Murambinda Mission Hospital

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BackgroundZimbabwe underwent a socioeconomic crisis and resultant increase in food insecurity in 2008–9. The impact of the crisis on Tuberculosis (TB) incidence is unknown.MethodsProspective databases from two mission hospitals, which were geographically widely separated, and remained open during the crisis, were reviewed.ResultsAt the Howard Hospital (HH) in northern Zimbabwe, TB incidence increased 35% in 2008 from baseline rates in 2003–2007 (p<0.01) and remained at that level in 2009. Murambinda Hospital (MH) in Eastern Zimbabwe also demonstrated a 29% rise in TB incidence from 2007 to 2008 (p<0.01) and remained at that level in 2009. Data collected post-crisis at HH showed a decrease of 33% in TB incidence between 2009 to 2010 (p<0.001) and 2010/2011 TB incidence remained below that of the crisis years of 2008/2009 (p<0.01). Antenatal clinic HIV seroprevalence at HH decreased between 2001(23%) to 2011(11%) (p<0.001). Seasonality of TB incidence was analyzed at both MH and HH. There was a higher TB incidence in the dry season when food is least available (September-November) compared to post harvest (April-June) (p<0.001).ConclusionThis study suggests that an epidemic of TB mirrored socioeconomic collapse and recovery in Zimbabwe. The seasonal data suggests that food security may have been associated with TB incidence both annually and during the crisis in this high HIV prevalence country.

To describe anaesthetic associated mortality in a district hospital in Zimbabwe. A retrospective descriptive study of anaesthesia associated mortality over an eight year period. Murambinda Mission Hospital: a 120 bed rural district hospital in Zimbabwe. All patients who died within 24 hours of receiving an anaesthetic. The overall mortality rate (OMR), being all deaths up to 24 hours after an anaesthetic. Avoidable anaesthetic mortality rate (AMR), are deaths in which correctable anaesthetic factors played a major role. An overall mortality rate (OMR) of 1:344 (2.9 deaths/1 000 anaesthetics) and avoidable mortality rate (AMR) for anaesthesia of 1:482 (2.1 deaths/1 000 anaesthetics) are reported. Factors under the control of the anaesthetist accounted for 72% of mortalities (AMR:OMR). All were emergency obstetric patients and had emergency surgery. The hospital maternal mortality rate of 360 per 100 000 and an operative obstetric mortality of 1:293 (3.4 deaths/1 000) are reported. Most of the anaesthetic factors are preventable. These results, although very poor, are consistent with reports from hospitals in the region. By comparison, developed countries are at least 10 times better. Improving the provision, skills, support and profile of anaesthesia providers in the care of peri operative patients, would reduce anaesthesia-associated factors in peri operative mortality. A system of national audit data collection comparable to the CEPOD or Confidential Enquiry into Maternal Deaths is overdue in Zimbabwe.