1. Buhera District

2. Demographic Data Demographic data (DHT Buhera 2010) Total population
Murambinda Growth Point
10.407
Birchenough Bridge Growth Point
12.142
Buhera
8.376
Pop < 1 year (3.1%)
7387
Pop 1-4 year (12.5%)
29787
Pop < 5 years (15.6%)
37174
Pop 5 – 14 years (37%)
88168
Pop > 15 years (47.4%)
112951
WCBA (25.6%)
61003
Expected pregnant women
9531

3. Total Tuberculosis diagnosis per year in Buhera District
Between 2007 and 2009 there has been a massive increase in the number of notifications. This might mean:
- High HIV prevalence (17%) in the district
- Improved identification of TB cases through decentralisation of sputum collection from clinics levels as from year 2008 facilitated by MSF decentralisation teams
- Increasing numbers of patients being diagnosed TB in Buhera while they are from neighbouring districts.
The 2009 TB Global report estimated Zimbabwean incidence of TB to be 782/100,000/year: but we have reached 700/ /year
The district has meet one of its TB targets since year 2008 of identifying more than 700 TB patients per 100,000 people per year. This is more than the WHO target of 557/100,000/year.

4. Notification rate of all TB cases per 100 000 population

5. Patients from outside Buhera District as from 2005 - 2011
Neighbhouring districts like, Gutu, Makoni, Chipinge, Bikita and Chikomba

6. Proportion of patient age groups

7. Proportion of new TB cases versus retreatment cases per year
Buhera district has recorded 8.61% retreatment cases of the total diagnosis (1649) in year The district on average records 5% retreatment cases of the total diagnosis per year. Relapses totals to 31% of the retreatment cases in There is concern about the possibility of an increasing prevalence of drug resistant tuberculosis.
As from January 2008 up-to December 2009 we have 17 relapse cases who have their sputum send for culture and sensitivity tests at Biomedical Research and Training Institute: Parirenyatwa Hospital. 13 out of 17 have received their results for culture, 7 are culture positive while 6 are negative, out of the 7 who are culture positive, 5 of them have received sensitivity results of which 3 are resistance to three or more anti-TB drugs. Two of them have died before receiving sensitivity results while the one who is alive has gone to South Africa to seek treatment of second line anti-TB drugs.

8. Active Screening of TB to HIV positive clients in Buhera district as from June 2010
July
Aug
Sept
Oct
Nov
December
Total
Percentage
Total screened
4756
2838
4249
4204
3490
4546
3998
28081
(100%)
100%
Total Symptomatic TB suspects investigated for sputum
185
263
153
195
117
131
100
1144
(4%) 4%
Number with smear positive result 14 21 9 13 16 10 92
(8%)
Number with smear negative result
171
242
144
182
108
115 90
1052
(92%)
Total asymptomatic
4571
2575
4096
4009
3373
4415
3898
26937
(96%)
96%

9. Tuberculosis diagnosis facilitated by sputum collection from clinics versus hospitals

10. Place of Smear collection
Total patients diagnosed TB, as a result of sputum collection from clinics from year
Year
(All)
Place of Smear collection %
Totals
Mudanda RHC
0.19% 1
Mudawose RHC
0.37% 2
Mombeyarara
0.56% 3
Bangure RHC
1.49% 8
Gombe RHC
1.68% 9
Rambanepasi RHC
2.05% 11
Chirozva RHC
Chiweshe RHC
2.24% 12
Chiwenga RHC
Murwira RHC
2.80% 15
Nyashanu Clinic
3.17% 17
Mutiusinazita RHC
3.36% 18
Zangama RHC
Garamwera RHC
Chabata RHC
Betera RHC
4.10% 22
Nerutanga RHC
4.29% 23
Madzimbashuro RHC
4.85% 26
Mutepfe RHC
5.60% 30
Buhera R. hospital
6.16% 33
Chapanduka RHC
6.34% 34
Muzokomba RHC
7.09% 38
Munyanyi RHC
7.65% 41
OI Clinic
21.64%
116
Grand Total
100.00%
536

11. Total Tuberculosis diagnosis per quarter for the past six years in Buhera District

12. 2010 TB diagnosis per quarter

13. Results of smears examined for culture and sensitivity tests
Item
2008
2009
2010
Total
Smear send for culture and sensitivity tests 3 18 11 32
Culture results
Culture positive 2 8 6 16
Culture negative 1 7
Waiting for results 5
MDR 4
We are not testing sputum for culture and drug sensitivity in the district due to shortage of resources, but we send sputa for culture and sensitivity test to national reference laboratory: Biomedical Research and Training Institute: Parirenyatwa Hospital in Harare. As from January to December 2010 the district managed to sent 11 smears for culture and sensitivity tests, of which 6 out of 11 have culture positive result while the remainder 5 out of 11 are still waiting for their culture results. 3 out of 6 who had a culture positive results had a sensitivity tests of which all were resistance to three or more first line anti-tuberculosis drugs (rifambicine, Isoniazide and Ethambutol)
As from January 2008 up-to December 2009 we have 21 relapse cases who have their sputum send for culture and sensitivity tests at Biomedical Research and Training Institute: Parirenyatwa Hospital. 18 out of 21 have received their results for culture, 10 were culture positive while 6 were culture negative, out of the 10 who were culture positive, 5 were resistance to two or three anti-TB drugs. Two of them had died while three are alive.

14. Percentage of Smear examination results of all PTB cases diagnosed
The line graph above shows the percentage of smear examination of all PTB patients diagnosed from year 2005 to In smear “Not tested”, I have only included the percentage of adult PTB patients who are 15 years and above, who are capable of producing sputa for examination excluding children of 14 years and below who in most cases could not produce sputa. As illustrated the percentage of smear positive increases from year 2005 (45%) to year 2007 (54%) then it tends to decrease to 31% in year The proportion who are smear positive falls but the absolute number of smear positives rises despite a fall in the proportion tested. This suggests a genuine increase in incidence of tuberculosis in Buhera district. The proportion of not tested cases decreases; irrespective of a slight increase of not tested cases from year 2007 to 2009 due to other diagnosis which were considered besides sputum examination as some of the patients were having unproductive cough.
The 2009 TB Global reportestimated incidence of SS+ pulmonary TB (PTB) was 298/100,000/year

15. Percentage of Smear examination results of all PTB cases diagnosed

16. PTB smear examination results of cases diagnosed in Buhera in years 2006-2011
2007
2008
2009
2010
2011
Pulmonary Smear Positive
443
48%
90%
514
54%
94%
581
47%
1130
91%
507
39%
1131
87%
399
29%
1202
398
34%
1025
88%
Pulmonary Smear Negative
386
42%
385
40%
549
44%
624
803
58%
627
Pulmonary Smear
Not Tested
Children <8 years and below 60
65%
10% 47
84% 6% 66
57% 9% 86
53%
13%
111 43
31%
12%
Children & adults 93 56
115
161
190
142
TOTAL PTB
756
922
955
1248
1292
1410
The percentages of sputum examination increases from 89% in year 2005 to 94% in year 2007, then a steady decrease up to year 2010 of 8% within three years, while that of not tested cases decreases from 11% in year 2005 to 6% in year 2007 then it doubled in year 2010 to 14%.
The proportion who are smear positive falls (e.g from 54% in 2007 to 47% in 2008) but the absolute number of smear positives rises(e.g 514 cases in 2007 to 580 cases in 2008) despite a fall in the proportion tested.

17. Treatment outcome for new PTB SS+ clients only by year

18. Treatment outcome for new PTB SS+ clients only by year
2005
2006
2007
2008
2009
Outcome %
Total
Totals
cured
48.53%
165
39.95%
177
43.77%
225
55.25%
321
57.99%
294
died
10.00% 34
11.06% 49
9.73% 50
9.47% 55
7.89% 40
MDR
0.00%
0.17% 1
1.38% 7
transferred out
13.82% 47
16.48% 73
13.42% 69
19.79%
115
8.09% 41
treatment complete
23.82% 81
21.67% 96
27.43%
141
13.43% 78
11.83% 60
treatment failed
0.88% 3
0.45% 2
0.58%
1.20%
2.17% 11
Defaulters
2.94% 10
10.38% 46
5.06% 26
0.69% 4
10.65% 54
Grand Total
100.00%
340
443
514
581
507

19. Success Rate
Target 85% success rate

20. Treatment outcome for PTB SS –ve, ND and EPTB clients by year
2005
2006
2007
2008
2009
Outcome %
Total
Totals
died
26.14%
155
26.17%
173
26.66%
185
19.78%
215
19.03%
207
MDR
0.00%  0 0 
0.09% 1
transferred out
13.32% 79
13.46% 89
11.24% 78
18.22%
198
5.42% 59
treatment complete
57.50%
341
50.98%
337
57.70%
401
58.79%
639
61.95%
674
Defaulters
3.04% 18
9.38% 62
4.32% 30
3.22% 35
13.51%
147
Grand Total
100.00%
593
661
694
1087
1088

21. Analysing Location of TB defaulters
Month Name
Outcome (Defaulters)
2009 Data
Patient’s location
(physical address)
Totals
Percentage (%)
Staying outside Buhera District
103
51.04%
Stay within Buhera District 98
48.96%
Grand Total
201
100.00%

22. Proportion of co-infected amongst TB patients

23. HIV status of TB patients at time of diagnosis

24. What proportion of TB patients not knowing their HIV status at diagnosis have been offered an HIV test?*
*Excludes those known to be HIV positive

25. HIV status after TB diagnosis per year

26. Proportion on HAART or Cootrimoxazole of those HIV positive
Statistics for HIV medication for the year 2010 has not been presented as it is in the process of updating.

27. Number enrolled in HIV Care

28. HIV Medication given

29. Comparison of those enrolled on ctx and ART

30. Partners involved in TB and HIV
MSF-B
TB Alert
NAC
New start and New life
Dananai, Rujeko and CARC
There are other partners involved in prevention and management

31. Achievements We now have 27 OI sites
10 were assessed to be stand alone sites but only 6 passed
MSF-B has acquired the Gene Expert Machine for BBH
Support and supervision visits being conducted quarterly

32. Challenges High workload versus staff shortage
Shortage of fuel for support and supervision
Management of MDR-TB
High defaulters