Health in Zimbabwe

Zimbabwe had an average life expectancy of 55.68 years according to the 2014 CIA estimate.[1]

A cholera epidemic in Zimbabwe that began in August 2008, swept across the country[2] and spread to Botswana, Mozambique, South Africa and Zambia.[3][4] By 10 January 2010 there had been 98,741 reported cases and 4,293 deaths making it the deadliest African cholera outbreak since 1993.[5][6] The Government of Zimbabwe declared the outbreak a national emergency and requested international aid.[7]

2018-2019 cholera outbreak

The 2018-2019 cholera outbreak began on 1 September 2018, and the last reported case occurred on 12 March 2019.[8] The outbreak occurred after Zimbabwe's largest outbreak in 2008. Zimbabwean government declared a national emergency on 6 September 2018 [9]. The outbreak originated in Glenview, a suburb in Harare Zimbabwe’s capital city, and then spread to the following provinces in Zimbabwe: Manicaland, Mashonaland East, Mashonaland West, Bulawayo, Mashonaland Central, Midlands, Masvingo and Matebeleland South.[10]The last report from the World Health Organization Afro regional office has listed the outbreak as a closed event with the outbreak running from 6 September 2018 to 12 March 2019. [11] They were a total of 10 421 cases, and 69 people died as a result of the outbreak.

There were several risk factors associated with the outbreak described by the World Health Organization, including intermittent supplies in Harare, particularly in high-density suburbs such as Glenview, the epicenter of the outbreak [12]. The city council was also unable to supply enough water for Harare creating shortages due to the increasing urban population. [13]

These shortages led to sanitation issues as people began to use unregulated wells, and boreholes leading people in Harare drinking contaminated water.[14] The deteriorating sanitation infrastructure is leading to issues such as raw sewage flowing in areas of Harare. [15] Another sanitation issue was the informal traders selling items such as fruit exacerbating the outbreak. [16]. Four cholera treatment centers were set up in Harare to deal with the initial outbreaking cholera [17]. The WHO began a campaign to vaccinate 1.4 million people in Harare against cholera for people living in areas at most risk of contracting the disease in October 2018. [18] They were further 487,825 people vaccinated in Chimanimani and Chipinge districts in the Manicaland Provinces. [19] These vaccines were distributed after both Cyclone Idai and Kenneth to preempt a possible cholera outbreak. [20] There were no cholera cases in Zimbabwe, but they were cases in Mozambique, a neighboring country after these cyclones. [21]

To address the water supply issues in key hotspots affected by cholera through increasing water supply through water trucking, adding water tanks, and repairing existing water infrastructure [22]. To address sanitation issues, items such as soap and chlorination tablets were distributed to households in hotspot areas [23].

Zimbabwe was and still is one of the countries that have been strongly afflicted by HIV/AIDS.[24] Many of the males were affected, hence leaving many widowed females.[24] This happened to bring on a sense of independence and the role of the breadwinner for the females – changing the roles of the sex.[24] The immensity of this health issue can be clearly determined through this particular statistic: one in every five children are orphaned due the HIV/AIDS crisis[25] – making an overall number of approximately 1 million orphans due to AIDS in 2011.[26]

The use of a four-question survey administered to large numbers of children may reduce the number of children put through the invasive medical test for HIV, and therefore save money.[27]

In 2011 the number of people living with HIV/AIDS reached approximately 1.2 million,[26] when Zimbabwe had a population of approximately 12.75 million at that time.[28] People infected with HIV/AIDS made up 9.41% of the population.

Zimbabwe is ranked among the 22 countries, where tuberculosis occurs frequently.[29] In 2000, the incidence rate of tuberculosis reached 726 incidents per 100,000 people, whereas in 2011 the number decreased to 603 incidents per 100,000 people.[30] In 2011, the number of incidences of tuberculosis in Zimbabwe was 80 thousand, and the number of deaths from this disease was 3.4 thousand.[31] Africa is the top continent where tuberculosis occurs frequently, as it reached an estimated value of 2.3 million for incidences in 2010 by the World Health Organization.[31]

According to the UNDP, Zimbabwe has eight Millennium Development Goals, the fourth is Child Health.[32] Zimbabwe's infant mortality rates have been decreasing. In 2000, the infant mortality rate was 63 deaths per 1000 people, whereas in 2010 the infant mortality rate was 45 deaths per 1000 people.[33] This is an optimistic result from the goals that the Zimbabwean government – the Ministry of Health and Child Welfare – has set up, in order to decrease the infant/child mortality rates. Some of the most common diseases that these young children are facing are hunger: iron deficiency anaemia, vitamin A deficiency, and mentally impaired (iodine deficiency), and childhood diseases: acute respiratory infections, diarrhoeal disease, and malaria.[34] Among these, the most common disease is 35,000 children suffering with mental impairment disabilities due to iodine deficiency.[34]

Many of the commonly occurring diseases which often to lead to death are regarding hunger – nutritional deficiencies are causes of much infant mortality in Zimbabwe. HIV/AIDS is also an immense conflict in Zimbabwe – it also affects their infant mortality. HIV/AIDS is transmitted many ways, one of which is through the process of giving birth – passing through the birth canal and breast feeding.[35] As the number of mothers infected with HIV/AIDS increases, the amount of infant mortality due to HIV/AIDS will also increase. HIV/AIDS is also one of the eight Millennium Development Goals that is wished to be achieved by Zimbabwe.[36]

Ranking 14th as the country with the highest rate of maternal mortality, Zimbabwe had 570 deaths per 100,000 live births in 2010.[37] It has decreased significantly from 2000, when the maternal mortality rate was 640 deaths per 100,000 live births.[38] According to the UNDP, maternal death mainly occurs due to AIDS-related diseases, hemorrhaging, and hypertension.[39] In many cases, the pregnant women and mothers lack in iron, causing iron deficiency anaemia; some women also deal with neural tube birth defects – all of these which may be passed onto their children.[34]

Zimbabwe has been the central focus of promoting contraceptives and their methods of use to countries within Africa. It began a new industry where they produce wooden penises to be exported to other parts of Africa, for demonstration purposes.[40] The use of contraceptives in Zimbabwe has definitely changed the size of its population and the growth rate – steadily declining. There are many civil servants who work for the government to promote and inform families in the rural areas of contraceptives and its uses.

Female condoms are used in Zimbabwe as a source of contraception. Their use is approximately 94-97% more effective in decreasing the risk of becoming infected with HIV, as compared to male condoms.[41]^:170It has been tested in Kenya, Thailand and the United States of America that female condoms are more efficient in terms of protecting the genital areas from becoming infected with STDs and STIs as compared to male condoms.[41] Female condoms became accessible for the Zimbabwean women after they signed petitions and presented them to the government to allow access to this source of contraception during the mid 1990s.[41]^:172

Recently, the use of contraceptives has been greatly demanded by the Zimbabwean youth.[42]

A large number of the youth have proclaimed that they are embarrassed to go into pharmacies and clinics to obtain contraceptives, because the workers think that they are too young to be involved in sexual intercourse or sometimes it is frowned upon by the workers and the society due to the "no sex before marriage" belief.[42] Due to this unfriendly service by the workers and the shame the society puts on these young adults, the youth demanded easier, faster access to the contraceptives from the Zimbabwean government.[42] This indicates that the use of contraception is occurring in many parts of Zimbabwe – hence explaining its falling population growth rate. It also shows how truly Zimbabwe fulfills its duties as the country to promote contraception to other parts of Africa.

The state of water and its cleanliness in Zimbabwe is at its lowest. The nature of water and its function as the crucial element of life is known as the opposite for the people of Zimbabwe. In Zimbabwe, water contains not life but life-threatening diseases due to contamination from industrial works.[43] One of the major origins of water pollution is Zimbabwe's small industry of mining. By mining for gold, platinum, and other precious, expensive metal alloys, mining makes up for one third of the earnings from Zimbabwe's exports.[43]

Although the mining industry is a profitable method of income for Zimbabwe, it is responsible for the many causes of water pollution. As they mine for precious metals, the miners are successful in finding them but also unfriendly guests of zinc, iron, nickel, copper and cobalt metals.[44]

An excessive amount of these metals in water deteriorates the health of humans but also the lives of animals and plants – hence it is dangerous for any type of organisms to consume. For example, intakes of excessive zinc may cause internal organ damage and reduce the immune system's function.[44] Although zinc is a major nutrient supplied with food, an excessive amount of it is harmful.[44]

Other diseases that occur in Zimbabwe due to water pollution are cholera, typhoid, infectious hepatitis, Giardia, Salmonella, and Cryptosporidium.[45] However, despite all this, because water is needed and the people of Zimbabwe are becoming more vulnerable and desperate, they consume this greatly contaminated water – hence, contamination-related health issues and epidemics arises.

Air pollution is also a growing problem in Zimbabwe, due to industries, poor waste management and transportation. The World Health Organization has set up a limit for the emission of sulfur dioxide to 20 μg/m³ 24-hour mean.[46] In Harare, Zimbabwe, that limit has been exceeded to 200 mg/m³.[47] This is only the beginning of the reality of the air pollution in Zimbabwe, especially in its capital, Harare. The release of sulfur dioxide is harmful to the life of humans and other organisms. The inhaling of sulfur dioxide leads to lung diseases, breathing difficulties,[48] formation of sulfurous acid along with the moisture of the mucous membranes causing a strong irritation[48] and prevents the respiratory system's role in defending the body against foreign particles and bacteria.[49] Hence, it can be concluded that the inhaling of sulfur dioxide is tremendously detrimental to the life of organisms. Not to mention, as sulfur dioxide is emitted into the atmosphere, it forms into acid precipitation as it reacts with water, nitrogen oxides and other sulfur oxides.[50]

This is an ecological consequence that arises from the burning of fossil fuels,[51] which is performed in many countries and many industries for the formation of energy, power plants, and automobiles.[52] Acid precipitation can lead to asthma, bronchitis, lung inflammation, emphysema, and other lung and heart diseases.[53] In 2007, the number of cars per 1000 person was 114, as compared to 17 cars per 1000 person in its neighbor, Zambia.[54] Zimbabwe has a decently great number of cars, mostly all of which are low second-handed. These low second-handed cars do not meet the standard emission rates of Zimbabwe,[55] hence being a greatly environment-polluting factor, becoming hazardous to the lives of Zimbabwe citizens.

Poor waste management also disrupts the harmony of health and the lifestyle of Zimbabwe. As mentioned above in water pollution, clean water is difficult to obtain. Hence, those who can afford bottled water are forced to buy them in order to provide themselves with drinking water. However, once they are done with using the bottles, the bottles are often thrown away or burned.[44] The burning of plastic releases toxic and carcinogenic fumes, which if inhaled causes great damage on the body. Some of the chemicals released in this process are benzo(a)pyrene and other polyaromatic hydrocarbons.[56] These fumes pollute the atmosphere, causing a greater long-term damage which will eventually work against the health and lifestyle of Zimbabwe.