Zimbabwean population: a qualitative analysis. BMC Public Health 2024; 24:1174. [PMID: 38679733 PMCID: PMC11057155 DOI: 10.1186/s12889-024-18650-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Vaccines are effective biological interventions that reduce health burdens. However, during the COVID-19 pandemic, there were concerns about varying levels of COVID-19 vaccination coverage in the Zimbabwean population. This study aimed to understand facilitators and barriers to COVID-19 vaccine uptake in the Zimbabwean population. METHODS In September-October 2023, key informant interviews (KIIs) and focus group discussions (FGDs) were conducted with a sample comprising health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected across the country. At each site, the participant sample was homogeneous. Data were collected using audiotapes, transcribed verbatim, and translated into English. Data were analysed manually using thematic analysis. RESULTS Ten FGDs and 30 KIIs were conducted across the country. Among the facilitators of COVID-19 vaccine uptake were the perceived benefits of COVID-19 vaccination, such as protection from infection, severe disease and death. People also complied with COVID-19 vaccination because of the government's call for mandatory vaccination, travel restrictions, restrictions when entering some premises for services, visiting, working, learning and functions. Barriers to COVID-19 vaccine uptake included low-risk perception, negative attitudes emanating from concerns about the origins of the vaccines, COVID-19 cases or death of vaccinated people, negative peer influence, religious doctrines, cultural beliefs and misconceptions circulating through social media. Other barriers included knowledge gaps on COVID-19 vaccines, safety, effectiveness, side effects, access-related challenges to COVID-19 services and concerns over the changing policy on COVID-19 vaccination. CONCLUSIONS The study has shown the importance of community engagement and data-driven public health communication strategies to facilitate behaviour change for increased uptake of a vaccine. In future epidemics, public health campaigns should focus on the timely provision of information explaining the benefits of an intervention, addressing safety concerns more effectively. To build trust and hence improve vaccine uptake by the public, there is a need for continuous engagement with people and to provide platforms for dialogue to address issues contributing to low vaccine uptake.
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Affiliation(s)
- Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Masceline Jenipher Mutsaka-Makuvaza
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe.
- Department of Microbiology and Parasitology, School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
| | | | | | - Tonderai Manengureni
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Gladys Mugadza
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Midzi N, Mutsaka-Makuvaza MJ, Charimari LS, Mangwiro P, Manengureni T, Mugadza G. Factors affecting hand hygiene practice during the COVID-19 pandemic in the Zimbabwean population: a qualitative study. BMC Infect Dis 2024; 24:385. [PMID: 38594631 PMCID: PMC11003113 DOI: 10.1186/s12879-024-09277-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Practicing hand hygiene is recommended as one of the key preventive measures for reducing the transmission of COVID-19 and other infectious agents. However, it is often not practiced frequently enough or correctly by the public. We aimed to identify barriers to and facilitators of hand hygiene in the Zimbabwean population during the COVID-19 pandemic. METHODS A qualitative study was conducted with a purposive sample of health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected from ten districts across the country from September to October 2022. Semistructured interviews were conducted with 3 key informant interviews per site. In addition, one homogenous focus group discussion was also conducted per site using a focus group discussion guide. The data were recorded on audiotapes, transcribed verbatim, and translated into English. All the analyses were performed manually using thematic analysis. RESULTS Two themes were identified as facilitators of hand hygiene. These include individual factors (knowledge of hand hygiene practices and how they are performed) and access-related factors (access to hand washing infrastructure, soap, and sanitizers). Among the barriers to hand hygiene, four themes were identified: individual factors (knowledge gaps in proper hand washing, lack of conviction about hand hygiene, and habitual behaviour), access-related factors (lack of access to hand washing infrastructure, soap, and sanitizers), safety concerns (concern about the side effects of sanitizers), and sociocultural and religious factors (social customs, cultural beliefs, values, and religious practices). CONCLUSION During public health emergencies, there is a need for people to access uninterrupted, on-premises water supplies to promote compliance with hand hygiene. The provision of clean water and hand washing facilities is critical for vulnerable communities to afford them the opportunity to improve quality of life and facilitate resilience in the event of future pandemics. Community engagement is important for identifying vulnerability factors to provide appropriate mitigatory measures.
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Affiliation(s)
- Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Masceline Jenipher Mutsaka-Makuvaza
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe.
- Department of Microbiology and Parasitology, School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
| | | | | | - Tonderai Manengureni
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Gladys Mugadza
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
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Wüthrich-Grossenbacher U, Midzi N, Mutsaka-Makuvaza MJ, Mutsinze A. Religious and traditional beliefs and practices as predictors of mental and physical health outcomes and the role of religious affiliation in health outcomes and risk taking. BMC Public Health 2023; 23:2170. [PMID: 37932702 PMCID: PMC10626672 DOI: 10.1186/s12889-023-17030-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While many studies from sub-Saharan countries, including Zimbabwe, allude to the important role of religion and tradition for young people living with HIV (YPLHIV), most of these studies tend to be descriptive and lack advanced statistical analysis. This study aims to close this gap. METHODS Data for this study was collected between July and October 2021 from 804 YPLHIV (aged 14-24) in Zimbabwe. The questionnaire included questions regarding participants' conceptions of HIV, their health seeking and risk-taking behaviour, current HIV viral load results, the prevalence of opportunistic infections, their mental health status, and demographic characteristics. The analysis was done using multilevel mixed-effects logistic regression. RESULTS We found that Traditional religious affiliation was linked to overall lower viral load (OR: 0.34; CI: 0.12-0.96; P: 0.042), Apostolic to more (OR: 1.52; CI: 1-2.3; P: 0.049) and Pentecostal to less (OR: 0.53; CI: 0.32-0.95; P: 0.033) treatment failure. Additionally, conceptions about HIV without spiritual or religious connotation, such as 'seeing HIV as result of a weak body' was associated with lower risk of treatment failure (OR: 0.6; CI: 0.4-1.0; P: 0.063), higher chances for undetectable viral load (OR: 1.4; CI: 1-2; P: 0.061), and overall lower viral load (OR: 0.7; CI: 0.5-1; P: 0.067). Moralizing concepts of HIV, like 'seeing HIV as a result of sin in the family', was linked to higher risk of opportunistic infections (OR:1.8; CI:1.1-3; P: 0.018), and higher risk of treatment failure (OR: 1.7; CI: 0.7-1.1; P: 0.066). Religious objections toward certain forms of therapy, like toward cervical cancer screening, was linked to higher risk of mental problems (OR: 2.2; CI: 1.35-3.68; P: 0.002) and higher risk of opportunistic infections (OR:1.6; CI:1.1-2.1; P: 0.008). Religious affiliations significantly influenced conceptions of HIV, health seeking behaviour, and risk taking. CONCLUSION To our knowledge, this study is the first to provide evidence about the statistically significant associations between religious and traditional beliefs and practices and current health outcomes and health risk factors of YPLHIV in Zimbabwe. It is also the first to identify empirically the role of religious affiliations as predictors of current viral load results. This new knowledge can inform contextualized approaches to support YPLHIV in Zimbabwe.
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Affiliation(s)
| | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Masceline Jenipher Mutsaka-Makuvaza
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
- Department of Microbiology and Parasitology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Abigail Mutsinze
- Africaid/Zvandiri, 11-12 Stoneridge Way North, Avondale, Harare, Zimbabwe
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Wüthrich-Grossenbacher U, Mutsinze A, Wolf U, Maponga CC, Midzi N, Mutsaka-Makuvaza MJ, Merten S. Spiritual and religious aspects influence mental health and viral load: a quantitative study among young people living with HIV in Zimbabwe. BMJ Glob Health 2023; 8:e012671. [PMID: 37586783 PMCID: PMC10432672 DOI: 10.1136/bmjgh-2023-012671] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The role of religion and spirituality as social determinants of health has been widely discussed. Studies among people living with HIV describe positive and negative influences of religion and spirituality on health outcomes. With a HIV prevalence of 14.8% for females and 8.6% for males, and 22 000 AIDS-related deaths in 2020, HIV infection remains a life-threatening condition in Zimbabwe, especially in young people. The aim of this research was to measure the influence of religion and spirituality on the health outcomes of young people living with HIV in Zimbabwe. METHODS A quantitative questionnaire with three different validated measures of religion and spirituality (Belief into Action Scale, Brief Religious Coping Index, Religious and Spiritual Struggles Scale), demographic, cultural, behavioural and health questions was administered to 804 young Zvandiri programme clients in rural, urban and peri-urban Zimbabwe between July and October 2021. Regression analysis established significant relations between the result of the three different measures and mental health and viral load results. RESULTS Religious coping significantly reduced the probability of common mental disorder, while high religious activity increased the risk. The Religious and Spiritual Struggles Scale proved to be a reliable indicator of higher viral loads, risk for treatment failure and the probability of common mental disorder. CONCLUSIONS All three measures of religion and spirituality related to health outcomes. More research is needed to generalise and further explore these findings. Because the Religious and Spiritual Struggles Scale was a strong indicator for both, higher viral loads and common mental disorder, we suggest that it should be used and validated in other sub-Saharan contexts. It could serve as a new diagnostic tool for the early detection and prevention of treatment failure as well as of common mental disorder.
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Affiliation(s)
| | | | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | | | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Masceline Jenipher Mutsaka-Makuvaza
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
- College of Medicine and Health Sciences, School of Medicine and Pharmacy, Department of Microbiology and Parasitology, University of Rwanda, Butare, Rwanda
| | - Sonja Merten
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Wüthrich-Grossenbacher U, Mutsinze A, Wolf U, Maponga CC, Midzi N, Mutsaka-Makuvaza MJ, Merten S. A validation of the religious and spiritual struggles scale among young people living with HIV in Zimbabwe: Mokken scale analysis and exploratory factor analysis. Front Psychol 2023; 14:1051455. [PMID: 37143595 PMCID: PMC10153667 DOI: 10.3389/fpsyg.2023.1051455] [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: 09/22/2022] [Accepted: 03/29/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Religious/spiritual convictions and practices can influence health- and treatment-seeking behavior, but only few measures of religiousness or spirituality have been validated and used outside of the US. The Religious and Spiritual Struggles scale (RSS) measures internal and external conflict with religion and spirituality and has been validated mainly in different high-income contexts. The aim of this study was the validation of the RSS in the Zimbabwean context and among young people living with human immunodeficiency virus (YPLHIV) aged 14-24. Methods Data collection with an Open Data Kit (ODK) questionnaire with 804 respondents took place in 2021. The validation was performed by confirmatory factor analysis (CFA), using statistical equation modeling (SEM), and Mokken scale analysis (MSA). After the low confirmability of the original scale sub-dimensions exploratory factor analysis (EFA) was applied. Results The EFA resulted in four new sub-domains that were different from the original six domains in the RSS but culturally more relevant. The new sub-domains are significantly related to health. Discussion The findings support the validity and relevance of the RSS and the new sub-domains in this context. As our study was limited to YPLHIV, further validation of the RSS among different population groups and contexts in the sub-Saharan region is encouraged.
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Affiliation(s)
- Ursula Wüthrich-Grossenbacher
- Centre for African Studies, Faculty of Humanities and Social Sciences, University of Basel, Basel, Switzerland
- *Correspondence: Ursula Wüthrich-Grossenbacher,
| | | | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, School of Medicine, University of Bern, Bern, Switzerland
| | - Charles Chiedza Maponga
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Nicholas Midzi
- Ministry of Health and Child Care, National Institute of Health Research, Harare, Zimbabwe
| | | | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Johnson O, Fronterre C, Amoah B, Montresor A, Giorgi E, Midzi N, Mutsaka-Makuvaza MJ, Kargbo-Labor I, Hodges MH, Zhang Y, Okoyo C, Mwandawiro C, Minnery M, Diggle PJ. Model-Based Geostatistical Methods Enable Efficient Design and Analysis of Prevalence Surveys for Soil-Transmitted Helminth Infection and Other Neglected Tropical Diseases. Clin Infect Dis 2021; 72:S172-S179. [PMID: 33905476 PMCID: PMC8201574 DOI: 10.1093/cid/ciab192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Maps of the geographical variation in prevalence play an important role in large-scale programs for the control of neglected tropical diseases. Precontrol mapping is needed to establish the appropriate control intervention in each area of the country in question. Mapping is also needed postintervention to measure the success of control efforts. In the absence of comprehensive disease registries, mapping efforts can be informed by 2 kinds of data: empirical estimates of local prevalence obtained by testing individuals from a sample of communities within the geographical region of interest, and digital images of environmental factors that are predictive of local prevalence. In this article, we focus on the design and analysis of impact surveys, that is, prevalence surveys that are conducted postintervention with the aim of informing decisions on what further intervention, if any, is needed to achieve elimination of the disease as a public health problem. We show that geospatial statistical methods enable prevalence surveys to be designed and analyzed as efficiently as possible so as to make best use of hard-won field data. We use 3 case studies based on data from soil-transmitted helminth impact surveys in Kenya, Sierra Leone, and Zimbabwe to compare the predictive performance of model-based geostatistics with methods described in current World Health Organization (WHO) guidelines. In all 3 cases, we find that model-based geostatistics substantially outperforms the current WHO guidelines, delivering improved precision for reduced field-sampling effort. We argue from experience that similar improvements will hold for prevalence mapping of other neglected tropical diseases.
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Affiliation(s)
- Olatunji Johnson
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Benjamin Amoah
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization , Geneva, Switzerland
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Nicholas Midzi
- National Institute of Health Research, Ministry of Health and Child Care, Zimbabwe
| | | | - Ibrahim Kargbo-Labor
- Neglected Tropical Disease Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mary H Hodges
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.,School of Mathematics, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya
| | - Charles Mwandawiro
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mark Minnery
- Deworm the World, Evidence Action, Washington, District of Columbia, USA
| | - Peter J Diggle
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,Health Data Research UK, London, United Kingdom
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Mutsaka-Makuvaza MJ, Zhou XN, Tshuma C, Abe E, Manasa J, Manyangadze T, Allan F, Chinómbe N, Webster B, Midzi N. Molecular diversity of Bulinus species in Madziwa area, Shamva district in Zimbabwe: implications for urogenital schistosomiasis transmission. Parasit Vectors 2020; 13:14. [PMID: 31924254 PMCID: PMC6954605 DOI: 10.1186/s13071-020-3881-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022] Open
Abstract
Background Bulinus species are freshwater snails that transmit the parasitic trematode Schistosoma haematobium. Despite their importance, the diversity of these intermediate host snails and their evolutionary history is still unclear in Zimbabwe. Bulinus globosus and B. truncatus collected from a urogenital schistosomiasis endemic region in the Madziwa area of Zimbabwe were characterized using molecular methods. Methods Malacological survey sites were mapped and snails were collected from water contact sites in four communities in the Madziwa area, Shamva district for a period of one year, at three-month intervals. Schistosoma haematobium infections in snails were determined by cercarial shedding and the partial mitochondrial cytochrome c oxidase subunit 1 gene (cox1) was used to investigate the phylogeny and genetic variability of the Bulinus spp. collected. Results Among the 1570 Bulinus spp. snails collected, 30 (1.9%) B. globosus were shedding morphologically identified schistosomes. None of the B. truncatus snails were shedding. The mitochondrial cox1 data from 166 and 16 samples for B. globosus and B. truncatus, respectively, showed genetically diverse populations within the two species. Twelve cox1 haplotypes were found from the 166 B. globosus samples and three from the 16 B. truncatus samples with phylogenetic analysis showing that the haplotypes fall into well-supported clusters within their species groups. Both B. truncatus and B. globosus clustered into two distinct lineages. Overall, significant negative values for both Tajima’s D statistic and the Fu’s Fs statistic were observed for B. globosus and B. truncatus. Conclusions The study provided new insights into the levels of genetic diversity within B. globosus and additional information on B. truncatus collected from a small geographical area in Zimbabwe. Low prevalence levels of infection observed in the snails may reflect the low transmission level of urogenital schistosomiasis in the area. Our results contribute towards the understanding of the distribution and population genetic structure of Bulinus spp. supporting the mapping of the transmission or risk of transmission of urogenital schistosomiasis, particularly in Zimbabwe.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Eniola Abe
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Justen Manasa
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Tawanda Manyangadze
- Geography Department, Faculty of Science, Bindura University of Science Education, Bag 1020, Bindura, Zimbabwe.,School of Nursing and Public Health, Department of Public Health Medicine University of KwaZulu-Natal, Durban, South Africa
| | - Fiona Allan
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History 14 Museum, Cromwell Road, London, SW7 5BD, UK
| | - Nyasha Chinómbe
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe
| | - Bonnie Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History 14 Museum, Cromwell Road, London, SW7 5BD, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe. .,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Tshuma C, Katsidzira A, Webster B, Zhou XN, Midzi N. Knowledge, perceptions and practices regarding schistosomiasis among women living in a highly endemic rural district in Zimbabwe: implications on infections among preschool-aged children. Parasit Vectors 2019; 12:458. [PMID: 31547850 PMCID: PMC6757404 DOI: 10.1186/s13071-019-3668-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 08/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background Schistosomiasis primarily affects poor and neglected communities due to their lack of safe water and sanitation facilities. In an effort to improve intervention strategies, the present study investigated the association of socio-demographic characteristics of women with their existing knowledge, perceptions and practices (KPP) in five urogenital schistosomiasis endemic rural communities in Zimbabwe. Methods In February 2016, a cross sectional study was conducted in which 426 women in rural Madziwa area, Shamva District were interviewed using a pretested structured questionnaire seeking their KPP and socio-demographic characteristics. Logistic regression analysis was performed to identify socio-demographic factors associated with the KPP variables. Results Among the 426 participants, 93.7% knew about schistosomiasis, while 97.7 and 87.5% understood the disease transmission and methods for prevention, respectively. A significantly higher percentage of women aged ≥ 30 years compared to those < 30 years indicated that infertility is a complication of untreated chronic schistosomiasis (OR: 1.7, 95% CI: 0.9–3.0). Compared to women who had no history of infection, those who had been infected before were more likely to think that they were currently infected (OR: 3.7, 95% CI: 2.4–6.0). Bathing in unsafe water sources was more common in non-apostolic compared to apostolic followers (OR: 2.1, 95% CI: 1.2–3.7). Sole use of unsafe water for domestic purposes was significantly higher in uneducated women compared to the educated (OR: 1.8, 95% CI: 1.0–3.1). Compared to women of the Chakondora community, those in Chihuri, Nduna and Kaziro were more likely to know that dysuria is a symptom of schistosomiasis while those in Chihuri were also likely to allow young children to perform water contact activities (OR: 2.9, 95% CI: 1.5–5.5). Conclusions Despite the high level of schistosomiasis awareness, some women had inadequate knowledge about the mode of transmission and preventive measures for schistosomiasis. Socio-demographic characteristics were associated with the KPP of women. Thus, disease control efforts should consider socio-demographic factors, which may influence the knowledge, perceptions and practices of occupants in a given setting.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Agnes Katsidzira
- Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
| | - Bonnie Webster
- Department of Life Sciences, Natural History Museum, 14 Cromwell Road, London, SW7 5BD, UK
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Katsidzira A, Tshuma C, Chin'ombe N, Zhou XN, Webster B, Midzi N. Urogenital schistosomiasis and risk factors of infection in mothers and preschool children in an endemic district in Zimbabwe. Parasit Vectors 2019; 12:427. [PMID: 31477172 PMCID: PMC6721289 DOI: 10.1186/s13071-019-3667-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To design appropriate schistosomiasis control programmes that include women and preschool-aged children (PSAC) it is essential to assess their disease profile and the risk factors predisposing them to infection. This study aimed to determine the prevalence of urogenital schistosomiasis and the risk factors of infection among PSAC and their caregivers in an endemic area of Zimbabwe. METHODS A cross-sectional study involving screening for urogenital schistosomiasis infections and treatment of 860 participants [535 children aged ≤ 5 years and 325 caregivers (≥ 15 years)] was carried out in five communities, namely Chihuri, Mupfure, Chakondora, Nduna and Kaziro, in February 2016. Haematuria was recorded for each participant and urine filtration was performed to determine the presence and infection intensity of Schistosoma haematobium. A pre-tested questionnaire was administered to the caregivers seeking knowledge, practices and perceptions regarding schistosomiasis. Data analysis was performed using descriptive statistics and logistic regression. RESULTS Overall 132 (15.4%) of the 860 participants had S. haematobium infections. Among these, 61 (18.7%) of the 325 caregivers and 71 (13.3%) of the 535 children were infected. The infection prevalence was significantly different between caregivers and PSAC (χ2 = 4.7040, df = 1, P = 0.030). Children whose caregivers used river water for bathing were more likely to be infected compared to children whose caregivers used protected well water (OR: 2.2, 95% CI: 1.3-3.7). The risks of being infected with schistosomiasis were higher in children whose caregivers were infected compared to children whose caregivers had no infection (AOR: 3.9, 95% CI: 1.7-8.6). In caregivers, those who bathed in river water were at higher risk of schistosomiasis infection compared to those who used water from a protected well (AOR: 3.0, 95% CI: 1.4-6.4). CONCLUSIONS According to the World Health Organization guidelines, the observed overall prevalence of urogenital schistosomiasis qualifies this area as a moderate risk area requiring mass chemotherapy once every two years. Water contact practices of caregivers, and their perceptions and knowledge regarding schistosomiasis are risk factors for infection in both themselves and PSAC. Thus, disease control efforts targeting caregivers or PSAC should include health education and provision of alternative clean and safe water sources.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Agnes Katsidzira
- Harare Central Hospital, P.O Box ST 14, Southerton, Harare, Zimbabwe
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of Health and Child Care, Bindura, Mashonaland Central, Zimbabwe
| | - Nyasha Chin'ombe
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, 200025, China
| | - Bonnie Webster
- Department of Life Sciences, Natural History Museum, 14 Cromwell Road, London, SW7 5BD, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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Mutsaka-Makuvaza MJ, Matsena-Zingoni Z, Tshuma C, Ray S, Zhou XN, Webster B, Midzi N. Reinfection of urogenital schistosomiasis in pre-school children in a highly endemic district in Northern Zimbabwe: a 12 months compliance study. Infect Dis Poverty 2018; 7:102. [PMID: 30268157 PMCID: PMC6162945 DOI: 10.1186/s40249-018-0483-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022] Open
Abstract
Background In light of the shift to aiming for schistosomiasis elimination, the following are needed: data on reinfection patterns, participation, and sample submission adherence of all high-risk age groups to intervention strategies. This study was conducted to assess prevalence, reinfections along with consecutive participation, sample submission adherence, and effect of treatment on schistosomiasis prevalence in children aged five years and below in an endemic district in Zimbabwe, over one year. Methods The study was conducted from February 2016–February 2017 in Madziwa area, Shamva district. Following community mobilisation, mothers brought their children aged 5 years and below for recruitment at baseline and also urine sample collection at baseline, 3, 6, 9 and 12 months follow up surveys. At each time point, urine was tested for urogenital schistosomiasis by urine filtration and children found positive received treatment. Schistosoma haematobium prevalence, reinfections as well as children participation, and urine sample submission at each visit were assessed at each time point for one year. Results Of the 535 children recruited from the five communities, 169 (31.6%) participated consecutively at all survey points. The highest mean number of samples submitted was 2.9 among communities and survey points. S. haematobium prevalence significantly reduced from 13.3% at baseline to 2.8% at 12 months for all participants and from 24.9% at baseline to 1.8% at 12 months (P < 0.001) for participants coming at all- time points. Among the communities, the highest baseline prevalence was found in Chihuri for both the participants coming consecutively (38.5%, 10/26) and all participants (20.4%, 21/103). Reinfections were significantly high at 9 months follow up survey (P = 0.021) and in Mupfure (P = 0.003). New infections significantly decreased over time (P < 0.001). Logistic regression analysis showed that the risk of acquiring schistosomiasis was high in some communities (P < 0.05). Conclusions S. haematobium infections and reinfections are seasonal and depend on micro-geographical settings. The risk of being infected with schistosomes in pre-school aged children increases with increasing age. Sustained treatment of infected individuals in a community reduces prevalence overtime. Participation compliance at consecutive visits and sample submission adherence are important for effective operational control interventions. Electronic supplementary material The online version of this article (10.1186/s40249-018-0483-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe
| | - Zvifadzo Matsena-Zingoni
- National Institute of Health Research, Ministry of Health and Child Care, P.O. Box CY573, Causeway, Harare, Zimbabwe.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 27 St Andrews' Road, Parktown, Johannesburg, 2193, South Africa
| | - Cremance Tshuma
- Mashonaland Central Provincial Health Office, Ministry of health and Child Care, Bindura, Zimbabwe
| | - Sunanda Ray
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Centre for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Bonnie Webster
- Parasites and Vectors Division, National History Museum, London, UK
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, P. O. Box A178, Avondale, Harare, Zimbabwe.
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11
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Osakunor DNM, Mduluza T, Midzi N, Chase-Topping M, Mutsaka-Makuvaza MJ, Chimponda T, Eyoh E, Mduluza T, Pfavayi LT, Wami WM, Amanfo SA, Murray J, Tshuma C, Woolhouse MEJ, Mutapi F. Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe. BMJ Glob Health 2018; 3:e000661. [PMID: 29616147 PMCID: PMC5875666 DOI: 10.1136/bmjgh-2017-000661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/14/2023] Open
Abstract
Background Recent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC. Methods Children (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence. Results At baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%-8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%-34%, depending on indices used. S haematobium-positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001. Conclusion We demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for inclusion of PSAC in schistosome control programmes.
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Affiliation(s)
- Derick Nii Mensah Osakunor
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Takafira Mduluza
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Nicholas Midzi
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Margo Chase-Topping
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Masceline Jenipher Mutsaka-Makuvaza
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Theresa Chimponda
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Enwono Eyoh
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Tariro Mduluza
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lorraine Tsitsi Pfavayi
- Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Welcome Mkululi Wami
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Seth Appiah Amanfo
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Janice Murray
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Clement Tshuma
- Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Mark Edward John Woolhouse
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
| | - Francisca Mutapi
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
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