Introduction: Mhondoro-Ngezi district is in the malaria elimination phase. However, Ward 13 experienced an unusual increase in malaria cases, surpassing the action threshold from week 11 to week 22 of 2022. Enhanced case-based surveillance was ongoing. We investigated the outbreak to determine factors associated with the resurgence of malaria in Ward 13, Mhondoro-Ngezi district, 2022. Methods: We conducted an unmatched 1:1 case-control study. A case was any resident of Ward 13 who presented with headache, fever, general body malaise, joint weakness, vomiting and tested positive for a rapid diagnostic test from 24 February to 7 April 2022. We collected data using a pre-tested, interviewer-administered questionnaire. Data were analysed using Epi Info 7. Results: We interviewed 72 cases and 72 controls. Males were 69 (95.8%) among cases and 63 (87.5%) among controls (p=0.07). The median age for cases was 28 years (IQR: 23-36) and 30 years (IQR: 25-36) for controls. Factors that were significantly associated with contracting malaria were stagnant water bodies near sleeping home (OR=2.2; 95%CI: 1.03-4.7), being a permanent resident of ward 13 (OR=7.8; 95%CI: 3.6-17.1) and sleeping outside at night (OR=8.09; 95% CI: 2.06-7.1). Significant factors associated with the reduction of malaria transmission were sleeping in a house with closable windows and openings (OR=0.2; 95%CI: 0.09 – 0.55) and residing outside Ward 13. Conclusion: Sleeping near a stagnant water source, being a permanent resident of Ward 13 and sleeping outside at night increased malaria transmission. Sleeping under an ITN and in a house with closable windows reduced malaria transmission. We recommended the distribution of ITNs.

IntroductionPublic health emergencies (PHEs) require strong coordination systems to ensure effective response, particularly in resource-limited settings. In Zimbabwe, the incident management system (IMS) framework was adopted to strengthen outbreak response at the national level, yet evidence on its implementation at the subnational level remained limited. In 2024, Kadoma City activated a virtual PHE operation center (PHEOC) and applied IMS during a cholera outbreak. This study presents the first systematic evaluation of IMS implementation at subnational level in Zimbabwe, examining its functionality and effectiveness during the 2024 cholera outbreak in Kadoma City.MethodsWe used a mixed-methods cross-sectional design combining a quantitative survey (n = 83), key informant interviews (n = 15) and systematic document review. Response personnel from Kadoma City Council and partner organizations who participated in the outbreak response were included. IMS functionality was assessed across four domains: coordination and leadership, information management and situation awareness, planning and monitoring, and logistics and resource mobilization. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically and triangulated with document review findings.ResultsEighty-three respondents were interviewed. Only 16 (19.3%) had received prior IMS training, and 33 (39.8%) demonstrated knowledge of the functions of at least one IMS section. A virtual PHEOC was activated within 48 h of outbreak detection, with 71 (85.5%) respondents reporting clear role understanding. Five memoranda of understanding (MoU) with partner organizations were signed, facilitating coordination and resource mobilization. Only three formal situation reports (SitReps) were produced; however, daily updates on case counts were shared informally via a WhatsApp work group. Resource challenges included supply shortages and insufficient staffing, despite surge support from other governmental departments.ConclusionThis first IMS evaluation in Zimbabwe demonstrated that rapid activation and clear coordination structures can be achieved at the subnational level even with limited resources. However, critical functionality gaps were noted in IMS training, information management, and resource mobilization. Strengthening subnational emergency response capacity requires systematic investments in pre-event IMS training, standardized documentation protocols, dedicated emergency budgets, and surge capacity planning to reduce dependence on external support and ensure sustainable outbreak response at the municipal level.

Following the 2014–2016 Ebola outbreak in West Africa, the World Health Organization Regional Office for Africa, the Africa Centres for Disease Control and Prevention and the West African Health Organization prioritized establishment and operationalization of Public Health Emergency Operations Centers (PHEOCs) across Member States as strategy for strengthening emergency preparedness and response. Public Health Emergency Operations Centers serve as important platforms for coordinating timely, multisectoral and effective responses to health emergencies. In 2024, Kadoma City in Zimbabwe, established a subnational PHEOC to institutionalize emergency preparedness, strengthen coordination and enhance local health system resilience. This case study documents the establishment process, governance arrangements, early achievements and operational challenges of the PHEOC in Kadoma. Data were derived from institutional document review and key informant interviews. The PHEOC was established through collaboration between Kadoma City Council, the Ministry of Health and Child Care and World Vision Zimbabwe. It is embedded within the Department of Health and Environmental Services, operating in alignment with the national Incident Management System framework. Early achievements included: upgrading infrastructure, equipping the center with core Information Communication and Technology systems and providing capacity-building programs. Despite these advances, the PHEOC faced key constraints including, dependence on external funding, fragmented and largely paper-based information systems and weak digital interoperability with provincial and national PHEOCs. These challenges pose risks to long-term sustainability and operational effectiveness. The experience from Kadoma demonstrates the feasibility of establishing functional subnational PHEOCs in resource-constrained settings through strategic partnerships and institutional integration. It also highlights critical system-level requirements for sustainability, including stable financing, dedicated human resources and interoperable digital infrastructure. As Zimbabwe expands its national PHEOC network, the Kadoma case provides transferable lessons for strengthening decentralized emergency preparedness and transitioning from ad hoc responses to institutionalized public health emergency management. What is already known on this topic: Public Health Emergency Operations Centers are important for coordinating emergency preparedness and response but are often centralized at the national level, with limited evidence on subnational implementation in resource-constrained settings. What this study adds: This study demonstrates that establishing a functional subnational PHEOC is feasible in low-resource settings like Kadoma. It highlights how integration with the national IMS frameworks enhances coherence and operational effectiveness. How this study might affect research, practice or policy: The experience from Kadoma offers a replicable model for other subnational levels aiming to institutionalize emergency response systems. It reinforces the importance of multisectoral collaboration and identifies challenges that must be addressed to sustain PHEOC functionality.

An Intra-Action Review (IAR) is a real-time evaluation conducted during an emergency response to identify good practices, challenges and inform corrective actions. It allows for timely learning and course correction during ongoing outbreaks. In 2024, Kadoma City experienced a cholera outbreak that resulted in 1799 cases managed at the Cholera Treatment Center (CTC), 2535 suspected cases seen at Oral Rehydration Points (ORPs), and 31 deaths. As part of the response, an IAR was conducted, led by Kadoma City Council, to evaluate coordination, identify challenges, and document best practices to improve the current response and strengthen preparedness for future outbreaks. The IAR employed a qualitative and participatory approach following WHO methodology to assess cholera outbreak response activities in Kadoma City. The IAR reviewed response activities from January 4 to April 30, 2024, and was conducted in-person on May 2, 2024, using a working group format. The working groups covered eight response pillars aligned to the five core functions of the Incident Management System (IMS). Out of 83 participants invited, 77 (92.8

Introduction: The Acute Flaccid Paralysis (AFP) surveillance system is a critical method for detecting poliomyelitis cases, which involves identifying AFP cases and confirming them through laboratory analysis of stool samples. A review of Kadoma City AFP surveillance data from 2018 to 2022 indicated that zero cases were detected in 2018 and 2021 against a target of two cases per 100,000 children under 15 years per year. An evaluation of the AFP surveillance system was done to assess knowledge of health workers, its usefulness and surveillance system attributes. Methods: A descriptive cross-sectional study was conducted in 2022 across all healthcare facilities in Kadoma, including both private institutions and council clinics, with interviewer-administered questionnaires to healthcare workers. Data were analysed for frequencies, medians and proportions to assess knowledge, usefulness, age, years in service and surveillance system attributes. Results: The majority of health workers (63.4%) had inadequate knowledge of the AFP surveillance system. Data quality was poor, with forms incomplete across three reporting categories. Furthermore, the system demonstrated low sensitivity, with zero reported AFP cases in 2018 and 2021, despite the target of two cases per 100,000 children under 15 years annually. Conclusion: The AFP surveillance system lacked sensitivity in detecting polio cases, was unstable, and suffered from poor data quality. These issues may be attributed to insufficient knowledge among healthcare workers. We recommend training for healthcare staff on case detection and reporting procedures, display of AFP case definitions at all facilities, and the inclusion of private institutions in surveillance activities.

Background The public health surveillance and response systems in Kadoma primarily rely on indicator-based surveillance (IBS), contributing to delayed detection and response to outbreaks. This protocol outlines the establishment of a Community Event-Based Surveillance (CEBS) system using the One Health approach to complement the existing IBS and enhance early identification and response to public health threats in Kadoma.Methods and analysis A mixed-methods approach will be used to establish and evaluate a CEBS system in Kadoma. The system set-up will follow the Africa Centre for Disease Control (Africa CDC) Event-Based Surveillance Framework guidelines. Healthcare personnel, community health workers (CHWs) and representatives from the animal health and environmental sectors will be trained in signal detection, triage, reporting and response. A preliminary evaluation will be conducted 5 months after implementation to assess system performance, including the frequency and verification of signals, the types of events detected, response timeliness and system acceptability. The full evaluation of the CEBS system is scheduled for September 2026, 3 years postimplementation, guided by the updated CDC guidelines for evaluating public health surveillance systems.Ethics and dissemination Authority to establish, evaluate and publish the protocol for the CEBS system in Kadoma was sought and obtained from the Kadoma City Health Department and its Institutional Review Board (IRB) (IRB number: Mun/08/23). The surveillance system set-up process will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the Belmont Report and in compliance with local ethical standards. Findings will be shared with stakeholders through formal reports and community feedback channels.

Introduction: measles is a vaccine-preventable disease and still causes morbidity and mortality in children in developing countries. Sanyati District identified three suspected measles cases and three suspected measles deaths on 4 August 2022. The specimens tested IgM positive for measles. We investigated the measles outbreak, knowledge, vaccine hesitancy, and health seeking practices of caregivers. We also determined the factors associated with measles transmission. Methods: an unmatched 1:1 case-control study was conducted in Sanyati District. A case was defined as any Sanyati District resident under the age of 15 years who had measles signs and symptoms or with IgM-positive results. A pretested interviewer-administered questionnaire and records review were used to collect data. Logistic regression was used to determine factors associated with measles transmission (p <0.05). Results: a total of 123 cases and 123 controls were interviewed. One hundred and eighteen (95.9%) cases knew symptoms of measles compared to 119 (96.8%) among controls. Sixty-one (48.8%) cases indicated that they sought treatment for measles. Forty-seven (38.2%) cases and 6 (4.9%) controls were vaccine-hesitant. The independent factors associated with measles transmission were not being vaccinated (aOR= 3.26 95%CI: 1.27-8.34), being over the age of five years (aOR=3.38 95%CI: 1.81-6.31) and having received vitamin A supplementation (aOR= 0.31 95%CI: 0.11-0.83). Conclusion: children who were not vaccinated and children above five years were at risk for contracting measles. We conducted supplementary activities for vaccination, vitamin A supplementation, and community sensitization in areas with high attack rates.

Introduction: In 2023, Zimbabwe declared a cholera outbreak that spread across multiple cities, reaching Kadoma by January 2024. Cholera outbreaks pose a major public health threat due to their potential to spread rapidly. Inadequate infection prevention and control (IPC) measures in treatment facilities can accelerate disease transmission, putting healthcare workers, patients, and surrounding communities at risk. Evaluating IPC implementation during outbreaks is essential to identify gaps, improve adherence to guidelines, and strengthening outbreak preparedness and response. We evaluated IPC implementation at a cholera treatment center (CTC) and oral rehydration points (ORPs) during the 2024 cholera outbreak in Kadoma, Zimbabwe. Methods: A mixed method approach incorporating quantitative (descriptive cross-sectional) and qualitative data collection techniques was used. Data on demographics, IPC knowledge and training, availability of IPC resources and adherence to guidelines were collected from May to June 2024. Data collection tools included a structured questionnaire, records review, checklists, and direct observations. Quantitative data were analyzed using Epi Info 7.2.5™ to calculate means and proportions, presented as tables and charts. Qualitative data were thematically analyzed to identify key findings and recommendations. Results: We recruited 146 respondents for the study. Most were auxiliary staff 74 (50.7%) and community health workers 31 (21.2%). Ninety-two respondents (63.0%) had good knowledge of IPC, and 84 (57.5%) had received IPC training. The CTC had adequate IPC supplies lasting over 14 days, while ORPs faced shortages with key resources not lasting more than 7 days. The setup of all cholera treatment facilities (1 CTC and 5 ORPs) adhered to the Global Task Force on Cholera Control (GTFCC) and Zimbabwe Cholera Control manual guidelines. Seventy-eight (53.4%) of respondents perceived staff shortages as the main IPC implementation barrier. Conclusion: Most respondents demonstrated good IPC knowledge and the cholera treatment facilities setup adhered to the national and GTFCC guidelines. However, IPC implementation was affected by staff shortages and resource constraints, particularly at ORPs. Ensuring adequate supplies and continuous health worker training is essential for compliance with IPC practices.

Introduction Sexual Exploitation and Abuse (SEA) is a fundamental failure to protect the vulnerable by those in power. The heightened vulnerability of individuals during public health emergencies contributes to a significant increase in reported SEA cases worldwide. PRSEA is essential to safeguarding survivors and offering support that prevents further exploitation or abuse. Kadoma City was one of the most affected areas in Zimbabwe that reported cholera cases in 2024. This study assessed the beneficiaries’ knowledge and experiences of SEA during the outbreak response. Methods We conducted a mixed methods study in Kadoma City. The study population were beneficiaries who received hygiene kits during the response from January to July 2024. A sample size 371 was calculated using Dobson’s formula. Data were collected using an interviewer-administered questionnaire, and a focus group discussion guide. Beneficiaries were selected from the cholera linelist. Analysis was done using Epi Info 7™ and thematic analysis for qualitative data. Results We interviewed 371 beneficiaries of which, 300 (81%) were females. Two hundred and ninety (78%) of them attained a secondary education (Form 1-4). Twenty-six (9%) females and 9 (13%) males had high SEA knowledge (p=0.3005). Seven (2%) respondents reported knowing a sexual relationship between a responder and a beneficiary. Three (1%) reported being sexually exploited and five (1%) reported being sexually abused during the response. Barriers to reporting SEA mentioned included fear 318 (86 %), slander 119 (32%) and perpetrator victimization 90 (24%).

Background Kadoma City has experienced repeated cholera outbreaks. The latest occurred in 2024 and affected all 17 administrative wards. In March 2024, a Knowledge, Attitude, and Practices (KAP) survey was conducted to inform planning and implementation of cholera preventive interventions. Methods A cross-sectional study was conducted employing a mixed-methods approach, utilizing both quantitative and qualitative data collection techniques. A sample size of 609 was calculated, and stratified sampling method was used to select households from which one member aged 18 years or above was interviewed. Data were collected using a pretested questionnaire and analyzed using Epi Info 7.2.5™. Thematic analysis was used for qualitative data analysis. Results We recruited 611 respondents with a median age of 31 years and majority, 399 (65.3%) were females. Three hundred and ninety-three (64.3%) respondents had completed secondary education, and 273 (44.7%) were self-employed. Drinking contaminated water was reported by 497 (81.3%) as a mode of cholera transmission while 525 (86.9%) reported handwashing with soap after visiting the toilet as a critical preventive measure. Overall, 356 (58.3%) had high knowledge of cholera. Attitudes were positive, 399 (65.3%) respondents agreed that cholera could be fatal if untreated, while 367 (60.1%) agreed that oral cholera vaccine (OCV) was an effective protective measure. Three hundred and thirty-seven (55.2%) reported disposing waste in refuse pits, 288 (47.1%) used plastic bins for collection by the council, and 127 (21%) reported disposing waste in neighborhood heaps. When asked about the preferred methods of receiving health related information, 413 (67.7%) preferred door-to-door campaigns and 345 (56.5%) preferred short message services (SMS). Conclusion Respondents demonstrated good cholera knowledge and positive attitudes, though gaps in sanitation were noted. We recommended improving waste collection in the city and incorporating health promotion messages in council utility bills and SMS sent to residents.

Introduction: Globally COVID-19 case fatality rate is estimated to be 2.5%. Zimbabwe recorded the highest case fatality rate (CFR) at 3.5%. No analysis of COVID-19 deaths was done in Kadoma City despite a case fatality rate of 10%. We conducted a descriptive analysis of COVID-19 deaths in Kadoma City from September 2020 to August 2021. Methods: A descriptive cross-sectional study was carried out to describe the deaths by person, place and time, clinical characteristics and trends in Kadoma City. Records of COVID-19 deaths were our objects of study. All 129 records were included in the study. The COVID-19 deaths list for Kadoma City was the data source. Variables analyzed include age, sex, signs and symptoms, preexisting conditions and survival time from date of onset. Demographics and clinical characteristics were summarized to come up with medians, frequencies and proportions. Results: The median days to death was 3 with interquartile range (IQR) (2-5) and the median age was (IQR) 67 (47-80) years. A total of 97 (75%) deaths occurred in the community and 32 (25%) occurred in isolation centres. The major cause of death was acute respiratory distress syndrome (ARDS) 127 (98%). Majority of the deaths 28 (45%) had diabetes and 28 (45%) had hypertension. The informal employment sector recorded the most deaths 45 (39%). Males were 79 (61%) and females were 50 (39%). Conclusion: We concluded that COVID-19 deaths were high among patients isolating at home. ARDS was the major cause of death. The burden was made worse by the cases that were brought in dead. We strengthened surveillance and risk communication.

Introduction: Zambia is a cholera-endemic country and the epidemic in the capital, Lusaka, 2017-2018, caused more than 5,900 cases and 110 deaths. Low-income resident districts in Lusaka are known as hotspots for cholera outbreaks. Among these districts, Kanyama sub-district has been the origin of the outbreaks in Lusaka, 2005- 2006, 2016, and 2017-2018. However, spatial factors are associated with the increased number of cholera cases in the Kanyama sub-district; the origin place is still not fully understood. We determined the environmental factors associated with the increased cholera cases in the Kanyama sub-district by using geocoordinate data collected during the outbreak in 2017-2018. Methods: We conducted a retrospective data analysis on geocoordinate data of houses of cholera cases identified in Kanyama sub-district during the outbreak in 2017-2018. Associations between the number of cases in each of the 218 generated zones within Kanyama sub-district and the distribution of environmental factors (e.g., water sources, toilets) were analyzed. Results: A total of 405 cholera cases were identified in 136 zones (62%, 136/218). Zones with cases had significantly larger numbers (median, interquartile range; IQR) of toilets outside houses (56.5, 0-256; vs 35.5, 0-151; p<0.001) and pit latrines (51, 0-194; vs 28; 0- 117; p<0.001), while significantly smaller number of water tanks than zones without cases (0, 0-21; vs 0.5, 0-19; p=0.021). The number of cases showed a positive correlation with the number of toilets outside houses (rho=0.307, p<0.001) and pit latrines (rho=0.354, p=0.001). Conclusion: Lack of access to sanitary toilet facilities was associated with the increased number of cholera cases in Kanyama sub-district; the origin place of the recent cholera outbreaks in Lusaka, Zambia. Our study highlighted the importance of targeted public health interventions to the sanitation systems in those areas.

Introduction: COVID-19 continues to be a major public health problem globally. On December 1, 2020, nine students at a high school presented at the school clinic with flu-like symptoms. COVID-19 was suspected and nasopharyngeal swabs were collected. The nine samples tested positive for SARS-CoV-2 on Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test. From the first to the 8th of December 2020, the attack rate increased from 2.6% to 29.8%. We described the outbreak by person, place and time and determined factors associated with the outbreak at the school.

Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross- sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.2.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate frequencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 (6.1%) discontinued ART, 415/2833 (14.7%) transferred out, 69/2833 (2.4%) died and 2176/2833 (76.8%) were retained on ART. Out of those who discontinued ART, sixty-five percent (112/173) were females. Approximately two-thirds had immunological failure 110/173 (64%). The trend in ART discontinuation decreased over the years but was not statistically significant (R2 = 0.57, p > 0.05). ART discontinuation was independently associated with being <40 years of age (adjusted pOR = 2.3, [95% CI: 1.6 - 3.2], p = 0.001), having never attended school (adjusted pOR = 3.9, [95% CI: 2.5 - 6.0], p = 0.003) and having immunological failure (adjusted pOR = 6.2, [95% CI: 4.5 - 8.6], p = 0.0001). The reasons mentioned by the health care workers which cause people living with HIV (PLHIV) to discontinue ART were health state not improving 13/18 (72.2%), participating in artisanal mining activities 11/18 (61.1%), change in marital status 9/18 (50.0%), medical side effects of ART 8/18 (44.4%), living far from health facilities 5/18 (27.8%) and relocating to neighbouring countries 3/18 (16.7%). Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisanal mining activities, change in marital status, medical side effects of ART, living far from health facilities, and relocating to neighbouring countries. We recommended continuous provision of health education, enhanced adherence counselling sessions to those with unsuppressed viral loads and investigating the cause of virologic failure.

This was an appraisal of a Rubella outbreak investigation carried out in Gokwe North District (Zimbabwe).The outbreak occurred from 24 th June to 12 August 2014 at a primary school.The manuscript has an abstract that provided the stance and thesis.The introductory part covered the epidemiology of the disease.Methods section detailed the study design.Findings of the descriptive and analytical epidemiology investigations are presented in the results sections.The article was published in the Pan African Medical Journal, a peer reviewed journal.This confers credence to the journal.It is tracked by HINARI, and Scopus, among others.The corresponding author is Donewell Bangure, a Zimbabwean epidemiologist.The manuscript was backed up by credible references from World Health Organization and other peer reviewed journals.However, wrong construction of the epidemic curve, may have led to erroneous conclusions.Most of the information in the manuscript was objectively developed.However, some references were unpublished, and, some outdated.The manuscript was published in a peer reviewed journal and this makes it stable.There are three tables and one graph in the article.There are three well labelled tables and a graph

Background: Anti-retroviral therapy was introduced in 1997 to manage people living with the Human Immune-deficiency virus (HIV).The success of treatment is dependent optimal levels of 95% or more adherence.A 2015 study conducted at the Rimuka Integrated HIV and TB Centre, revealed a suboptimal adherence rate 0f 87% by self-report and 65% by pill counts.We set out to investigate the efficacy of cell phone short message service on adherence among clients on ART at the center.Methodology: KAMPS was a parallel design randomized controlled trial of HIV clients receiving ART at Kadoma (Zimbabwe).Respondents were randomised 1:1.Respondents in the intervention group received a weekly motivational SMS in addition to standard HIV care whilst those in the nonintervention arm received standard care alone.The primary outcome was adherence measured using a composite scale.Secondary outcomes were weight, CD4+; and, viral load, measured at baseline and 26 weeks.The primary analysis was by intention to treat.The trial was registered PACT20161001858240.Results: Of the 552 assessed respondents, 470 were eligible and were randomized into the study.However, analysis was done for 449 respondents.At 26 weeks, 180 (76.9%) respondents in the intervention group were considered adherent compared to 127(59%) in the non-intervention group (p=0.65).The mean CD4+ cell count at six months was 554 cells mm -3 among those in the nonintervention group compared to 619 cells per mm -3 among those in the intervention group.Mean viral load was 392 copies ml -1 of blood in the intervention group compared to 2859 copies ml -1 in the nonintervention arm.Among those in the intervention group 140(60%) had viral suppression compared to 93 (43%) in the non-intervention arm.Conclusion: We conclude that weekly motivational short message influenced adherence and ultimately CD4+ cell count, viral loads and viral suppression.

Introduction: This is a critical review of an article by Zewdneh Shewamene published in the July 2015.The central theme is that consistent condom use among HIV patients is important in preventing transmission of HIV.Article summary: The premise of the authors is that consistent condom use among HIV infected is critical for interrupting transmission of HIV and acquisition of resistant strains of HIV.Among the 317 respondents, condoms awareness was 96.2%.Independent factors for consistent use were, male sex (AOR=6.87;p=0.001), urban residency, (AOR=4.65;p=0.001), a higher education attainment (AOR=8.98;p=0.001), and prolonged duration on ART (AOR=3.91;p=0.001).The conclusion was that some HIV infected people were not using condoms.Article critique: The article maybe considered as objective, and unbiased due to the peer review process.The journal that published it is indexed on PubMed, and, Embase, among others.That the article was published in a journal for those with an interest in HIV and palliative care makes it relevant for HIV programming particularly in Africa where HIV burden is high.The objectives are well spelt, and the methodology is easy to follow.Only verbal consent was obtained from the respondents contrary to the dictates of the Belmont report that requires written informed consent.Conclusion: The articles contributed to literature and can provide a basis of improving future studies of a similar nature.However, it is suggested that measurement of condom use should be serial and be recoded to a dichotomous variable in analysis.

Outbreak investigation is a key component of public health training. A good outbreak investigation can go beyond determining the causative agent by recommending policies to be formulated by policy makers. This case study simulates a real-life investigation of pyrexia of unknown origin in Shamva District, Zimbabwe, during the period of September to October 2015. It aims at reinforcing principles and skills taught in class on outbreak investigation, study design and policy initiation. The target audience for the case study is Field Epidemiologists at their advanced level of training. It is expected to be completed in approximately 2 hours. General instructions: ideally, 1 to 2 facilitator(s) is/are required to facilitate the case study for 10 to 20 participants. The facilitator should request participants to read a paragraph out loud, going around the room to give each participant a chance to read. When the participant reads a question, the facilitator encourages all participants to engage in discussions, perform calculations, and draw graphs among other tasks. The facilitators request the participants to play different roles or take different sides in answering a question. As a result, participants learn from each other, not just from the facilitators.

Globally, it is estimated that foodborne-associated illness accounts for 2.2 million deaths. This is caused by contamination of food with toxins, parasites, bacteria or viruses that can lead to increased levels of morbidity and mortality. Although steps to conducting an outbreak investigation have been outlined in most epidemiology textbooks, identifying the causative agent for a foodborne illness outbreak can be complex based on the setting. In view of that, this case study was developed based on a foodborne illness outbreak at agirls' boarding school to model the steps of an investigation. This case study will reinforce skills and theoretical knowledge attained by public health trainees, to be able to build competences in foodborne outbreak investigation. The target audiences are intermediate and advanced public health trainees. Estimated time of facilitation is 3 hours with a class size of 10- 20 students.