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Midzi N.,National Health Research Institute | Midzi N.,P.A. College | Mtapuri-Zinyowera S.,P.A. College | Mapingure M.P.,University of Zimbabwe | And 6 more authors.
Acta Tropica | Year: 2010

The effect of concomitant infection with schistosomes, Plasmodium falciparum and soil transmitted helminths (STHs) on anaemia was determined in 609 Zimbabwean primary school children. P. falciparum, haemoglobin levels and serum ferritin were determined from venous blood. Kato Katz, formal ether concentration and urine filtration techniques were used to assess prevalence of Schistosoma mansoni, STHs and Schistosoma haematobium infections. The prevalence of S. haematobium, S. mansoni, P. falciparum, hookworm, Trichuris trichiura and Ascaris lumbricoides were 52.3%, 22.7%, 27.9%, 23.7%, 2.3% and 2.1%, respectively. The overall prevalence of anaemia and iron deficiency anaemia (IDA) were 48.4% (277/572) and 38.1% (181/475). Haemoglobin levels among children who had P. falciparum, S. haematobium and hookworm were lower than negative individuals, p<0.001, p<0.001 and p = 0.030, respectively. The prevalence of anaemia and IDA in co-infections was almost double that in single infection. Children with P. falciparum/STHs/schistosome and schistosomes/. P. falciparum co-infections recorded higher prevalence of anaemia and IDA (80.8% and 57.4%, respectively) than other combinations, p<0.001. Logistic regression revealed that, age group. ≥ 14years,P. falciparum,S.haematobium light and heavy infections, and S.mansoni moderate and heavy infection, hookworm light infection were predictors of anaemia. This study suggests that integrated school based de-worming and malaria control have the potential to reduce the burden of anaemia. © 2010.


Midzi N.,National Health Research Institute | Mtapuri-Zinyowera S.,P.A. College | Paul N.H.,University of Zimbabwe | Makware G.,Central Statistical Office | And 7 more authors.
BMC International Health and Human Rights | Year: 2011

Background: The geographical congruency in distribution of helminths and Plasmodium falciparum makes polyparasitism a common phenomenon in Sub Saharan Africa. The devastating effects of helminths-Plasmodium co-infections on primary school health have raised global interest for integrated control. However little is known on the feasibility, timing and efficacy of integrated helminths-Plasmodium control strategies. A study was conducted in Zimbabwe to evaluate the efficacy of repeated combined school based antihelminthic and prompt malaria treatment. Methods. A cohort of primary schoolchildren (5-17 years) received combined Praziquantel, albendazole treatment at baseline, and again during 6, 12 and 33 months follow up surveys and sustained prompt malaria treatment. Sustained prompt malaria treatment was carried out throughout the study period. Children's infection status with helminths, Plasmodium and helminths-Plasmodium co-infections was determined by parasitological examinations at baseline and at each treatment point. The prevalence of S. haematobium, S. mansoni, STH, malaria, helminths-Plasmodium co-infections and helminths infection intensities before and after treatment were analysed. Results: Longitudinal data showed that two rounds of combined Praziquantel and albendazole treatment for schistosomiasis and STHs at 6 monthly intervals and sustained prompt malaria treatment significantly reduced the overall prevalence of S. haematobium, S. mansoni, hookworms and P. falciparum infection in primary schoolchildren by 73.5%, 70.8%, 67.3% and 58.8% respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001 respectively). More importantly, the prevalence of STH + schistosomes, P. f + schistosomes, and P. f + STHs + schistosomes co-infections were reduced by 68.0%, 84.2%, and 90.7%, respectively. The absence of anti-helminthic treatment between the 12 mth and 33 mth follow-up surveys resulted in the sharp increase in STHs + schistosomes co-infection from 3.3% at 12 months follow up survey to 10.7%, slightly more than the baseline level (10.3%) while other co-infection combinations remained significantly low. The overall prevalence of heavy S. haematobium, S. mansoni and hookworms infection intensities were significantly reduced from: 17.9-22.4% to 2.6-5.1%, 1.6-3.3% to 0.0% and 0.0-0.7% to 0.0% respectively. Conclusion: Biannual Integrated school based antihelminthic and sustained prompt malaria treatment has a potential to reduce the burden of helminths-plasmodium co-infections in primary school children. In areas of stable malaria transmission, active case finding is recommended to track and treat asymptomatic malaria cases as these may sustain transmission in the community. © 2011 Midzi et al; licensee BioMed Central Ltd.


Chin'ombe N.,University of Zimbabwe | Muzividzi B.,National Microbiology Reference Laboratory | Munemo E.,National Microbiology Reference Laboratory | Nziramasanga P.,University of Zimbabwe
Open Microbiology Journal | Year: 2016

Background: Several nontuberculous mycobacteria (NTM) were previously isolated from diverse environments such as water, soil, sewage, food and animals. Some of these NTM are now known to be opportunistic pathogens of humans. Objective: The main purpose of the study was to identify NTM isolates stored at the National Microbiology Reference Laboratory (NMRL) and were previously isolated from humans during a national tuberculosis (TB) survey. Methods: Pure NTM cultures already isolated from human sputum samples during the national TB survey were retrieved from the NMRL and used for this study. DNA was extracted from the samples and 16S ribosomal RNA gene amplified by polymerase chain reaction. The amplicons were sequenced and bioinformatics tools were used to identify the NTM species. Results: Out of total of 963 NTM isolates stored at the NMRL, 81 were retrieved for speciation. Forty isolates (49.4%) were found to belong to Mycobacterium avium-intracellulare complex (MAC) species. The other 41 isolates (50.6%) were identified asM. lentiflavum (6.2%), M. terrae complex (4.9%),M. paraense (4.9%), M. kansasii (3.7%), M. moriokaense (3.7%), M. asiaticum (2.5%), M. novocastrense (2.5%), M. brasiliensis (2.5%), M. elephantis (2.5%), M. paraffinicum (1.2%), M. bohemicum (1.2%), M. manitobense (1.2%), M. intermedium (1.2%), M. tuberculosis complex (1.2%),M. parakoreense (1.2%), M. florentinum (1.2%), M. litorale (1.2%), M. fluoranthenivorans (1.2%), M. sherrisii (1.2%), M. fortuitum (1.2%) and M septicum (1.2%). Two isolates (2.5%) could not be identified, but were closely related to M. montefiorense and M. phlei respectively. Interestingly, the MAC species were the commonest NTM during the survey. Conclusion: The study emphasizes the importance of identifying species of NTM in Zimbabwe. Future studies need to ascertain their true diversity and clinical relevance. © Chin’ombe et al.


Tarupiwa A.,National Microbiology Reference Laboratory | Tapera S.,National Microbiology Reference Laboratory | Mtapuri-Zinyowera S.,National Microbiology Reference Laboratory | Gumbo P.,National Microbiology Reference Laboratory | And 4 more authors.
BMC Research Notes | Year: 2015

Background: Salmonella enterica serovar Typhi, the causative agent of typhoid, is endemic in most parts of the world especially in Africa. Reliable and rapid diagnosis of the bacterium is therefore critical for confirmation of all suspected typhoid cases. In many parts of Zimbabwe, laboratory capacity to isolate the microorganism by culture method as a way of diagnosis has limitations. In this study, two rapid serological kits, TUBEX-TF and OnSite Typhoid IgG/IgM Combo, were evaluated for possible expeditious diagnosis of Salmonella enterica serovar Typhi infection during a typhoid outbreak in Zimbabwe. Methods: Blood was collected from patients with clinical signs and symptoms of typhoid in Harare, Zimbabwe during an outbreak. The standard culture method was used to diagnose the disease. Two rapid kits, the TUBEX-TF and OnSite Typhoid IgG/IgM Combo, were also used in parallel to diagnose typhoid according to manufacturers' instructions. The diagnostic accuracy of the two kits was evaluated using the culture method as the gold standard. Results: From all the cases diagnosed by the blood culture (n = 136), we enrolled 131 patients for the TUBEX-TF and 136 for the OnSite Typhoid IgG/IgM Combo tests. With the culture method as a reference standard, we found that TUBEX-TF test was 100% sensitive and 94.12% specific, with 63.16% positive and 100% negative predictive values (NPVs) and the OnSite Typhoid IgG/IgM Combo test was 100% sensitive and 94.35% specific, with 63.16% positive and 100% NPVs. Conclusion: Our results indicated that TUBEX-TF and OnSite Typhoid IgG/IgM Combo rapid tests were useful tools for the rapid diagnosis of Salmonella enterica serovar Typhi infection during typhoid outbreaks in Zimbabwe. The tests performed very well in laboratory evaluations of blood culture-confirmed typhoid cases in Harare, Zimbabwe. © 2015 Tarupiwa et al.


PubMed | University of Zimbabwe and National Microbiology Reference Laboratory
Type: Journal Article | Journal: Germs | Year: 2014

We aimed to perform a risk assessment in a rural setting, where drinking water is obtained from both protected and unprotected deep or shallow wells, boreholes and springs. Water is consumed untreated and this poses a risk of acquiring waterborne infections that may cause diarrhea.The study included 113 study participants who volunteered in Chiweshe rural community (Musarara village) in Mashonaland Central Province in Zimbabwe. There were 34 (30%) males and 79 (70%) females with ages ranging from 2 to 89 years. HIV counseling was carried out at the communal meeting and testing was done at home visits. Stool and drinking water samples were collected from 104 subjects. Routine laboratory methods were used to examine for parasitic infections.Only 29 (25.7%) of participants were confirmed HIV positive using 2 rapid serology tests; eighty-four (74.3%) were negative. Diarrheic stool samples were observed in 17 (16.3%) participants and of these 5 (29.4%) were HIV seropositive. Several parasites were isolated from stool samples: G. duodenalis 6 (5.7%), E. histolytica/dispar 19 (18.2%), C. parvum, 8 (7.6%) and C. cayetanensis 23 (22.1%). Eleven out of 30 (36.6%) water bodies had protozoan parasites: G. duodenalis 2 (6.6%), E. histolytica 4 (13.3%), C. parvum 1 (3.3%), C. cayetanensis 3 (10%), E. coli 1 (3.3%).The water sources were being used without treatment and were shown to pose a risk for acquiring diarrheagenic protozoan parasites.


PubMed | University of Zimbabwe and National Microbiology Reference Laboratory
Type: | Journal: BMC research notes | Year: 2015

Salmonella enterica serovar Typhi, the causative agent of typhoid, is endemic in most parts of the world especially in Africa. Reliable and rapid diagnosis of the bacterium is therefore critical for confirmation of all suspected typhoid cases. In many parts of Zimbabwe, laboratory capacity to isolate the microorganism by culture method as a way of diagnosis has limitations. In this study, two rapid serological kits, TUBEX-TF and OnSite Typhoid IgG/IgM Combo, were evaluated for possible expeditious diagnosis of Salmonella enterica serovar Typhi infection during a typhoid outbreak in Zimbabwe.Blood was collected from patients with clinical signs and symptoms of typhoid in Harare, Zimbabwe during an outbreak. The standard culture method was used to diagnose the disease. Two rapid kits, the TUBEX-TF and OnSite Typhoid IgG/IgM Combo, were also used in parallel to diagnose typhoid according to manufacturers instructions. The diagnostic accuracy of the two kits was evaluated using the culture method as the gold standard.From all the cases diagnosed by the blood culture (n = 136), we enrolled 131 patients for the TUBEX-TF and 136 for the OnSite Typhoid IgG/IgM Combo tests. With the culture method as a reference standard, we found that TUBEX-TF test was 100% sensitive and 94.12% specific, with 63.16% positive and 100% negative predictive values (NPVs) and the OnSite Typhoid IgG/IgM Combo test was 100% sensitive and 94.35% specific, with 63.16% positive and 100% NPVs.Our results indicated that TUBEX-TF and OnSite Typhoid IgG/IgM Combo rapid tests were useful tools for the rapid diagnosis of Salmonella enterica serovar Typhi infection during typhoid outbreaks in Zimbabwe. The tests performed very well in laboratory evaluations of blood culture-confirmed typhoid cases in Harare, Zimbabwe.


Vogt F.,Médecins Sans Frontières | Van Den Bergh R.,Médecins Sans Frontières | Bernasconi A.,Médecins Sans Frontières | Moyo B.,Médecins Sans Frontières | And 7 more authors.
PLoS ONE | Year: 2015

Background Blood collected in conventional EDTA tubes requires laboratory analysis within 48 hours to provide valid CD4 cell count results. This restricts access to HIV care for patients from rural areas in resource-constraint settings due to sample transportation problems. Stabilization Tubes with extended storage duration have been developed but not yet evaluated comprehensively. Objective To investigate stability of absolute CD4 cell count measurement of samples in BD Vacutai-ner CD4 Stabilization Tubes over the course of 30 days. Methods This was a laboratory-based method comparison study conducted at a rural district hospital in Beitbridge, Zimbabwe. Whole peripheral blood from 88 HIV positive adults was drawn into BD Vacutainer CD4 Stabilization Tubes and re-tested 1, 2, 3, 5, 7, 14 and 30 days after collection on BD FacsCount and Partec Cyflow cytometers in parallel. Absolute CD4 cell levels were compared to results from paired samples in EDTA tubes analysed on BD Facs-Count at the day of sample collection (references methodology). Bland-Altman analysis based on ratios of the median CD4 counts was used, with acceptable variation ranges for Limits of Agreements of +/-20%. Results Differences in ratios of the medians remained below 10% until day 21 on BD FacsCount and until day 5 on Partec Cyflow. Variations of Limits of Agreement were beyond 20% after day 1 on both cytometers. Specimen quality decreased steadily after day 5, with only 68% and 40% of samples yielding results on BD FacsCount and Partec Cyflow at day 21, respectively. Conclusions We do not recommend the use of BD Vacutainer CD4 Stabilization Tubes for absolute CD4 cell count measurement on BD FacsCount or Partec Cyflow due to large variation of results and decay of specimen quality. Alternative technologies for enhanced CD4 testing in settings with limited laboratory and sample transportation capacity still need to be developed. © 2015 Vogt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | National Microbiology Reference Laboratory, Epicentre, Médecins Sans Frontières and Beitbridge District Hospital
Type: Comparative Study | Journal: PloS one | Year: 2015

Blood collected in conventional EDTA tubes requires laboratory analysis within 48 hours to provide valid CD4 cell count results. This restricts access to HIV care for patients from rural areas in resource-constraint settings due to sample transportation problems. Stabilization Tubes with extended storage duration have been developed but not yet evaluated comprehensively.To investigate stability of absolute CD4 cell count measurement of samples in BD Vacutainer CD4 Stabilization Tubes over the course of 30 days.This was a laboratory-based method comparison study conducted at a rural district hospital in Beitbridge, Zimbabwe. Whole peripheral blood from 88 HIV positive adults was drawn into BD Vacutainer CD4 Stabilization Tubes and re-tested 1, 2, 3, 5, 7, 14 and 30 days after collection on BD FacsCount and Partec Cyflow cytometers in parallel. Absolute CD4 cell levels were compared to results from paired samples in EDTA tubes analysed on BD FacsCount at the day of sample collection (references methodology). Bland-Altman analysis based on ratios of the median CD4 counts was used, with acceptable variation ranges for Limits of Agreements of +/-20%.Differences in ratios of the medians remained below 10% until day 21 on BD FacsCount and until day 5 on Partec Cyflow. Variations of Limits of Agreement were beyond 20% after day 1 on both cytometers. Specimen quality decreased steadily after day 5, with only 68% and 40% of samples yielding results on BD FacsCount and Partec Cyflow at day 21, respectively.We do not recommend the use of BD Vacutainer CD4 Stabilization Tubes for absolute CD4 cell count measurement on BD FacsCount or Partec Cyflow due to large variation of results and decay of specimen quality. Alternative technologies for enhanced CD4 testing in settings with limited laboratory and sample transportation capacity still need to be developed.


PubMed | National Microbiology Reference Laboratory
Type: Comparative Study | Journal: Journal of acquired immune deficiency syndromes (1999) | Year: 2010

Point-of-care (POC) CD4 testing was implemented at a stand-alone HIV voluntary testing and counseling centre in Harare, Zimbabwe. To validate the use of this new technology, paired blood samples were collected from 165 patients either by a nurse or a laboratory technician and tested using POC and conventional laboratory CD4 machines. Finger prick (capillary) blood was collected directly into the PIMA POC CD4 Analyzer cartridges and tested immediately, whereas venous blood collected into evacuated tubes was used for CD4 enumeration on a Becton Dickinson FACSCalibur. There was no significant difference in mean absolute CD4 counts between the POC PIMA and Becton Dickinson FACSCalibur platforms (+7.6 cells/microL; P = 0.72). Additionally, there was no significant difference in CD4 counts between the platforms when run by either a nurse (+18.0 cells/microL; P = 0.49), or a laboratory technicians (-3.1 cells/microL; P = 0.93). This study demonstrates that POC CD4 testing can be conducted in a voluntary testing and counseling setting for staging HIV-positive clients. Both nurses and laboratory technicians performed the test accurately, thereby increasing the human resources available for POC CD4 testing. By producing same-day results, POC CD4 facilitates immediate decision-making, patient management and referral and may help improve patient care and retention. POC CD4 may also alleviate testing burdens at traditional central CD4 laboratories, hence improving test access in both rural and urban environments.


PubMed | National Microbiology Reference Laboratory
Type: Journal Article | Journal: The Central African journal of medicine | Year: 2010

To determine the predominant serotype and antibiotic sensitivity pattern of Shigella isolates during 2004 and 2005 in Zimbabwe.Cross sectional study.National Microbiology Reference Laboratory (NMRL), Harare, Zimbabwe.259 clinical isolates of Shigella species isolated during 2004 and 2005 in Zimbabwe were studied. These samples had been referred to the NMRL for further testing.Serotype and antibiotic sensitivity pattern of Shigella species.Of the 259 clinical isolates of Shigella tested the following species were serotyped; 141 (54.4%) were S. flexneri; 70 (27%) S. sonnei; 38 (14.7%) S. dysenteriae and 10 (3.9%) S. boydii. About 4% of all Shigella isolates tested showed full sensitivity to commonly used antibiotics, 20.8% were resistant to one antibiotic only while 75.3% were resistant to at least two antibiotics. The most common resistance among Shigella species was to cotrimoxazole (89%), tetracycline (73%), ampicillin (49%) and chloramphenicol (41%). High susceptibility among Shigella species was observed to nalidixic acid (86%), ciprofloxacin (99%) and ceftazidine (99%).There was a low drug resistance of Shigella species to nalidixic acid, a drug of choice in Zimbabwe, except among Shigella dysenteriae type 1 strains. Continuous monitoring of the susceptibility patterns of Shigella species is important in order to detect the emergence of drug resistance and to update guidelines for antibiotic treatment in shigellosis.

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