Health Promotion Enquiry: Epidemy in Zimbabwe - Term Paper Example

 Health Promotion Enquiry - Epidemiological Report Introduction Zimbabwe is seriously affected by the prevalence of cholera in urban and rural areas. World Health Organization, who globally collects health related data and carries out disease control programs in all countries including in Zimbabwe, regularly updates Cholera-related statistics and other necessary information. World Health Organization (WHO) (2015) uses Cholera statistics of the Ministry of Health and Child Welfare (MoHCW) and highlights that till the end of 18 February 2009, around 79613 Cholera cases were reported in which 3731 Cholera-caused deaths, which is equivalent of 4.7 per cent (Case Fatality Rate (CFR)). Alarmingly, WHO reports that Cholera is not restricted to any one province instead has spread to all 10 provinces of Zimbabwe. Importantly, there are 375 Cholera Treatment Centres (CTCs) and Cholera Treatment Units (CTUs) are smoothly working in all designated locations inside the country (World Health Organization, 2015). WHO (2015) elucidates that the CFR ratio hovers around 4 per cent and this looks a daunting health challenge not only for Zimbabwe but also for the WHO as well. in the following parts of this paper, first relevant statistics have been critically analyzed in which data collection methods and their relative strengths and weaknesses have been appropriated evaluated. It is followed by the part explaining the application of triangle model (agent, host and environment). Before the conclusion part, health promotion strategy has been made part of the paper. Prevalence of cholera Figure 01: Cholera cases and deaths reported in Zimbabwe (1992 to 2009) Source: (Mukandavire et al., 2011). The graph shows a growing trend of Cholera in Zimbabwe since 1992 till 2009. Cholera cases are constantly increasing over these years as the graph highlights that the dark black bar is regularly going upward, signifying that the cholera is getting strength throughout this period. More importantly, the graph depicts that the highest number of cases were reported in the last reported year (2009) in which more than 2000 cases were highlighted. At the same time, cholera-caused deaths and CFR were also increasing with the trend depicted by the cholera cases. The graph clearly hallmarks the level of precautionary measures taken to control and eliminate Cholera from Zimbabwe. The graph exhibits that the bar representing the cholera death is not diminishing over these years instead it is consistently increasing throughout the period, stipulating that the provided vaccination process and other precautionary measures were not satisfying their intended objectives. At the same time, the graph also signifies that the CRF ratio has been abnormally increasing higher. For example, from 2002 to 2007, CFR ratio was the highest when it is compared with the bars representing cholera cases and cholera-caused deaths. Again, this growing depiction clearly highlights the type and level of efforts to control cholera in Zimbabwe. However, it is pertinent to indicate that the graph fails to provide details in 1995 and 1996, raising questions about the data validity and data integrity as well. In this regard, it is important to mention that Zimbabwe is a developing country where regulatory infrastructure or governance is not up to the mark as the issue of corruption; embezzlement and lack of sufficient funds for carrying out the routine performance are common. And it is difficult to fully reply on the validity of the collected data as the collected data are not provided or gathered by WHO instead it is compiled by the MoHCW which is a government-owned institution in the country. More importantly, it is highly essential that before making or drawing conclusions from any data, sources of data and their reliability are always considered. As this consideration enables a researcher to understand validity and reliability of data which is largely reliant on the sources providing or generating data, it is highly difficult to fully rely on the data provided by the MoHCW. At the same time, this source has not highlighted which data collection method that have been used for collecting data have also not been mentioned by the authority. In addition, Zimbabwe has Figure 02: Cholera cases and deaths reported in Zimbabwe (1992 to 2009) Source: (Mukandavire et al., 2011). This graph is more clearly depicting the historical presence of cholera in Zimbabwe. In 1992, 1993 and 1994, 2048, 5385 and 3 cholera cases were reported respectively. If the comparison between 1992 and 1993 is made, the subsequent result indicates that more than 150 per cent increase was reported in the cholera cases in that period. However, in 1994, this 150 per cent increase started to decline and ends in negative growth, highlighting some serious flaws and shortcomings in the data collection methods. Additionally, this flaw is not restricted to these years instead it is also found in the subsequent years as well. For example, in 1999, 4081 cases were highlighted and in 2000, only 1911 cases, highlighting a decrease of more than 300 per cent in a single year; additionally, in 2006, there were only 789 cases reported and in the subsequent year only 65 cases, signifying some serious flaws with the data collection methods. Under this situation, certain possibilities cannot be undermined. First, the data collection institution might had not been able to appropriately collect and retain data from sources or the institution might had faced the problem of adequate resources for either collecting the data or retaining the data record in a proper format and proper condition as well. Figure 03: Cholera cases and reported deaths from MoHCW (Nov. 2008 to July 2009) Source: Source: (Mukandavire et al., 2011). This figure provides overview about the prevalence of cholera in different provinces of Zimbabwe. The figure takes into account total population, total cases, attack rate, total deaths and CFR %. From the perspective of population, Harare remains the most populated areas where 2,012,784 people were living during the reported time; total infected cases were 19,577, attack rate per 10,000 97 and 655 deaths were recorded during the period. On the other hand, the least populated area is Bulawayo inhibiting 718,278 people, 445 infected, 6 attack rate per 10,000, 18 deaths and 4.04 CFR %. When these statistics compared with the statistics of Harare, it can be deduced that Bulawayo faces the problem of inadequate health facilities whereas Harare has comparatively better vaccination, and improved basic infrastructure. At the same time, in terms of total infected cases, the highest cases were reported in Mashonaland West where 22,751 people were infected. As a result, attack rate and reported total deaths were the highest recorded during that period. Additionally, in terms of CFR %, the highest rate was provided by Mashonaland East where 6.94 and 6.09 CFR was recorded in Matebeleland North, highlighting the level of deaths and reported attacks in these regions. Triangle Model Triangle model is appropriate to define and elaborate the level of cholera prevalence in the different provinces of Zimbabwe. The figure 04 represents the relationship between agent, host and environment where each has its own types and relationship with other host and environmental factors. Figure 04: Triangle Model Source: (Mausner and Kramer, 1985). For example, Bhopal (2008) has clearly identified and highlighted different types of agent, host and environment: agent factors encompass, serotype organism, virulence organism, antibiotic resistance; age sex, genetic inheritance, previous disability, weight , height and behaviours; environmental factors consist of weather, air composition, water composition, home overcrowding, food contamination, cooling tower use, human or animal contact and workplace hygiene. The application of triangle model clearly represents the spread of cholera in Zimbabwe. Fundamentally, the role of agent which include vegetables, water, fruit, and other consumable items which provide basic source of cholera is important to understand as it has overarching significance and contribution in the spread of this disease in the country. For example, agent works as a transmitter which carries the infectious organism for spreading the diseases. However, it is still important to indicate that this source does not do anything on its own instead it relies on other factors which add or facilitate them. For example, lack of clean drinking water remains the major environmental factor through which agent works and transmit and spread the disease in humans and other contacting organisms. The triangle model is important to understand that how this disease is spreading throughout Zimbabwe. For example, agent reaches host and the host is affected by the environment and which also facilitate the agent to carry over cholera organisms and affect children and adults living in these areas. At the same time, some organisms spread faster than others as they receive support from environmental factors or weather conditions that enable them to move from one host to other. And this spread has also become a source of spreading cholera in different provinces of Zimbabwe. As a result, the cholera has become epidemic disease across Zimbabwe where the intermingling of these different factors directly and indirectly contributes to the spread of cholera. Health promotion strategy Effective health promotion strategy should be envisioned and implemented for making Zimbabwe free of cholera. For this purpose, a multi-prone strategy would be needed in which each and everyone should play their assigned role and provide contribution against this noble cause. For attaining this objective, it is highly essential that mass awareness campaigns, economic development, infrastructural development, institutional role and most importantly family role should be planned and devised. And all these activities must be coordinated so as to attain the objective of this strategy. In this regard, it is important to mention that without the active and full support of those involved, it would be nearly impossible to eradicate this disease from the different provinces of Zimbabwe. Health strategy and policy First, the government of Zimbabwe should lead this strategy by developing certain cholera specific short term and long term goals. For example, the government of Zimbabwe should develop a comprehensive health policy in which eradication of cholera from Zimbabwe should be the fundamental objective of the health policy. More specifically, the government should plan that by the end of 2018, the country would be cholera-free country. Through this policy, the government should set small goals for every province where a reasonable and strong health monitoring and promotion institution should be established. Awareness programs Cholera-related information booklets, adult sessions and other related information sources should be distributed across Zimbabwe; In the awareness booklet, cholera-specific information, causes, symptoms, effects, types, sources, prevention methods and treatments should be clearly mentioned (World Health Organisation, 2010). It is important that all related booklets should be in the native language along with pictures and other graphic images should be used for making learning easier for them (World Health Organisation, 2010). More importantly, this campaign should be village or community specific (World Health Organisation, 2010). This strategy would be highly practical and result-oriented as it will make easier for organisers to assess and evaluate efficacy of programs. At the same time, interactive adult sessions in which women and men should be given information through showing a practical demonstration of activities (World Health Organisation, 2010). This would enable the participants to understand the activities easily. Economic development Economic empowerment is essential (Samantha, 1999; Smith et al.2004), especially women empowerment (SOS Children’s Villages, 2014; Burra et al., 2005; Gallina, 2014). Providing adequate employment opportunities is important as this will enable them to have access to the basic human needs including access to safe clean drinking water, healthy and fresh fruit and vegetables are some of the important nutrition-related intakes. In other words, this economic prosperity will enable them to avoid consuming those food items which cause cholera and other diseases. Institutional role Medical health care institutions are the key against cholera. Currently, many health care institutions and units are not performing adequately; consequently, this underperformance also contributes to the spread of cholera. For example, health care units should have adequate pills, and medical and surgical instruments along with sufficient quantity of qualified professional doctors. Family role This approach works at the micro level. Housewife should be given special attention as she runs house and looks after children. If she is adequately educated and trained, the rate of cholera would start declining. For this purpose, special awareness programs and sessions specific to housewives should be devised and implemented as well. References Bhopal, R. S. (2008). Cause and Effect: The epidemiological approach. Oxford: Oxford University Press. Burra, N., Deshmukh-Ranadive, J., & Murthy, R.K., (2005). Micro-Credit, Poverty and Empowerment: Linking the Triad. New Delhi: SAGE. Gallina, A. (2014). Gender Equality and Women’s Empowerment: Nepal Case-Study. Available: http://asia.procasur.org/wp-content/uploads/2014/12/6.-Nepal-scaling-up-gender-Draft-Ambra-Gallina-14-Feb.pdf Accessed: 10 February, 2015 Mausner, J., & Kramer, S. (1985). Mausner & Bahn epidemiology: An introductory text. 2nd ed. Philadelphia: W. B. Saunders. Mukandavire, Z., Liao, S., Wang, J., Gaff, H., Smith, D.L., Morris, J.G. (2011). Estimating the reproductive numbers for the 2008-2009 cholera outbreaks in Zimbabwe. Proceedings of the National Academy of Sciences, Vol. 108, No. 21. Pp. 8767-8772. Samanta, R.K. (Ed.). (1999). Empowering Women: Key to Third World Development. New Delhi: M.D. Publications. Smith, P.E., Troutner, J.L., Hunedfeldt, C. (Eds.). (2004). Empowerment: Women in Asia and Latin America. Maryland: Rowman & Littlefield. SOS Children’s Villages, (2014). Women’s economic Development: What is it, and why does it matter? Available: http://www.soschildrensvillages.org.uk/news/archive/2014/03/women-economic-empowerment Accessed: 15 February, 2015. 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