Tuberculosis (TB) is a major public health problem in Zimbabwe. Zimbabwe is one of the 30 TB, TB/HIV and DR-TB high burden countries. In 2014, Zimbabwe reported 32 016 all TB cases, 9% less from the 35 278 cases reported in 2013. Of the cases reported in 2014, a total of 29 653 were new cases and relapse cases and 2 363 were other retreatment cases (excluding relapses). Of the new cases, a total of 11 224 (38%) were bacteriologically confirmed pulmonary TB cases, and 13 151 (45%) were clinically diagnosed pulmonary TB cases. Concerning these new cases, children (<15 years) accounted for 8% of the cases. TB/HIV co-infection rate for 2014 was very high at 68%. For the 2013 TB patient cohort, the treatment success rate among new sputum smear-positive cases was 80%. Case detection of all forms of TB was also estimated at 70% in 2014.
IOM in partnership with the Ministry of Health and Child Care seeks to harness and encourage positive health outcomes for migrants by promoting accessible and equitable health services for vulnerable migrants. When cross-border Zimbabwean migrants live in neighboring countries such as Botswana and South Africa, they are particularly hard-to-reach. This is because of the many challenges they encounter as they try to access health services. For instance: irregular migrants often avoid using public health facilities in host countries out of fear of being intercepted and deported; long distances between the health facilities and the main road network affects attendance; negative attitudes of health workers can impact turnout; lack of time, the cost of travel and health services, and opportunity cost also have a negative impact. In addition, poverty and a poor understanding of TB disease can cause migrants to put off care seeking. The overcrowded living conditions in host countries render them more susceptible to TB infection. This need to be addressed as stated by Pillar 2 component D in The End TB Strategy “Social protection, poverty alleviation and actions on other determinants of TB as part of policy and supportive systems in the fight against TB. This pillar requires intense participation across government, communities and other stakeholders. In many cases, presumptive TB cases of this hard-to-reach group are initiated on TB treatment without the requisite diagnostic tests and with poor follow-up due to their mobility patterns. Pillar 1 talks of integrated, patient-centred care and prevention. This pillar puts patients at the heart of service delivery.
Efficiently monitoring TB incidence and prevalence in this population requires innovative approaches and active case finding. With the support from TB REACH Secretariat, International Organization for Migration, the Ministry of Health and Child Care implemented several interventions were designed to increased access to early TB case detection, rapid diagnosis and improved treatment outcomes among irregular Zimbabwean migrants returned from South Africa and Botswana, and the communities they interact with in Matabeleland South Province. The intervention project which is in high migrant areas of Beitbridge, Plumtree and the rest of Matabeleland South province include: systematic TB screening for irregular Zimbabwean migrants deported from South Africa and Botswana; improving access to TB screening and treatment services for migrants and host communities through the establishment of mobile clinics along the transport corridor; increasing awareness of TB and HIV/AIDS among migrants and high migrant-sending communities through door to door TB health messaging conducted by community health workers; distribution of educational videos for display on buses, as well as in schools and shops; and the use of m-health technology, which employs ECONET to transmit TB health educational messages to ECONET subscribers in Matabeleland South Province.
To increase early detection of TB as per the End TB Strategy Pillar 3 component A which stresses on innovation, IOM supported the installation of two Gene Xpert machines at two district hospitals in the province, also at Plumtree and Beitbridge Reception and Support centers where South African and Botswana Zimbabwean deportees (irregular migrants) are received. In addition IOM has supported the training local health staff on TB case management. Since the start of the project in January 2015, the project has tested over 3 233 presumptive TB cases with Gene Xpert machines and LED microscopes, detecting 273 TB positive cases with 10 drug resistant TB cases.
TB REACH project is being made possible by Stop TB Partnership/ TB REACH and Global Affairs Canada. IOM looks forward to support the Ministry of Health and Child Care in managing health-related aspects of migrant health issues as well as implementation of future projects.
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