im tat Zimbabwe National Statistics Agency

im tat Zimbabwe National Statistics Agency

Ministry of Health & Child Welfare Department of Epidemiology and Disease Control National Health Information & Surveillance Unit in conjunction with the Zimbabwe National Statistics Agency (ZIMSTAT) im tat Zimbabwe National Statistics Agency

ACKNOWLEDGEMENTS The Zimbabwe National Health Profile report of 211 was produced with funding support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Department of Health and Human services Centers for Disease Control and Prevention (CDC) Grant No. 1U2GPS3118-1being implemented by the Strengthening Health Data Dissemination and Information Use Systems Project (ZimHISP), implemented by RTI International in collaboration with the Biomedical Research and Training Institute (BRTI) and the Health Information Support Programme South Africa (HISP-SA). This report was developed by the Directorate of Epidemiology and Disease Control in the Zimbabwe Ministry of Health and Child Welfare (MOHCW), National Health Information and Surveillance Unit in collaboration with Zimbabwe National Statistics Agency (ZimStat), the Strengthening Health Data Dissemination and Information Use Systems Project (ZimHISP). The authors especially thank the following individuals for their contributions to this report: The MoHCW - Dr Portia. Manangazira (Director Epidemiology and Disease Control), Dr Ponesai. Nyika, Mr Joshua. Katiyo; ZimSTAT - Ms Evelyn Marima; RTI International Mr Henry Chidawanyika, Mr Tongai Chokuda, Ms Fortunate Machingura, Ms Eileen Reynolds; CDC Zimbabwe Ms Elizabeth Gonese, Dr Celia Woodfill; HISP-SA Ms Norah Stoops and BRTI - Ms Shungu Munyati. I N T E R N A T I O N A L

FOREWORD TO THE 211 NATIONAL HEALTH PROFILE Zimbabwe was among the first countries in the region to respond to emerging calls for increased availability of data for improved and effective implementation, monitoring and evaluation of health programs. Information does not only need to be available, but it should be the right information, in the right place and at the right time. The Ministry of Health and Child Welfare has produced annual health profiles at district, provincial and national levels since 1995. The National Health Profile, (NHP) is a bound document that shows collated and aggregate health data for the year, collected through the surveillance and routine reporting systems of the NHIS system. It also gives the demographic characteristics of the population, as well as climatic patterns by region, because the occurrence and distribution of certain diseases and other health-related events are influenced by these. The data is presented in tables and graphs, with comments, disaggregated by province and/or district, showing the occurrence and distribution of diseases, conditions and health-related events that commonly occur in the country and are monitored by the Ministry, for the year 211. In some cases we also provide data from previous years for comparison. As the country went through a difficult economic period in the past decade, the National Health Information and Surveillance (NHIS) system was not spared the challenges affecting the health delivery system. This resulted in the health information unit struggling to ensure timely production of complete and reliable information for planning, policy development and improved targeting of health services. As a result, there have been no profiles for 29 and 21, the last profile having been produced in 28. The situation has however gradually changed for better as from end of 29, when deliberate attempts were made for initiating improvements in the accuracy, timeliness and completeness of health data. The development of the National Health Information Strategic Plan (29 214) by the National Health Information Steering Committee with the support of the United Nations Population Fund, (UNFPA) gave way to broader multi-sectoral involvement of all players in shaping the course of health information in Zimbabwe. The Ministry s senior management closely guided the Steering Committee and these two structures continue to oversee improvements in the data collection, processing and use. There has also been increasing interest and funding towards improvements to the NHIS, with the Global Fund s Health Systems strengthening, the PEPFAR s funding through CDC, the National Health Care Trust of Zimbabwe and recently, UNICEF under the Health Transition Fund. All these initiatives should contribute greatly to the success of implementing the National Health Information Strategy, and fulfilling the health information demands of all our stakeholders. We encourage you to make use of this profile, reading it with scrutiny for its user friendliness and any errors; in order that we continue to improve and better serve your data needs in this information age and we prepare to report on the Millennium Development Goals in 215. Brigadier General (Dr) Gwinji Permanent Secretary, Ministry of Health and Child Welfare i

TABLE OF CONTENTS 1. GENERAL INFORMATION 1.1. PHYSICAL AND ADMINISTRATIVE BORDERS 1.1.1. Administrative Borders Map by District 1 1.2. CLIMATE AND RAINFALL 1.2.1. Rainfall Recorded at Main Meteorological Station by Province/City and Month 2 2. DEMOGRAPHIC PATTERN 2.1.1.a. Population Projection Figures by Province and Main Demographic Group 4 2.1.1.b. 211 National Population Projections by Sex and Age Group 5 2.1.1.c. Population Projections by Sex and Age Group, 211 projections 5 2.1.2. Population Projections Trend by Province/City, 23-211 6 2.1.3. Population Projections by Province and District 7 3. SOCIO-ECONOMIC PATTERN 3.1.1. Economically Active and Inactive Population, 28 ICDS 1 3.1.3.a. Primary School Enrolment by Level and Sex, 21 11 3.1.3.b. Secondary School Enrolment by Level and Sex, 21 11 3.1.5. Sources of Drinking Water 12 3.1.6. Sanitation Facilities 13 4. HEALTH STATUS 4.1. NUTRITIONAL STATUS 4.1.1. Weight for Age by Age Group, Province and City, 211 14 4.1.1.a. Low Weight for Age by Age Group (Under 5) 15 4.1.1.b. Underweight Percentage by Province and District/City, 211 16 4.1.2.b. Underweight for Under 5s, Top 2 Districts 17 4.1.2.c. Underweight for Under 5s,Top 1 Districts 18 4.1.3. Under 5 years Total Weighed and Below Line by Month 19 4.1.4. Percentage Below the Line,Weight for Age Trend by Age Group 19 4.1.5. Low Birth Weight Trend by Year, 24/211 21 4.1.6. Total Clinical Nutritional Deficiencies Trend by Year 22 4.2. MORBIDITY STATUS: COMMON DISEASES 4.2.1. Notifiable Diseases & Reported Outbreaks 4.2.1.1. Notifiable Diseases by Province, All Ages 23 4.2.1. 2. Notifiable Diseases Trend by Year, 23-211 23 4.2.2. Out-patient Diseases and Conditions 4.2.2.1.a. OPD General Diseases/Conditions by Age Group 24 4.2.2.1.b. OPD General Diseases/Conditions by Age Group 24 4.2.2.1.c. OPD General Diseases/Conditions by Province/City 26 4.2.2.2.a. Selected Out-Patient General Diseases Breakdown by Age Group 28 4.2.2.2.b. Selected Out-Patient General Diseases Breakdown by Age Group 28 4.2.2.2.c. Selected Out-Patient General Diseases Breakdown by Province/City 29 4.2.2.3 OPD Chronic Diseases/Conditions by Age Group, Province and City 3 4.2.2.4 OPD Chronic Diseases/Conditions by Age Group, Province and City 33 4.2.3. In-patient Diseases and Conditions 4.2.3.1. In-Patient Diseases/Conditions by Age Group, Excluding Central Hospitals 35 4.2.3.2. Total In-Patient Diseases/Conditions and Average Length of Stay, Excluding Central Hospitals 37 4.2.3.3. Top Ten Diseases/Conditions by Age Group 39 4.2.3.4. Top Ten Causes of Mortality by Age Group, Excluding Central Hospitals 4 4.2.3.5a. Top Ten Causes of Hospital Bed Stay, Excluding Central Hospitals 41 4.2.3.5b. National Out-Patient and In-Patient Cases and Deaths, Excluding Central Hospitals, 21-211 41 i i

4.2.3.6. National Hospital Diagnoses, Including Central Hospitals 42 4.2.3.7. Top Ten Inpatient Diseases and Conditions, Including Central Hospitals 43 4.2.4. EPI Target diseases 4.2.4.1. EPI Target Diseases: Inpatient Cases and Deaths by Province/City 44 4.2.4.2. Measles Cases Trend by Age Group, 2-211 45 4.2.4.3. Measles Inpatient Cases and Deaths by Age Group and Province/City 45 4.2.4.4. Weekly Disease Surveillance, 21-211 46 4.3. MORBIDITY STATUS: OTHER IMPORTANT DISEASES 4.3.1. HIV and related diseases 4.3.1.1. New AIDS Cases by Sex and Age Group 47 4.3.1.2. New Cases of AIDS and Related Diseases by Province/City 48 4.3.1.3. HIV and Related Conditions by Year 49 4.3.1.4. HIV Sentinel Surveillance Data in Ante Natal Care Women by Year 5 4.3.1.5. TB New Cases by Province/City, Age Group and Sex 51 4.3.2. ARI diseases 4.3.2.1. ARI Outpatients Cases by Age Group, Province/City 53 4.3.2.2. OPD New ARI Breakdown by Province/City 54 4.3.2.3. OPD New Cases of Acute Respiratory Infection by Age Group 55 4.3.2.4. ARI Inpatient Cases, Deaths and Case Fatality Ratio (CFR) by Age and Province/Hospital 56 4.3.3. Malaria 4.3.3.1. All Malaria Cases, Tested, positive and Positivity Rate by Province 57 4.3.3.2 Confirmed Malaria New Cases by Province/City and Age Group 58 4.3.3.3a. Confirmed Malaria Cases and Rainfall by Year 59 4.3.3.3b. Monthly Trends of Confirmed Malaria Cases 59 4.3.3.4. Malaria Inpatient Cases and Deaths by Province 6 4.3.3.5. Malaria Top 2 Districts 61 4.3.4. Diarrhoea and Dysentery 4.3.4.1. National Diarrhoea and Dysentery Cases and Incidence Rates 63 4.3.4.2. Monthly Trends of Diarrhoea and dysentery 64 4.3.4.3. National Diarrhoea and Dysentery Cases, 25-211 64 4.3.4.4. Diarrhoea and Dysentery Incidence Rates by District, All Ages 65 4.3.5. Leprosy 4.3.5.1. Leprosy Cases by Province 67 4.3.5.2. National Leprosy New Cases, 23-211 67 4.3.6. Schistosomiasis 4.3.6.1. Schistosomiasis Cases by Age Group and Province/City 68 4.3.6.2. Schistosomiasis Outpatient Cases by Age Group and Year 69 4.3.6.3. Schistosomiasis Incidence Rates and Rainfall Trends 7 4.3.6.4. Schistosomiasis New Cases by Month 71 4.3.7. Injuries 4.3.7.1. Injuries by Age Group and Province/City 72 4.3.7.2. Common Causes of Injury Cases and Deaths Among Inpatients by Age and Province/City/Hospital 74 4.6. MORTALITY STATUS 4.4.1. Life Expectancy at Birth by Year and Sex 75 4.4.2. Infant Mortality Rates by Year 76 4.4.3. Hospital Based Institutional Perinatal Deaths 77 4.4.4. Institutional Mortality by Age Group and Year 77 iii

5. HEALTH RESOURCES 5.1. HEALTH FACILITIES 5.1.1. Health Facilities in Zimbabwe 77 5.1.2. Rural Hospitals and Clinics/Rural Health Centres by Ownership and Province 78 5.1.3. Provincial Health Institution Distribution by Referral Level 79 5.1.4. Government and Mission Hospitals by District 8 5.2.1. Hospital Bed Distribution by Function 82 5.2.2. Waiting Mother Shelters by Province 83 5.2.3. Facilities in Health Institutions by Province/City 84 5.2.4. X-Ray Perfomance by Level and Main Hospitals 85 5.2.5. Distribution of Pharmacies by Province/City 86 5.2.6. Summary of Staff Return 87 5.3 FINANCIAL RESOURCES 5.3.1. Government Budget Allocation Breakdown 88 5.3.2. Vote 15 for Ministry of Health and Child Welfare 89 5.3.3. Ministry of Health and Child Welfare Expenditure by Sector 9 5.3.4. Vote 15. Ministry of Health and Child Welfare 91 6. HEALTH SERVICES 6.1 PREVENTIVE AND PROMOTING ACTIVITIES 6.1.1. Antenatal and Postnatal Care by Province/City 92 6.1.2. Antenatal and Postnatal care by Year 94 6.1.3. Maternity Care by Province/City 95 6.1.4. Maternity Care by Year 97 6.1.5.a. Maternal Mortality Rates by Province/City 98 6.1.5.b. Major Causes of Maternal Mortality 99 6.1.5.c. Comparison of Reported Maternal Deaths by Notification Forms vs T5 forms 1 6.1.6.a. Family Planning Visits by Province and Contraceptive Methods 11 6.1.6.b. Family Planning (new and repeat) Visits by Province/City 12 6.1.7. Methods of Contraception by Number issued and Province/City 13 6.1.8. Methods of Contraception by Year 15 6.1.9. Vaccination Type by Age Group and Province/City 17 6.1.1. Vaccination Type by Year and Age Group 19 6.2. CURATIVE ACTIVITIES 6.2.1. OPD Utilisation Rates by Province/City 11 6.2.2. NHIS Completeness of the Data Submission by Province/City 111 6.2.3. National Workload (OPD and Inpatient) by Level of Institution 112 6.2.4. National Workload (OPD Curative and Preventive, Inpatient) by Year 113 i v

Figure 1.1.1. Zimbabwe Administrative Boarders Zambia UMP Kariba Shamva Mudzi Mazowe Gokwe North Bindura Mutoko Zvimba Harare Binga Murehwa Victoria Falls Nyanga Kadoma Chegutu Gokwe South Seke Marondera Makoni Hwedza Lupane Mutasa Hwange Nkayi Chikomba Kwekwe Chirumanzu Buhera Mutare Tsholotsho Gweru Bubi Gutu Shurugwi Chimanimani Umguza Bulawayo Insiza Masvingo Bikita Bulililama Umzingwane Zvishavane Chivi Zaka Chipinge Botswana Hurungwe Guruve Centenary Mt Darwin Rushinga Mangwe Mberengwa Matobo Gwanda Chiredzi Mwenezi Beitbridge Makonde Mozambique Mozambique N South Africa 1

Table 1.2.1. Rainfall (millimeters) Recorded at Main Meteorological Stations by Province/City and by Month, 211 Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare City Bulawayo City National Year Month m m mm mm mm mm mm mm mm mm mm mm 211 Jan 353 278 342 313 235 179 45 279 263 175 2 822 Feb 53 91 72 64 57 23 45 14 127 25 571 Mar 88 61 8 76 84 45 43 16 13 19 616 Apr 123 28 23 29 56 47 34 61 32 81 514 May 2 1 1 4 6 7 6 45 Jun 3 2 4 4 2 1 5 9 2 31 Jul 23 2 2 2 4 4 32 4 73 Aug 4 6 1 Sep 12 1 14 Oct 48 28 47 25 15 15 29 9 37 53 36 Nov 119 26 111 117 87 89 112 113 113 56 943 Dec 233 191 312 172 132 138 135 224 294 137 1 969 TOTAL 211 1 61 78 994 811 68 546 817 763 983 552 7 914 Source: Department of Meteorology Bulawayo City received the least rainfall and the surrounding Mat North and South province also received low rains and this will affect water supply to Bulawayo city and perpetuate the ongoing diarrhea and other hygiene related diseases. 2

Figure 1.2.1. Rainfall (millimeters) Recorded at Main Meteorological Stations by Province/City and by Month, 211 12 1 Rainfall in mm 8 6 4 2 Manicaland Mashonaland Central Mashonaland East Matebeleland West Matebeleland North Matebeleland South Midlands Masvingo Harare City Bulawayo City Province 3

Table 2.1.1 a. Population Projection by Province and Age Group, 211 Province / City Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare Population 1 715 916 1 88 684 1 357 788 1 339 44 77 992 714 236 1 61 148 1 444 Under 1 yr 56 554 37 42 42 739 43 256 28 916 22 81 53 77 45 Under 5 yrs 27 513 171 33 24 177 21 746 133 45 111 69 251 998 222 5-14 yrs 557 473 337 85 416 242 394 615 248 255 222 144 47 62 475 Above 15 yrs 745 358 46 887 93 579 53 737 368 743 42 389 692 381 23 878 548 Women of Child Bearing age15-49 424 959 262 277 338 2 322 242 181 12 168 345 394 685 Expected Pregnant Women 55 589 35 269 43 987 43 391 24 977 23 138 51 871 Expected births 47 874 25 257 32 723 35 762 2 663 17 642 43 551 42 144 422 654 862 628 24 784 313 1 595 51 237 41 947 48 51 33 Chitungwiza 476 353 55 11 726 5 37 86 713 216 442 9 687 11 26 8 Bulawayo 545 7442 313 22941 557 1366 618 165769 369 47667 57 193817 National 12721372 12.8%415486 1854788 36197 656843 294863 453 23974 388147 945 14949 37756 Percentages by Age Group Under 1 yr 3.3 3.4 3.1 3.2 3.8 3.2 3.3 3.1 3.2 3.2 3.1 3.3 Under 5yrs 15.8 15.7 15. 15.1 17.3 15.6 15.7 15.4 5-14 yrs 32.5 31. 3.7 29.5 32.2 31.1 29.4 33. Above 15 yrs 51.7 53.2 54.3 55.5 5.5 53.3 54.9 51.6 Women 15-49 yrs 24.8 24.1 24.9 24.1 23.5 23.6 24.7 24.8 Pregnant Women 3.2 3.2 3.2 3.2 3.2 3.2 3.2 3.2 Expected births 2.8 2.3 2.4 2.7 2.7 2.5 2.7 2.9 14.9 14.3 14. 14.6 25.7 24.5 22.4 28.5 59.4 61.2 63.6 51.1 25.6 25.6 26.2 23.2 3.2 3.2 3.2 3.1 2.1 2.5 2. 2.4 Source: Zimbabwe National Statistics Agency The general Fertility rate is 1.28 per 1. 4

Table 2.1.1b. National Population Projections by Sex and Age Group, 211 Age group Males Females Total In years -4 1 18 995 1 14 6 2 249 98 5-9 964 746 995 382 1 96 171 1-14 67 458 679 496 1 349 997 15-19 79 85 721 73 143 922 2-24 622 361 63 962 1 253 366 25-29 523 955 541 518 1 65 516 3-34 394 928 445 71 84 41 35-39 282 589 318 612 61 243 4-44 233 727 274 381 58 149 45-49 188 354 216 191 44 586 5-54 139 196 155 39 294 547 55-59 111 56 114 229 225 328 6-64 95 67 111 912 27 19 65-69 6 93 6 939 121 885 7-74 52 655 51 867 14 566 75+ 47 56 57 392 14 938 Total 6 26 32 6 514 393 12 721 372 Source: Zimbabwe National Statistics Agency Figure 2.1.1c. Population Projections by Age Group and Sex, 211 12 1 Population Thousands 8 6 4 2-4 5-9 1-14 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 65-69 7-74 75+ Age Group Males Females Because of a high birth rate, low under 5years mortality and low life expectancy our pyramid is wide at the base. 5

Table 2.1.2. Population Projection Trends by Province/City and Year Province/City 23 24 25 26 27 28 29 21 211 Manicaland 1584623 1 6 465 1 616 474 1 632 638 1 648 965 1 Mashonaland Central 15383 1 15 435 1 25 591 1 35 847 1 46 23 1 665 451 1 682 15 1 698 927 1 715 916 56 665 1 67 232 1 77 95 1 88 684 Mashonaland East 1138687 1 15 74 1 279 95 1 173 191 1 184 922 1 317 852 1 331 33 1 344 344 1 357 788 Mashonaland West 123692 1 249 271 1 261 762 1 274 381 1 287 127 1 3 11 1 313 11 1 326 142 1 339 44 Matabeleland North 711997 719 117 726 38 733 573 74 97 748 317 755 8 763 358 77 992 Matabeleland South 659585 666 18 672 842 679 572 686 367 693 23 7 162 77 164 7 142 35.5 Midlands 1478633 1 493 419 1 58 351 1 523 437 1 538 668 1 554 57 1 569 598 1 585 295 1 61 148 Masvingo 1333642 1 346 979 1 36 449 1 374 54 1 387 794 1 41 672 1 415 688 1 429 846 1 444 144 Harare 1 915 13 1 934 252 1 836 78 1 973 133 18 72976 1 891 7 1 91 617 1 929 723 1 949 2 Bulawayo 683 418 69 261 697 156 74 127 711 168 718 278 725 46 732 715 74 42 National 12 74 467 11 865 453 11 984 18 12 1 526 12 224 984 12 347 233 12 47 79 12 595 418 12 721 372 Source: Zimbabwe National Statistics Agency 6

Table 2.1.3. Population Projections by Province and District, 211 NATIONAL POPULATION ALL AGES : 12 721 372 MANICALAND : 1 715 916 District Name Population All Ages Under 1Yr Buhera 24 676 7 461 3.1 Chimanimani 126 99 4 35 3.2 Chipinge 31 379 11 174 3.6 Makoni 271 226 8 137 3. Mutare 429 653 14 179 3.3 Mutasa 29 616 7 337 3.5 Nyanga 128 266 4 233 3.3 Total 1 715 916 56 554 3 % 1-4 Yrs 3 85 16 141 41 91 32 547 5 699 25 783 16 83 213 958 % 12.5 12.8 13.5 12. 11.8 12.3 13.1 12 Under 5Yrs 37 546 2 176 53 75 4 684 64 878 33 119 21 36 27 513 % 15.6 16. 17.1 15. 15.1 15.8 16.4 16 5-14 Yrs 89 5 41 991 1 873 93 32 121 162 68 125 42 969 557 473 % 37. 33.3 32.5 34.4 28.2 32.5 33.5 32 15Yrs+ % 114 81 47.4 63 932 5.7 156 431 5.4 137 241 5.6 243 613 56.7 18 371 51.7 64 261 5.1 887 93 52 MASHONALAND CENTRAL 1 88 684 District Name Population All Ages Under 1Yr Bindura 155 556 5 133 3.3 Centenary 117 874 4 243 3.6 Guruve 22 659 6 89 3.4 Mazowe 213 189 6 822 3.2 Mt. Darwin 218 724 7 655 3.5 Rushinga 73 481 3 13 4.1 Shamva 17 21 3 645 3.4 Total 1 88 684 37 42 3 % 1-4 Yrs 18 44 14 499 25 13 25 156 27 559 1 434 13 79 133 91 % 11.6 12.3 12.4 11.8 12.6 14.2 12.2 12 Under 5Yrs 23 178 18 742 32 2 31 978 35 215 13 447 16 723 171 33 % 14.9 15.9 15.8 15. 16.1 18.3 15.6 16 5-14 Yrs 41 845 37 62 66 67 63 317 71 741 24 69 32 589 337 85 % 26.9 31.9 32.6 29.7 32.8 33.6 3.4 31 15Yrs+ % 9 534 58.2 61 53 52.2 14 572 51.6 117 893 55.3 111 768 51.1 35 345 48.1 57 888 54. 579 53 53 MASHONALAND EAST 1 357 788 District Name Population All Ages Under 1Yr % Chikomba 131 513 3 419 2.6 Goromonzi 194 614 6 422 3.3 Ump 114 111 3 766 3.3 Wedza 77 298 2 242 2.9 Marondera 169 168 5 413 3.2 Mudzi 14 182 4 96 3.5 Murewa 177 36 5 321 3. Mutoko 144 66 4 774 3.3 Seke 28 882 6 475 3.1 Total 1 357 788 32 897 2 1-4 Yrs 14 335 2 434 14 66 13 45 17 763 17 83 2 751 17 648 24 648 126 669 % 1.9 1.5 12.8 17.4 1.5 12.7 11.7 12.2 11.8 9 Under 5Yrs 17 754 26 857 18 372 15 692 23 176 22 79 26 72 22 422 31 123 159 566 % 13.5 13.8 16.1 2.3 13.7 16.2 14.7 15.5 14.9 12 5-14 Yrs 43 662 47 68 38 455 25 895 42 123 49 24 59 61 48 75 61 411 324 899 % 33.2 24.5 33.7 33.5 24.9 35.1 33.3 33.7 29.4 24 15Yrs+ % 7 97 53.3 12 77 61.7 57 284 5.2 35 712 46.2 13 869 61.4 68 269 48.7 92 227 52. 73 487 5.8 116 347 55.7 547 195 4 MASHONALAND WEST 1 339 44 District Name Population All Ages Under 1Yr % 1-4 Yrs Chegutu 246 251 7 88 3.2 28 319 Hurungwe 339 571 1 866 3.2 41 428 Kadoma 258 365 8 268 3.2 29 712 Kariba 64 32 2 315 3.6 7 99 Makonde 189 47 6 442 3.4 23 115 Zvimba 241 445 7 485 3.1 28 8 Total 1 339 44 43 256 3 158 491 % 11.5 12.2 11.5 12.3 12.2 11.6 12 Under 5Yrs 36 199 52 294 37 98 1 224 29 557 35 492 21 746 % 14.7 15.4 14.7 15.9 15.6 14.7 15 5-14 Yrs 67 965 11 21 72 6 17 169 56 841 7 19 394 615 % 27.6 32.4 28.1 26.7 3. 29. 29 15Yrs+ % 142 87 57.7 177 256 52.2 147 785 57.2 36 99 57.4 13 72 54.4 135 934 56.3 743 42 55 7

MATABELELAND NORTH 77 992 District Name Population All Ages Binga 131 251 Bubi 52 355 Hwange 144 869 Lupane 17 912 Nkayi 122 741 Tsholotsho 13 893 Umguza 8 971 Total 77 992 Under 1Yr 6 38 1 728 4 781 3 993 4 296 4 843 3 239 28 916 % 4.6 3.3 3.3 3.7 3.5 3.7 4. 4 1-4 Yrs 19 819 7 16 17 239 15 431 17 429 17 81 9 393 14 129 % 15.1 13.4 11.9 14.3 14.2 13.6 11.6 14 Under 5Yrs 25 856 8 743 22 2 19 424 21 725 22 645 12 631 133 45 % 19.7 16.7 15.2 18. 17.7 17.3 15.6 17 5-14 Yrs 43 575 16 754 38 825 37 985 44 432 45 551 21 133 248 255 % 15Yrs+ % 33.2 61 819 47.1 32. 26 858 51.3 26.8 84 24 58. 35.2 5 53 46.8 36.2 56 584 46.1 34.8 62 698 47.9 26.1 47 26 58.3 32 389 692 51 MATABELELAND SOUTH 714 236 District Name Population All Ages Beit Bridge 113 441 Bulilima 13 156 Mangwe 85 485 Gwanda 142 22 Insiza 93 644 Matobo 19 66 Umzingwane 67 242 Total 714 236 Under 1Yr 4 84 2 785 2 565 4 55 3 184 3 49 2 152 22 81 % 3.6 2.7 3. 3.2 3.4 3.2 3.2 3 1-4 Yrs 14 974 12 276 1 344 16 69 12 8 14 179 8 338 88 259 % 13.2 11.9 12.1 11.3 12.9 13. 12.4 12 Under 5Yrs 19 58 15 61 12 98 2 619 15 264 17 669 1 49 111 69 % 16.8 14.6 15.1 14.5 16.3 16.2 15.6 16 5-14 Yrs 35 394 34 42 26 842 35 48 31 464 37 49 21 585 222 144 % 15Yrs+ % 31.2 58 99 52. 33. 54 54 52.4 31.4 45 734 53.5 24.9 86 174 6.6 33.6 46 915 5.1 34.3 53 987 49.5 32.1 35 168 52.3 31 381 23 53 MIDLANDS 1 61 148 District Name Population All Ages Chirumhanzu 77 29 Gokwe North 234 441 Gokwe South 321 128 Gweru 246 231 Kwekwe 312 278 Mberengwa 2 581 Shurugwi 96 671 Zvishavane 112 788 Total 1 61 148 Under 1Yr 2 234 8 44 11 239 7 633 1 35 6 619 2 997 3 69 5 843 % 2.9 3.6 3.5 3.1 3.3 3.3 3.1 3.2 3 1-4 Yrs 8 858 32 587 42 71 28 7 37 473 25 875 1 827 12 52 19 63 % 11.5 13.9 13.3 11.4 12. 12.9 11.2 11.1 12 Under 5Yrs 11 92 41 27 53 949 35 74 47 778 32 494 13 824 16 129 24 96 % 14.4 17.5 16.8 14.5 15.3 16.2 14.3 14.3 15 5-14 Yrs 23 956 69 629 95 696 68 26 89 624 67 195 26 294 3 2 446 646 % 15Yrs+ % 31.1 41 981 54.5 29.7 123 785 52.8 29.8 171 482 53.4 27.7 142 322 57.8 28.7 174 876 56. 33.5 1 892 5.3 27.2 56 552 58.5 26.6 66 658 59.1 28 836 567 52 MASVINGO 1 444 144 District Name Population All Ages Bikita 171 643 Chiredzi 255 944 Chivi 17 221 Gutu 217 136 Masvingo 288 686 Mwenezi 138 65 Zaka 22 449 Total 1 444 144 Under 1Yr 5 321 8 72 5 277 5 863 8 949 4 832 6 478 45 422 % 3.1 3.4 3.1 2.7 3.1 3.5 3.2 3 1-4 Yrs 166 322 247 242 164 944 211 273 279 737 133 232 195 97 1 398 721 % 96.9 96.6 96.9 97.3 96.9 96.5 96.8 97 Under 5Yrs 171 643 255 944 17 221 217 136 288 686 138 65 22 449 1 444 144 % 1. 1. 1. 1. 1. 1. 1. 1 5-14 Yrs 5 321 8 72 5 277 5 863 8 949 4 832 6 478 45 422 % 15Yrs+ % 3.1 83 418 48.6 3.4 134 115 52.4 3.1 8 515 47.3 2.7 11 739 51. 3.1 169 17 58.6 3.5 68 66 49.3 3.2 99 65 49.2 3 745 628 52 8

HARARE 1 595 476 District Name Population All Ages Harare 1 595 476 Under 1Yr % 51 55 3 1-4 Yrs 186 671 % 12 Under 5Yrs 237 726 % 15 5-14 Yrs 41 37 % 15Yrs+ % 26 947 713 59 CHITUNGWIZA 353545 District Name Population All Ages Chitungwiza 353 545 Under 1Yr 11 313 % 3 1-4 Yrs 39 243 % 11 Under 5Yrs 5 557 % 14 5-14 Yrs 86 618 % 15Yrs+ % 25 216 369 61 BULAWAYO 7442 District Name Population All Ages Bulawayo 74 42 Under 1Yr 22 941 % 3 1-4 Yrs 8 665 % 11 Under 5Yrs 13 66 % 14 5-14 Yrs 165 769 % 15Yrs+ % 22 47 667 64 The proportion of 15 years plus in Harare, Chitungwiza and Bulawayo provinces are higher than the national average of 51% which could be due to sustained rural to urban migration in search of a better life. 9

Students 68.8% Table 3.1.1. Economically Active and Inactive Population, 28 Total Population 1% Children Under 15 41.4% Adult 15 Years and Above 58.6% Economically Inactive 23.1% Activity Not Stated 1.6% Economically Active 75.2% Home Makers 21.6% Retired, Sick/ Too Old/ Other 9.7% Unemployed 5.7% Employed 94.3% 1

Table 3.1.3a. Primary School Enrolments by Level and Sex, 21 Grade 1 2 3 Male 235 19 212 935 192 599 Female 23 26 29 83 189 686 Total 465 225 422 765 382 285 4 181 849 183 822 365 671 5 173 889 174 39 347 928 6 169 265 169 623 338 888 7 158 969 16 742 319 711 Special Total 11 72 1 335 597 8 839 1 326 787 19 911 2 662 384 Source: Ministry of Education, 21 Note: Data for 211 is not available Special - this is a class of children with handicaps The difference between males and females in enrolment in each grade is less than 1.2% and from grade 4 upwards there are more females than males. Figure 3.1.3a. Primary School Enrolments by Level and Sex, 21 25 Enrolment in Thousands 2 15 1 5 1 2 3 4 5 6 7 Special Grade/Class Male Female Table 3.1.3b. Secondary School Enrolments by Level and Sex, 21 Form I II III IV V VI Special Total Male 11 2196 15 281 99 628 93 987 1 511 14 218 42 436 241 Female 114 669 18 29 98 77 85 76 8 833 1 863 298 427 285 Total 226 865 213 49 198 335 179 693 19 344 25 81 718 863 526 Source: Ministry of Education, 21 Note: Data for 211 is not available Special - this is a class of children with disability check your spellings and correct terminology for the disabilities The difference between males and females in enrolment in each level is less than 1.5% in all levels. 11

Figure 3.1.3b. Secondary School Enrolments by Level and Sex, 21 14 14 Thousands 14 14 14 14 14 14 I II III IV V VI Special Class/Form Male Female The graphs show a decline in enrolment from form II to IV.A small proportion of students manage to proceed to 'A' level and there is a gender bias towards males, but this is more pronounced in the rural secondary schools. Table: 3.1.5. Percent Distribution of Households by Source of Drinking Water, 211 Characteristic Households Population Urban Rural Total Urban Rural Total Source of Drinking Water Improved Source Piped water into dwelling/yard/plot 71. 7.3 28.8 71.5 5.1 25.4 Public tap/standpipe 5.5 4.2 4.7 5.2 3.1 3.7 Tubewell/borehole 11.6 37. 28.4 12. 38.5 3.4 Protected dug well 6.5 2.8 16. 6.2 21. 16.5 Protected spring. 1.1.7.1 1..7 Rainwater...... Bottled water.2..1.2..1 Non-Improved Source Unprotected dug well 3.6 17.3 12.7 3.4 18.4 13.8 Unprotected spring.3 3.5 2.4.4 3.6 2.6 Tanker truck/cart with drum.7.1.3.4.1.2 Surface water.2 8.6 5.8.3 9.2 6.4 Other Source.2.1.1.4.1.2 Total 1. 1. 1. 1. 1. 1. Percentage Using any improved source of drinking water 94.9 7.4 78.7 95.1 68.7 76.7 Source: Zimbabwe Demographic and Health Survey, 21/11 12

Table 3.1.6. Percent Distribution of Households by Type of Toilet/Latrine Facilities, 211 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 44.9 3.8 35.5 49.8 31.8 37.3 Flush/pour flush to piped sewer system 36. 1.9 13.4 4.6 1.6 13.5 Flush/pour flush to septic tank 5.2 1.2 2.5 5.5.9 2.3 Flush/pour flush to pit latrine 1.4.5.8 1.5.4.7 Ventilated improved pit (VIP) latrine/blair toilet 1.3 16.4 11.3 1.2 17.6 12.6 Pit latrine with slab 1. 1.7 7.4 1. 11.3 8.1 Shared facility 48.5 18.9 28.9 44. 15.5 24.2 Flush/pour flush to piped sewer system 38.5.6 13.4 35.9.4 11.3 Flush/pour flush to septic tank 3.7.3 1.5 3..2 1. Flush/pour flush to pit latrine 2.5.1.9 2.1.1.7 Ventilated improved pit (VIP) latrine/blair toilet 1.8 11.5 8.2 1.5 9.1 6.8 Pit latrine with slab 2.1 6.4 4.9 1.6 5.7 4.4 Non-improved facility 6.6 5.3 35.6 6.2 52.7 38.5 Flush/pour flush not to sewer/septic tank/pit latrine 1..1.4.9.1.3 Pit latrine without slab/open pit 1.9 11.5 8.3 2.1 12.5 9.3 Bucket 1.7..6 1.5..5 No facility/bush/field 1.9 38.6 26.2 1.6 4. 28.3 Other.1.1.1.1.1.1 Total 1. 1. 1. 1. 1. 1. Number 3 29 6 466 9 756 12 344 28 57 4 41 Source: Zimbabwe Demographic and Health Survey, 21/11 13

Table 4.1.1. Weight for Age by Age Group, Province and City, 211 AGE GROUP Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South (Months) Total Below Line Total Below Line Total Below Line Total Below Line Total Below Line Total Below Line Weighed N % Weighed n % Weighed N % Weighed N % Weighed n % Weighed n % 5 123 91 2 575 2.1 77 985 2 79 2.7 95 328 2 668 2.8 112 615 2 39 1.8 48 19 1 13 2.3 44 79 1 378 3.1 6 11 141 495 5 867 4.1 84 854 4 597 5.4 116 549 6 954 6. 111 298 4 685 4.2 47 667 2 728 5.7 46 211 2 59 5.6 12-23 144 851 14 425 1. 77 93 9 5 12.3 126 46 17 863 14.1 18 637 1 389 9.6 46 321 7 32 15.8 47 667 7 567 15.9 24-59 142 189 11 271 7.9 65 572 5 311 8.1 118 143 11 747 9.9 94 515 7 871 8.3 41 374 5 448 13.2 51 924 6 857 13.2 TOTAL 552 436 34 138 6.2 35 54 21 487 7. 456 426 39 232 8.6 427 65 24 984 5.9 183 552 16 68 9. 189 881 18 392 9.7 AGE GROUP Midlands Masvingo Chitungwiza Bulawayo Harare National (Months) Total Below Line Total Below Line Total Below Line Total Below Line Total Below Line Total Below Line Weighed N % Weighed n % Weighed n % Weighed N % Weighed n % Weighed n % 5 113 125 2 655 2.3 112 272 1 321 1.2 16 911 171 1. 93 984 1 733 1.8 262 464 3 255 1.2 1 1 854 21 4 1.9 6 11 115 996 5 237 4.5 115 312 2 425 2.1 17 41 445 2.6 77 856 2 6 3.3 243 445 4 526 1.9 1 118 84 42 654 3.8 12-23 15 755 12 624 11.9 114 799 5 554 4.8 16 119 691 4.3 64 297 3 859 6. 247 325 1 326 4.2 1 99 27 1 1 9.1 24-59 97 43 8 531 8.8 125 579 4 299 3.4 12 546 461 3.7 57 665 1 663 2.9 196 689 5 966 3. 1 3 599 69 425 6.9 TOTAL 432 279 29 47 6.7 467 962 13 599 2.9 62 977 1,768 2.8 293 82 9 855 3.4 1 6 14 27 652 2.6 4 321 87 233 183 5.4 Source: T5 returns. Note: Cut off point for low weight is a line representing the third percentile, i.e. 8% of the Harvard Standard The Agro regions of Mashonaland and Manicaland provinces wich have good rains have low weight for age proportions greater than 5%. Matabeleland provinces have the highest percentages and the towns have the lowest proportions of less than 3.5%. 14

Figure 4.1.1a. Low Weight for Age by Age Group (Under 5), 211 1. 9. 9.1 8. 7. 6.9 % below line 6. 5. 4. 3.8 5.4 3. 2. 1.9 1.. - 5 6-11 12-23 24-59 TOTAL Age Group (months) Figure 4.1.1b. Low Weight For Age by Province (Under 5), 211 12. 1. 8.6 9. 9.7 % below line 8. 6. 4. 6.2 7. 5.9 6.7 2.9 2.8 3.4 2.6 5.4 2.. MAN MAC MAE MAW MAT N MAT S MID MASV CHIT BYO HRE TOTAL Province/City Weight for age is a composite indicator of stunting and wasting. Prevalence increases from 23 months with children between the 12 23 months age being the most affected group with rates of underweight being 9.1%. Low weight for age can be associated with poor infant feeding practices especially quality and quantity of complementary foods introduced at 6 months. Other causes could be poor hygienic and sanitation practices which could lead to disease which compromise growth and development at a stage where they are most vulnerable. The prevalence decreases as a child grows older than two years as they become less vulnerable to disease and independent in terms of food choices. Matabeleland South has the highest prevalence of underweight at 9.7% and followed closely by Matabeleland South at 9.% and Mashonaland East at 8.6%. 15

Table 4.1.2a. Under Weight Percentage by District/City and Province (Under 5 yrs), 211 Manicaland Province % Below Line Mashonaland East % Below Line Matabeleland North % Below Line Midlands % Below Line Buhera 6.6 Chikomba 7.2 Binga 11.9 Chirumhanzu 7.6 Chimanimani 6.5 Goromonzi 7.7 Bubi 9.9 Gokwe North 6.3 Chipinge 6. Hwedza 9.7 Hwange 7.1 Gokwe South 9.7 Makoni 6.3 Marondera 5.8 Lupane 9.6 Gweru 4.9 Mutare 4.1 Mudzi 8.7 Nkayi 8.4 Kwekwe 4.4 Mutasa 8.4 Murewa 9. Tsholotsho 11.2 Mberengwa 7.4 Nyanga 8.3 Mutoko 9.7 Umguza 7.3 Shurugwi 4.1 Province 6.2 Seke 9.7 Province 9. Zvishavane 8. UMP 12.4 Province 6.7 Province 8.6 Mashonaland Central % Below Line Mashonaland West % Below Line Matebeleland South % Below Line Masvingo % Below Line Bindura 6.4 Chegutu 6.8 Beitbridge 3.9 Bikita 3.4 Centenary 7.9 Hurungwe 6.4 Bulilima 12.1 Chiredzi 2.8 Guruve 5. Kariba 4.6 Gwanda 6.1 Chivi 3.8 Mazowe 8.1 Makonde 3. Insiza 8. Gutu 1.9 Mbire 6.1 Mhondoro 5.7 Mangwe 12. Masvingo 2.4 Mount Darwin 6.4 Sanyati 4.2 Matobo 13.4 Mwenezi 4.3 Rushinga 8.1 Zvimba 7. Umzingwane 8.4 Zaka 3.3 Shamva 7. Province 5.9 Province 9.7 Province 2.9 Province 7. Bulawayo City 3.4 Harare City 2.6 Chitungwiza City 2.8 Districts with high rates of underweight like Chikomba, Nyanga, Murewa, Mutoko, Seke, Ump, Binga, Gokwe South, Mazowe,Shamva,Hurungwe had high prevalence rates of STH as per the National Prevalence Survey for soil transmitted helminthiasis and schistosomiasis of 21 16

Table 4.1.2b. Underweight in the Under 5 Years; Top 2 Districts, 211 Ranking District % Underweight 1 Matobo 13.4 2 UMP 12.4 3 Bulilima 12.1 4 Mangwe 12. 5 Binga 11.9 6 Tsholotsho 11.2 7 Bubi 9.9 8 Hwedza 9.7 9 Mutoko 9.7 1 Gokwe South 9.7 11 Seke 9.7 12 Lupane 9.6 13 Murewa 9. 14 Mudzi 8.7 15 Nkayi 8.4 16 Umzingwane 8.4 17 Mutasa 8.4 18 Nyanga 8.3 19 Rushinga 8.1 2 Mazowe 8.1 17

Table 4.1.2c. Underweight for the Under 5 Years by Year, Top Ten Districts, 28-211 28 29 21 211 Rank Name % Below Line Name % Below Line Name % Below Line Name % Below Line 1 Mutoko 11.1 Binga 12.5 Binga 13. Matobo 13.4 2 Seke 11. Tsholotsho 11.4 Matobo 11.4 UMP 12.4 3 Tsholotsho 1.6 Mangwe 1.8 Mangwe 11.2 Bulilima 12.1 4 Murewa 9.9 Murewa 1.5 Tsholotsho 1.9 Mangwe 12. 5 Wedza 9.9 UMP 1.3 Bulilima 1.8 Binga 11.9 6 Motobo 9.8 Matobo 1.3 Gokwe South 1.7 Tsholotsho 11.2 7 Mazowe 9.6 Gokwe North 1.3 UMP 1.3 Bubi 9.9 8 U.M.P 9.3 Seke 9.8 Lupane 9.6 Hwedza 9.7 9 Mangwe 9.2 Bubi 9.7 Bubi 9.4 Mutoko 9.7 1 Binga 9.1 Mazowe 9.7 Mutoko 9.3 Gokwe South 9.7 National Average 5.5 National Average 6.1 National Average 5.5 National Average 5.3 Source :- T5 Forms Districts such as Tsholotsho, Binga, Mangwe and UMP have constantly featured in the top ten districts to report high rates of underweight. The National Nutrition Survey 21 revealed that exclusive breastfeeding rates in these districts are at %. 18

Table 4.1.3. Under 5 Years Total Weighted and Below Line by Month, 28-211 28 29 21 211 MONTH Total Below % Total Below % Total Below % Total Below % Weighed Line Weighed Line Weighed Line Weighed Line Jan 244 15 12 625 5.2 155 289 8 51 5.9 125 83 7 74 5.6 327 515 16 426 5. Feb 263 92 14 884 5.6 196 52 1 993 5.6 144 416 8 451 5.9 363 651 18 57 5.1 Mar 248 866 13 158 5.3 27 347 12 884 6.1 156 913 9 564 6.1 35 173 18 93 5.4 Apr 266 48 12 633 4.7 22 358 12 29 5.8 141 615 8 699 6.1 369 219 21 493 5.8 May 245 945 11 339 4.6 21 597 11 23 5.5 174 65 1 954 6.3 37 2 18 819 5.1 Jun 247 332 12 212 4.9 3 235 19 159 6.4 167 795 1 229 6.1 44 972 21 442 5.3 Jul 247 28 12 375 5. 173 258 9 354 5.7 122 148 7 226 5.9 368 575 18 383 5. Aug 349 244 22 149 6.3 12 78 6 912 5.8 299 756 14 4 4.8 366 323 18 85 4.9 Sep 238 977 12 884 5.4 81 214 5 747 5.8 296 469 14 843 5. 365 788 18 191 5. Oct 216 944 12 379 5.7 128 188 7 889 6 314 451 16 72 5.1 382 37 2 834 5.4 Nov 185 997 1 83 5.8 127 453 7 628 5.9 334 195 18 123 5.4 415 756 25 12 6. Dec 171 647 12 76 7. 162 529 12 589 7.1 342 534 18 934 5.5 347 482 2 577 5.9 Monthly average 243 859 13 293 5.5 171 337 1 392 6.1 218 394 12 47 5.5 369 335 19 73 5.3 Pop. <5yrs 1 9 861 1 919 591 1 938 787 1 958 394 % Of Children Weighed 12.8 8.9 11.3 18.9 Source: T5 returns. The percentages of underweight children increased from 28 and peaked in 29 and 21 and declined in 211. There is no significant monthly variation in all the years. Figure 4.1.3. Total Children (Under 5 Years) Weighed by Month, 29-211 8. % of Low Weight for Age 7. 6. 5. 4. 3. 2. 1.. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Months 211 28 29 21 19

Table 4.1.4. Percentage below the Line, Weight for Age Trend by Year, by Age Group, 211 Age 25 26 27 28 29 21 211-5 m 2.2 2.2 2.2 2.2 2.3 2.2 2. 6-11 m 3.4 3.3 3.6 3.8 4. 4. 3.8 12-23 m 7.9 7.7 7.8 8.4 9.3 9. 8.9 24-59 m 8.2 7.8 7.9 7.8 8.5 7.3 6.7-59 m 5.6 5.4 5.4 5.5 6.1 5.5 5.3 Total Children Weighed 13 28 85 3 918 998 3 42 63 2 926 35 2 56 48 2 62 727 4 432 24 Source: T5 returns. Figure 4.1.4. Weight for Age Trends 25 211 1. 9. 8. Weight-for-Age (%) 7. 6. 5. 4. 3. 2. 1.. 25 26 27 28 29 21 211 Year - 5 m 6-11 m 12-23 m 24-59 m - 59 m The prevalence of underweight remains between 5.3% - 6.1% for children under 5 years of age in the period 26 to 211. Peak rates were recorded in 29, but thereafter the higher rates but prevalence has slightly declined. Children within the 12 23 year age group remain the most affected as they are the most vulnerable as explained in Fig 4.1.1b with regards to care and feeding practices. The number of children weighed has also decreased from 25 up to 21 but has picked up in 211. There is need to continue encouraging mothers to come for regular growth monitoring so as to capture more children. 2

Table 4.1.5. Low Birth Weight Trends by Year, 24-211 24 25 26 LBW % 11.2 15.1 11.9 1.3 9. 9.1 6.9 9.1 Total Babies Under 2.5kg 24 518 114 78 12 918 22 118 16 387 9 685 15 724 29 131 Source: T5 returns. 27 28 29 21 211 Figure 4.1.5. Low Birth Weight (National Percentages), 24-211 16 15.1 14 12 11.2 11.9 1 1.3 9. 9.1 9.1 Percent 8 6 6.9 4 2 24 25 26 27 28 29 21 211 Years LBW % Percentage of underweight children peaked in 25 and showed a downward trend with its lowest in 21 at 6.9% and rose again slightly to 9.1% in 211. 21

TABLE 4.1.6. Total Clinical Nutritional Deficiencies Trends, 25-211 OUT-PATIENT 25 Disease/Condition n % Inc. /1 26 n % Inc. /1 27 n % Inc. /1 28 N % Inc. /1 29 n % Kwashiorkor 16 183.6 1.4 14 477.5 1.2 12 81.5 1.4 11 33.4.9 12 463.2 Marasmus 5 363.2.4 4 715.2.4 3 678.1.4 3 419.1.3 5 21.1 Pellagra 5 538.2.5 5 21.2.4 4 9.2.6 4 487.2.4 2 945. Total Nutritional Deficiencies 27 84 1.1 2.3 17 352.5 1.1 2 659.8 2.3 19 29.7 1.6 2 618.3 Total All New Cases 2 55 424 2 813 612 2 646 596 2 645 992 5 537 92 Under 5 y population 1 849 31 1 867 522 1 886 133 19 584 1 919 591 Annual Population 11 984 18 12 13 953 12 224 984 12 347 385 12 47 79 Inc. /1 21 Inc. 211 Inc. n % /1 n % /1 1. 13 95.1.7 17 572.1 1.4.4 5 346..3 6 315..5.2 2 513..1 2 241..2 1.7 2 954.1 1.1 26 128.2 2.1 12 516 6 11 82 979 1 938 787 1 958 394 12 595 418 12 721 372 Percentage represents the proportion of individual nutritional conditions out of all new cases of diseases/conditions. 2.5 2.3 2.3 2.1 2. 1.6 1.7 1.5 Incidence/1 population 1..5. 25 1.1 1.1 25 25 25 25 25 25 Year 22

Table 4.2.1.1. Notifiable Diseases by Province, All Ages, 211 PROVINCE Cholera Plague Yellow Fever Typhus Fever S C D S C D S C D S C Manicaland 786 244 15 Mashonaland 2 Central Mashonaland East - - - - - - - - - - - Mashonaland West 31 5 1 Matabeleland North Matabeleland South - - - - - - - - - - - Midlands Masvingo - - - - - - - - - - - Harare City - - - - - - - - - - - Chitungwiza - - - - - - - - - - - Bulawayo City - - - - - - - - - - - TOTAL 819 249 16 D - - - - - - Viral Rabies Anthrax Hepatitis Meningococcal Typhoid Haemorragic Meningitis Fever S C D S C D S C D S C D S C D S C D 23 49 2 1 562 2 1 43 2 1 - - - - - - - - - - - - - - - - - - 32 2 1 1 7 3 1 3 1 2 9 1 1 16 31 - - - - - - - - - - - - - - - - - - 242 2 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 949 3 6 112 1 7 3 1 36 2 2 2 1 The CFR for cholera of 6.4% is above the WHO recommended standard of less than 1%. For rabies there are deaths in Midlands and Mashonaland West without a record of cases. There is need to appreciate the human rabies cases in relation to dog bites by unvaccinated dogs and other animal bites whose vaccination status in unknown. Table 4.2.1.2. Notifiable Diseases Trends by Year, 23-211 Cholera Plague Year S C D S C 23 166 54 38 2 24 75 9 5 25 621 17 17 8 26 589 114 46 27 41 15 6 2 28 5412 444 227 3 29 1511 3727 432 21 383 16 9 211 819 249 16 Source : T2 Monthly Returns D Yellow Typhus Viral Haemorragic Rabies Anthrax Hepatitis Meningococcal Typhoid Fever Fever Fever Meningitis S C D S C D S C D S C D S C D S C D S C D S C D 19 1 385 6 19 2 5 8 38 85 13 1 1 1 1 742 15 7 344 19 2 11 25 24 7 3 3 729 1 1 51 13 4 59 24 9 16 7 2 2 3 1 823 1 5 362 2 2 37 43 1 7 4 2 917 233 6 1 24 13 1 4 3 2 3 2 9 16 917 5 5 94 2 18 6 3 17 1 1 2 71 3 19 2 3 4 3 1 1 858 3 1 182 8 1 34 7 4 9 6 2 33 1 949 3 6 112 1 7 3 1 5 2 2 34 1 Key : S = Suspected Cases C =Confirmed Cases D=Deaths - = not reported This table captures notifiable disease cases for which notification forms were completed. In huge outbreaks, like the 28-9 outbreak which recorded over 98 5 cases, notification forms were not completed for every case, hence the low figures displayed in the table. However, all the cholera cases were reported through the weekly disease surveillance system. 23

Table 4.2.2.1a. Out-Patient General New Disease/ Conditions by Age Groups, 211 Out-Patient Cases Cases Cases Disease/Condition -4 yrs % 5+ yrs % ALL AGES % Diarrhoea 371 973 1 329 29 4 71 182 6.1 Nutritional Deficiencies 22 353 1 3 775 26 128.2 Malaria 185 613 5 817 277 1 1 2 89 8.7 ARI 1 651 849 46 2 44 899 26 3 696 748 32.1 Bilharzia 8 146 12 5 2 128 196 1.1 Acute mental disorder 254 5 186 5 44. Diseases of the eye 127 987 4 279 232 4 47 219 3.5 Skin diseases 336 667 9 459 89 6 796 557 6.9 Dental conditions 5 472 177 212 2 182 684 1.6 Burns + Other Injuries 99 966 3 42 984 5 52 95 4.5 Poisoning & Toxic Eff 5 41 19 477 24 518.2 Dysentery 15 741 42 413 1 58 154.5 All other 748 871 21 3 22 449 4 3 951 32 34 TOTAL NEW CASES 3 579 933 1 7 922 53 1 11 51 986 1 TOTAL REPEAT VISITS 575 594 1 354 593 1 93 187 REFERRAL OUTS 7 28 181 256 251 284 Source: T5 returns. Table 4.2.2.1 b. Out-Patient General New Disease/ Conditions by Age Groups, 211 Out-Patient Cases Cases Cases Cases Cases Disease/Condition -9yrs % 1-24yrs % 25-49yrs % >5yrs % ALL AGES % STD 6 439 2 61 924 19 215 18 67.4 35 624 11.2 318 993 1. STD REPEAT VISITS 965 9 249 29 65 6 968 46 832. NOTES: T5 forms All Other = Diseases not listed on the T5 Form STIs, a proxy of HIV infection, is highest in the 25-49 year age group, our health education and promotion efforts should thus focus on this sexually active age group. 24

Figure 4.2.2.1a. Top Ten Out-Patient General New Disease/ Conditions, 211 Dysentery.5 Diagnosis Bilharzia Dental conditions Diseases of the eye Burns + Other Injuries Diarrhoea Skin diseases Malaria 1.1 1.6 3.6 4.5 6.1 6.9 8.7 ARI All other 32.2 34.5 1 2 3 4 % of total New Cases 25

Table 4.2.2.1c. Out-Patient General Diseases/Conditions by Province/City, 211 Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Disease/ Condition All ages % All ages % All ages % All ages % All ages % All ages % Diarrhoea 16 544 5 8 27 7 87 65 7 82 813 8 47 853 6 28 392 4 Nutritional Deficiencies 4 672 2 475 3 572 2 311 1 547 1 154 Malaria 382 495 2 121 645 1 19 317 15 95 691 9 49 126 7 11 327 2 ARI 59 819 26 364 158 3 343 59 27 39 384 29 239 144 32 222 489 34 STD 43 99 2 28 45 2 38 387 3 35 517 3 13 364 2 17 839 3 Bilharzia 21 227 1 21 43 2 16 992 1 15 32 1 2 25 2 871 Ac.Mental Disorders 754 559 1 8 43 254 226 Diseases of the Eye 53 73 3 34 677 3 39 8 3 29 44 3 24 654 3 23 584 4 Skin Diseases 121 725 6 63 771 5 68 995 5 6 182 6 58 93 8 56 525 9 Dental Conditions 26 82 1 18 848 2 19 727 2 17 741 2 18 618 2 11 879 2 Burns/Other Injuries 81 717 4 55 314 5 57 326 4 55 279 5 29 86 4 27 415 4 Poisoning & Toxic Effects 3 811 1 62 2 796 3 241 1 12 1 943 Dysentery 9 374 9 548 1 5 843 7 164 1 5 462 1 1 452 All Other 573 53 3 44 689 34 418 258 32 334 61 32 256 319 34 243 81 37 Total New Cases 1 938 255 1 1 27 49 1 1 294 261 1 1 49 87 1 748 51 1 65 96 1 Total Repeat Visits 242 724 133 697 218 841 138 98 95 169 11 39 Referral Out 33 344 13 183 24 931 24 368 1 73 14 53 Diarrhoea 16 544 5 8 27 7 87 65 7 82 813 8 47 853 6 28 392 4 Midlands Masvingo Harare Chitungwiza Bulawayo National Disease/ Condition All ages % All ages % All ages % All ages % All ages % All ages % Diarrhoea 86 929 7 14 526 6 46 397 3 19 652 17 1 156 2 71 182 6 Nutritional Deficiencies 3 372 3 348 1 553 8 1 1 324 26 128 Malaria 32 645 3 99 62 6 16 63 1 3 224 3 755 1 2 89 8 ARI 37 86 31 565 22 32 585 997 43 28 18 24 157 925 33 3 696 748 31 STD 4 463 3 5 971 3 34 521 3 3 57 3 12 47 3 318 993 3 Bilharzia 14 424 1 31 122 2 1 844 472 244 128 196 1 Acute.Mental Disorders 435 683 427 41 254 5 44 Diseases of the Eye 43 636 4 75 43 4 57 67 4 1 73 9 14 588 3 47 219 3 Skin Diseases 84 686 7 135 65 8 95 32 7 6 232 5 44 64 9 796 557 7 Dental Conditions 21 168 2 3 37 2 6 34 4 757 4 7 253 2 182 684 2 Burns/Other Injuries 57 31 5 65 841 4 68 769 5 6 953 6 15 175 3 52 95 4 Poisoning & Toxic Effects 3 15 3 666 2 8 818 1 48 24 518 Dysentery 6 54 1 9 621 1 2 123 389 674 58 154 All Other 437 81 36 592 97 34 445 688 33 3 24 26 214 98 45 3 951 32 33 Total New Cases 1 23 239 1 1768 327 1 1 365 26 1 116 148 1 48 1 11 82 979 1 Total Repeat Visits 193 361 35 843 312 52 19 97 216 297 1 977 19 Referral Out 27 965 32 653 52 463 2 226 16 25 251 284 Diarrhoea 86 929 7 14 526 6 46 397 3 19 652 17 1 156 2 71 182 6 26

Figure. 4.2.2.1c: Top Ten OPD Diseases/conditions by Age Group, 211 Top 1 Out-Patient Under 5 Years, 211 Diagnosis Dental conditions Bilharzia Dysentery Nutritional Deficiencies Burns + Other Injuries Diseases of the eye Malaria Skin Diseases Diarrhoea All other ARI.2.2.4.6 2.8 3.6 5.2 9.4 1.4 2.9 46.1. 1. 2. 3. 4. 5. Top 1 Out-Patient Under 5 Years and Above, 211 Dysentery.5 Diagnosis Bilharzia Dental conditions Diseases of the eye Diarrhoea Burns + Other Injuries Skin Diseases 1.5 2.2 3.5 4.2 5.3 5.8 Malaria 1.3 ARI 25.8 All other 4.4. 5. 1. 15. 2. 25. 3. 35. 4. 45. Percentage of Total New Cases 27

Table 4.2.2.2a. Selected Out-Patient General New Disease Breakdown, by Age Group, 211 OUT-PATIENT DISEASES/CONDITIONS -5 yrs n % Above 5 yrs n All Ages % n % No Dehydration 335 291 9.1 31 954 91.7 637 245 9.9 Diarrhoea With Dehydration 36 682 9.9 27 255 8.3 63 937 9.1 TOTAL 371 973 1 329 29 1 71 182 1 Kwashiorkor 16 376 73.3 1 196 31.7 17 572 67.3 Marasmus 5 688 25.4 627 16.6 6 315 24.2 Pellagra 289 1.3 1 952 51.7 2 241 8.6 Nutritional Deficiencies TOTAL 22 353 1 3 775 1 26 128 1 Ear, Nose & Throat 127 32 7.7 235 339 11.5 362 659 9.8 Mild 647 441 39.2 667 976 32.7 1 315 417 35.6 ARI Moderate 828 246 5.1 1 16 683 54.1 1 934 929 52.3 Severe 48 842 3. 34 91 1.7 83 743 2.3 TOTAL 1 651 849 1 2 44 899 1 3 696 748 1 Chicken Pox 9 33 2.8 23 361 5.1 32 691 4.1 Herpes Zoster 951.3 29 212 6.4 3 163 3.8 Skin Diseases Scabies 46 534 13.8 42 391 9.2 88 925 11.2 Other Forms 279 852 83.1 364 926 79.4 644 778 8.9 TOTAL 336 667 1 459 89 1 796 557 1 Burns & Scalds 27 97 Road Traffic Accidents 3 264 27.9 3.3 26 925 35 63 6.4 54 832 1.5 8.5 38 867 7.5 Injuries All Other Injuries 68 795 68.8 358 456 85.1 427 251 82. Table 4.2.2.2b. Selected Out-Patient General New Disease Breakdown, by Age Group, 211 DISEASES/ CONDITIONS -9yrs 1-24yrs 25-49yrs >5yrs Urethral Discharge 457 n % n % 7.1 31 196 n 5.4 15 447 % N 49 13 459 Genital Ulcers 223 3.5 11 849 19.1 38 155 18 5 429 Ophthalmia Neonatarum 5338 82.9. PID 52.8 6 17 9.9 27 266 13 7 186 Other forms of STD 369 5.7 12 76 2.6 44 162 21 9 55 % n ALL AGES 37.8 15 559 15.2 55 656. 5 338 2.2 4 611 26.8 66 841 STD TOTAL 6 439 1 61 912 1 215 18 1 35 624 1. 318 993 There were 6 439 cases of STs in the -9years age group and only 5338 cases of Ophthalmia Neonatarum. There is need to explore the reason for the differences 28

Table 4.2.2.2c. Selected Out-Patient General New Disease Breakdown by Province/City, 211 DISEASES/ CONDITIONS Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvi ngo Harare Chitungwiza Bulawayo Total No Dehydration 96 2 75 857 81 713 77 128 45 647 26 531 77 275 94 46 39 33 14 793 8 365 637 245 Diarrhoea With Dehydration 1 344 4 413 5 937 5 685 2 26 1 861 9 654 1 12 7 67 4 859 1 791 63 937 TOTAL 16 544 8 27 87 65 82 813 47 853 28 392 86 929 14 526 46 397 19 652 1 156 71 182 Kwashiorkor 3 325 1 667 2 524 1 444 1 6 638 2 583 1 681 1 198 67 845 17 572 Nutritional Marasmus 1 116 659 863 339 392 449 544 1 123 274 122 434 6 315 Deficiencies Pellagra 231 149 185 528 95 67 245 544 81 71 45 2 241 TOTAL 4 672 2 475 3 572 2 311 1 547 1 154 3 372 3 348 1 553 8 1 324 26 128 Ear, Nose, Throat 44 414 35 452 24 926 22 683 17 49 17 971 26 668 4 947 19 595 758 21 836 362 659 Mild 17 245 125 488 134 118 12 23 78 653 81 822 129 875 22 485 191 752 15 168 65 68 1 315 417 ARI Moderate 283 256 197 762 176 1 158 935 14 236 119 734 26 118 313 818 263 789 9 632 65 648 1 934 929 Severe 11 94 5 456 8 545 7 563 2 846 2 962 8 199 7 952 2 861 2 622 4 833 83 743 TOTAL 59 819 364 158 343 59 39 384 239 144 222 489 37 86 565 22 585 997 28 18 157 925 3 696 748 Urethral Discharge 2 15 14 563 17 49 17 837 5 437 8 252 18 384 22 921 17 759 1 531 6 34 15 547 Genital Ulcers 8 13 5 35 7 329 6 429 2 584 3 548 6 499 8 476 4 787 571 2 115 55 656 PID 5 384 2 286 4 239 3 981 1 628 1 914 6 772 7 366 4 868 56 1 667 4 611 STD Ophthalmia Neonatarum 582 466 777 472 13 195 394 365 1 653 35 269 5 338 Other forms of STD 9 78 5 425 8 633 6 798 3 585 3 93 8 414 11 843 5 454 864 2 115 66 841 TOTAL 43 99 28 45 38 387 35 517 13 364 17 839 4 463 5 971 34 521 3 57 12 47 318 993 Chicken Pox 3 291 2 532 3 537 3 159 2 85 2 896 3 292 5 31 4 73 53 2 22 32 691 Herpes Zoster 3 186 2 413 3 323 3 185 1 923 2 324 3 388 5 374 3 199 351 1 497 3 163 Skin Scabies 14 667 3 31 5 348 3 871 1 663 7 727 1 326 21 635 6 947 532 3 899 88 925 Diseases Other Forms 1 581 55 516 56 787 49 967 44 259 43 578 67 68 13 295 81 83 4 846 37 186 644 778 TOTAL 121 725 63 771 68 995 6 182 58 93 56 525 84 686 135 65 95 32 6 232 44 64 796 557 Injuries Burns & Scalds 8 113 5 288 5 737 5 623 2 838 2 449 5 53 6 614 9 76 1 199 1 762 54 832 Road Taffic Accidents 4 82 3 95 4 29 5 566 1 814 1 799 4 33 4 369 6 186 1 13 757 38 867 All Other Injuries 68 784 46 76 47 299 44 9 25 28 23 167 47 495 54 858 52 877 4 741 12 656 427 251 TOTAL 81 717 55 314 57 326 55 279 29 86 27 415 57 31 65 841 68 769 6 953 15 175 52 95 Source : T5 Forms 29

Table 4.2.2.3. Out-Patient Chronic Disease/ Conditions by Age Group, Province and City, 211 Out-Patient Manicaland Mashonaland Central Diagnosis -24 yrs 25 yrs and above -24 yrs 25 yrs and above New Follow-up New Follow-up New Follow-up New Follow-up Diabetes 8 24 1 336 1 984 27 163 413 6 451 Asthma 316 3 368 1 26 431 13 1 641 527 22 558 Leprosy 43 69 5 19 12 12 25 16 Epilepsy 24 2 649 482 11 912 47 1 4 292 8 616 Metal Illness 33 55 327 13 784 38 214 279 7 124 Disabled/Handicapped 17 133 24 244 58 185 6 61 Hypertension 27 49 2 45 77 15 21 172 1 317 58 115 R.H.D. 26 35 133 1 898 13 9 58 96 CCF 37 144 76 4 926 11 58 299 2 77 CRF 5 7 71 215 3 11 38 173 Breast Cancer 3 3 48 56 42 116 Cervical cancer 16 9 145 162 1 2 128 378 Prostate Cancer 2 267 595 1 11 565 Other Cancers 9 14 87 296 12 32 111 318 Total 818 7 819 7 36 148 843 374 3 62 3 636 18 365 Out-Patient Mashonaland East Mashonaland West Diagnosis -24 yrs 25 yrs and above -24 yrs 25 yrs and above New Follow-up New Follow-up New Follow-up New Follow-up Diabetes 59 343 552 8 928 42 177 519 6 22 Asthma 133 3 87 625 28 599 217 1 862 554 19 69 Leprosy 2 7 44 6 24 15 136 Epilepsy 88 1 843 224 1 519 98 1 77 271 8 181 Metal Illness 29 439 239 11 131 38 544 287 7 969 Disabled/Handicapped 161 21 62 18 2 42 2 15 Hypertension 33 542 2 214 79 58 48 178 1 85 53 34 R.H.D. 86 359 98 1 355 11 235 81 1 418 CCF 22 76 681 4 77 11 28 331 1 654 CRF 2 1 35 29 2 2 5 186 Breast Cancer 1 24 42 1 42 3 Cervical cancer 2 53 81 5 1 151 146 Prostate Cancer 44 153 87 28 Other Cancers 2 3 72 94 6 8 56 153 Total 616 6 925 4 93 145 64 487 4 88 4 296 98 815 3

Table 4.2.2.3. Out-Patient Chronic Disease Conditions by Age Group, Province, City and National (Continued) Out-Patient Matabeleland North Matabeleland South Diagnosis -24 yrs 25 yrs and above -24 yrs 25 yrs and above New Follow-up New Follow-up New Follow-up New Follow-up Diabetes 16 12 237 3 757 8 4 254 4 216 Asthma 85 2 78 321 14 237 58 1 441 288 14 326 Leprosy 17 2 57 4 2 17 Epilepsy 39 1 422 111 5 237 28 841 17 4 555 Metal Illness 17 254 155 5 4 1 129 125 5 414 Disabled/Handicapped 2 22 4 31 54 8 21 29 Hypertension 7 86 552 32 924 5 52 624 38 568 R.H.D. 2 277 51 644 16 22 61 344 CCF 17 51 164 1 558 3 27 282 1 87 CRF 2 9 71 24 59 Breast Cancer 2 1 14 1 1 6 17 Cervical cancer 1 31 55 1 31 22 Prostate Cancer 1 6 19 14 33 Other Cancers 2 1 19 43 2 34 37 Total 27 4 315 1 676 64 43 185 2 835 1 873 69 444 Out-Patient Midlands Masvingo Diagnosis -24 yrs 25 yrs and above -24 yrs 25 yrs and above Followup New New Follow-up New Follow-up New Follow-up Diabetes 24 186 74 1 518 6 168 548 13 139 Asthma 156 1 933 723 23 449 22 4 115 557 35 831 Leprosy 2 16 5 65 7 3 Epilepsy 123 1 628 371 1 78 61 2 58 27 12 87 Metal Illness 18 465 377 1 315 3 92 235 14 831 Disabled/Handicapped 15 89 25 69 124 338 112 523 Hypertension 12 241 1 39 57 282 41 163 895 7 424 R.H.D. 13 213 7 1 28 27 562 45 1 517 CCF 1 76 569 4 337 12 141 353 6 334 CRF 2 5 42 199 2 18 119 Breast Cancer 2 44 5 2 2 18 48 Cervical cancer 3 6 162 17 1 1 76 136 Prostate Cancer 3 3 146 244 1 62 171 Other Cancers 15 11 145 148 6 1 35 228 Total 398 4 872 4 728 118 132 566 8 92 3 161 155 418 31

Table 4.2.2.3. Out-Patient Chronic Disease Conditions by Age Group, Province, City and National (Continued) Out-Patient Harare Chitungwiza Diagnosis -24 yrs 25 yrs and above -24 yrs 25 yrs and above Followup New New Follow-up New Follow-up New Follow-up Diabetes 154 548 2 733 15 648 35 45 74 2 159 Asthma 331 97 1 57 8 474 312 36 411 1 192 Leprosy 2 3 2 4 1 29 Epilepsy 3 1 774 523 4 95 94 157 153 56 Metal Illness 153 4 594 314 17 182 122 236 18 949 Disabled/Handicapped 3 6 12 41 Hypertension 71 324 5 274 87 9 45 312 519 4 925 R.H.D. 15 193 255 781 3 4 252 111 CCF 14 147 1 64 6 835 23 68 35 584 CRF 17 8 338 519 11 19 61 613 Breast Cancer 1 5 281 1 731 8 28 52 Cervical cancer 3 1 116 2 56 1 25 52 Prostate Cancer 5 37 484 44 9 27 Other Cancers 19 323 1 578 3 779 1 7 15 Total 1 358 8 932 15 595 15 713 647 1 552 2 666 11 39 OUT-PATIENT BULAWAYO NATIONAL TOTALS DIAGNOSIS -24 yrs 25 yrs and above -24 yrs 25 yrs and above Followup Follow- New New Follow-up New up New Follow-up Diabetes 25 196 814 4 749 53 2 532 8 85 86 769 Asthma 229 639 352 3 4 2 169 21 44 6 415 197 17 Leprosy 4 2 3 12 7 174 66 1 14 Epilepsy 257 1 38 178 3 74 1 339 16 67 2 919 79 769 Metal Illness 57 726 88 11 314 545 9 8 3 326 15 413 Disabled/Handicapped 3 2 26 436 1 99 27 1 39 Hypertension 1 279 2 22 648 32 2 758 18 959 582 334 R.H.D. 46 329 67 372 366 2 823 1 171 1 68 CCF 8 12 339 1419 33 918 5 669 36 994 CRF 25 16 19 34 67 82 75 2 478 Breast Cancer 12 26 17 47 25 45 654 2 199 Cervical cancer 81 111 3 23 1 999 3 819 Prostate Cancer 7 9 116 98 18 51 1 336 2 517 Other Cancers 25 6 17 25 188 49 2 314 5 316 Total 777 3 371 5 56 47 113 6 433 57 969 54 653 1 117 799 The high incidence rate of asthma in outpatients in the age group 25years and above needs a revisit of the case definition of this condition. Prostate cancer is the second highest recorded cancer, and awareness must be raised to the same level as that of breast and cervical cancer. 32

Table 4.2.2.4. Out-Patient Chronic Disease/Conditions by Age Group, Province and City, 211 OUT-PATIENT MANICALAND MASHONALAND CENTRAL DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs 5yrs and above -9 yrs 1-24 yrs 25-49yrs 5yrs and above New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up Tuberculosis 589 1 338 5 991 1 989 622 798 4 129 1 124 AIDS 2 28 2 782 17 785 5 819 2 82 3 42 21 815 6 697 Kaposi s Sarcoma 22 4 21 99 7 134 46 Total 2 819 4 16 23 977 7 97 3 442 4 27 26 78 7 867 OUT-PATIENT MASHONALAND EAST MASHONALAND WEST DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs 5yrs and above -9 yrs 1-24 yrs 25-49yrs 5yrs and above New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up New Follow-up Tuberculosis 276 796 5 272 1 496 375 1 425 6 77 2 223 AIDS 3 88 4 186 24 438 9 864 4 68 7 223 37 69 9 233 Kaposis Sarcoma 1 14 141 64 3 11 237 72 Total 3 365 4 996 29 851 11 424 4 986 8 659 44 634 11 528 OUT-PATIENT MATABELELAND NORTH MATABELELAND SOUTH DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs New Follow-up New Follow-up Tuberculosis 255 61 2 AIDS 1 27 719 5 New Follow-up 5yrs and above New Follow-up New -9 yrs New 831 842 273 77 17 1 44 871 1 Kaposis Sarcoma 1 2 27 18 7 Total 1 283 1 331 7 965 2 264 1 144 2 1-24 yrs 346 6 Followup Followup New 3 9 12 25-49yrs 429 1 62 51 5yrs and above Follow-up New Follow-up 1 28 2 524 14 3 566 33

Table 4.2.2.4. Out-Patient Chronic Disease/Conditions by Age Group, Province and City, 211 (continued) OUT-PATIENT MIDLANDS MASVINGO DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs 5yrs and above -9 yrs 1-24 yrs New Follow-up New Followup New Followup New New Tuberculosis 526 1 AIDS 1 96 3 New New 11 5 365 22 25-49yrs 5yrs and above New 395 1 752 41 5 654 Kaposis Sarcoma 2 17 222 68 Total 2 488 4 483 28 UT-PATIENT HARARE CHITUNGWIZA DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs 5yrs and above -9 yrs 1-24 yrs 25-49yrs Tuberculosis 1 AIDS 1 New Follow-up New 368 3 59 1 Followup Followup New 398 15 96 14 Kaposis Sarcoma 14 2 2 Total 2 441 5 54 32 Followup New 923 3 189 2 New New 51 162 734 2 224 89 234 1 New 27 7 474 Follow-up Followup Followup Followup Followup 5yrs and above New 77 833 395 467 38 746 28 6 42 6 471 251 968 413 1 36 OUT-PATIENT BULAWAYO NATIONAL TOTALS DIAGNOSIS -9 yrs 1-24 yrs 25-49yrs 5yrs and above -9 yrs 1-24 yrs 25-49yrs New Follow-up New Follow-up Tuberculosis 471 65 2 AIDS 572 1 New 142 4 Followup Followup New 869 686 4 963 2 14 18 New New 917 11 32 26 512 55 35 158 Kaposis Sarcoma 1 4 86 32 44 32 3 Total 1 44 1 751 7 918 2 822 23 263 38 119 217 New Follow-up Followup Followup Followup 5yrs and above New 253 15 474 82 45 99 446 1 165 51 62 629 Followup Followup Followup Followup 34

Table 4.2.3.1. Inpatient Diseases /Conditions by Age Group, Excluding Central Hospital, 211 Disease/Conditions Under 1 Year 1-4 years 5 years and Over Total/ All Ages Patient Days Cases Deaths Cases Deaths Cases Deaths Cases Deaths 1. Intestinal Infections 1315 167 1 596 129 3 32 383 5 943 679 33 337 2. Pulmonary TB 84 14 195 24 3 79 895 4 69 933 45 719 3. Extra-pulmonary TB 1 3 7 49 71 53 78 5 716 4. Meningococcal & other Meningitis 38 21 39 1 963 428 1 4 459 12 25 5. Other bacterial 89 7 21 1 126 14 236 22 3 468 6. Measles 49 3 61 1 125 2 235 6 916 7. HIV related / AIDS 134 35 255 32 3 422 759 3 811 826 35 87 8. Other viral Diseases 97 32 149 27 2 46 774 2 652 833 32 65 9. Malaria 57 36 1 88 36 7 11 379 9 425 451 37 69 1. Other Anthropod-borne 4 11 2 53 11 68 13 638 11. Venereal 5 1 1 179 1 185 11 757 12. Other Infectious & Parasitic 62 12 96 9 416 145 574 166 4 165 13. Malignant Neoplasm of Oesophagus 3 36 4 39 4 366 14. Kaposi's Sarcoma 2 4 26 1 32 1 171 15. Malignant Neoplasm of Female Breast 58 9 58 9 57 16. Malignant Neoplasm of Cervix Uteri 241 24 241 24 2 473 17. Lymphomas & OtherLymphatic, Haematopoietic Tissue 11 1 11 1 65 18. All Other Malignant Neoplasms 1 1 12 2 53 68 552 71 5 325 19. Benign Neoplasms 5 17 616 39 638 39 5 719 2. Diabetes Mellitus 2 8 1 269 137 1 279 137 11 866 21. OtherEndocrine & Metabolic & Immunity Disorders 99 32 93 9 35 42 497 83 2 831 22. Nutritional Deficiencies 48 96 1 9 214 136 27 1 76 337 18 912 23. Anaemias & Blood-forming Organ Diseases 38 5 74 11 1 51 29 1 163 225 1 294 24. Mental Disorders 3 15 1 287 58 1 35 58 2 24 25. Nervous System 22 1 75 1 782 79 879 81 1 145 26. Eye and Adnexae 72 2 32 2 92 4 1 6 8 3197 27. Ear and Mastoid Process 44 1 49 1 73 3 166 5 775 28. Acute Rheumatic Fever & Rheumatic Heart Dis. 1 1 14 2 85 16 1 19 1 749 29. Hypertensive Disease 4 9 2 643 246 2 656 246 15 291 3. Ischaemic Heart Disease 1 5 7 51 7 418 31. Cerebo-vascular Accidents 1 5 2 68 151 686 153 7 544 32. Pulmonary Circulation & other Circulatory System Disease 1 2 18 1 1 41 275 1 429 278 12 549 33. ARI (Upper Tract) 714 64 724 27 98 36 2 346 127 9 631 34. ARI (Lower Tract) 3 51 327 2 989 136 5 759 749 12 249 1212 68 33 35. Chronic Brochitis & other Obstructive Pulmonary 46 1 135 8 1 69 61 1 25 7 6 62 36. Other Respiratory Diseases 338 2 332 19 428 37 1 98 76 4 257 37. Oral Cavity & Digestive System 191 16 23 18 1 758 182 2 179 216 14 171 38. Urinary System 23 2 7 1 629 51 722 54 4 745 39. Male Genital Organs 22 1 51 3 62 2 693 24 5 124 4. Salpingitis & Pelvic Tissue Inflammatory 1 3 56 2 1 324 44 1 39 49 3 941 Meningococcal is epidemic prone and rare though reported in Zimbabwe, this kind of implies we see more of that than the bacterial, AIDs related crypto and the viral. Meningoccocal is reported through RDNS. 35

Table 4.2.3.1. (Cont'd) Inpatient Diseases /Conditions by Age Group, Excluding Central Hospital, 211 Disease/Conditions Under 1 Year 1-4 years 5 years and Over Cases Deaths Cases Deaths Cases Deaths Total/ All Ages Cases Deaths Patient Days 41. Other Female Genital Organs 7 42. Abortion 43. Direct & Indirect Obstetric Causes 44. Normal Delivery 45. Skin and Subcutaneous 352 3 523 46. Musculoskeletal Syst. & Connective Tissue 14 2 44 47. Congenital Anomalies 3 2 22 48. Certain Conditions orig. in the Peri-natal period 1 451 453 71 49. Signs, Symptoms and ill-defined conditions 472 99 535 5. Fractures 6 2 33 51. Intracranial & Internal Injuries, including nerves 6 1 231 52. Open Wounds & all Other Injuries 54 268 53. Burns 122 7 512 54. Poisoning & Toxic Effects 14 1 7 55. Complications & Late Effects of Injuries, Poisoning 2 2 11 56. Other reasons for Contact with Health Services 7 1 9 1 1 5 32 5 3 2 13 4 5 1 558 4 283 11 682 4 574 1 97 876 196 363 3 38 2 918 2 77 1 615 582 558 1 511 163 16 25 64 7 47 24 29 25 213 45 49 23 19 19 27 3 565 4 283 11 682 4 574 2 782 934 248 1 885 4 45 3 38 2 368 1 937 1 216 642 1641 171 16 3 576 25 18 287 64 61 456 7 112 865 59 2 26 27 6 585 32 2 49 483 18 28 344 24 57 52 34 825 53 17 851 25 12 549 39 21 924 24 2 914 34 8 32 4 485 TOTAL 1 695 1 475 13 85 818 119 69 7 149 143 47 9 442 826 22 EXTERNAL CAUSES External Causes of Injury and Poisoning DISEASES / CONDITIONS Under 1 year 1-4 years Cases Deaths 1. Motor Vehicle & Road Traffic Accidents 54 6 Cases Deaths 2. Other Transport Accidents 2 3. Accidental Poisoning 6 16 13 27 5 4. Accidental Falls 5. Accidents by Fires and Flames 49 6. Other Accidents, incl. during Medical Care 37 7. Drugs, Medicaments Adverse Effects 8. Suicide and Self-inflicted injury 9. Homicide & Injury purposely inflicted by other Persons 2 18 1. Other Violence 21 184 124 12 24 148 5 5 years and over Cases 2 133 63 131 1 262 617 9 59 763 Deaths 64 5 11 3 27 13 Total all Ages Cases 2 347 65 164 1 495 778 9 61 932 Deaths Patient Stay days 83 12 36 154 1 683 23 11 58 27 4 62 62 27 1 388 18 5 521 TOTAL 171 6 Source: Inpatient Quarterly Returns - T9 661 59 5 568 123 6 4 188 36 224 36

Table 4.2.3.2. Total Inpatient Diseases/Conditions and Average Length of Stay, Excluding Central Hospitals, 211 DISEASE / CONDITIONS Cases Deaths Patient Stay Days Average Length of Stay (Days) Number % Number % Number % 1. Intestinal Infections 5 943 4.1 679 7.2 33 337 4. 6 2. Pulmonary TB 4 69 2.8 933 9.9 45 719 5.5 11 3. Extra-pulmonary TB 53.4 78.8 5 716.7 11 4. Meningococcal & other Meningitis 1 4.7 459 4.9 12 25 1.5 12 5. Other bacterial 236.2 22.2 3 468.4 15 6. Measles 235.2 6.1 916.1 4 7. HIV related / AIDS 3 811 2.7 826 8.7 35 87 4.2 9 8. Other viral Diseases 2 652 1.8 833 8.8 32 65 3.9 12 9. Malaria 9 425 6.6 451 4.8 37 69 4.6 4 1. Other Anthropod-borne 68. 13.1 638.1 9 11. Venereal 185.1 11.1 757.1 4 12. Other Infectious & Parasitic 574.4 166 1.8 4 165.5 7 13. Malignant Neoplasm of Oesophagus 39. 4. 366. 9 14. Kaposi's Sarcoma 32. 1. 171. 5 15. Malignant Neoplasm of Female Breast 58. 9.1 57.1 1 16. Malignant Neoplasm of Cervix Uterine 241.2 24.3 2473.3 1 17. Lymphomas & Other Lymphatic, Haematopoietic Tissue 11. 1. 65. 6 18. All Other Malignant Neoplasms 552.4 71.8 5 325.6 1 19. Benign Neoplasms 638.4 39.4 5 719.7 9 2. Diabetes Mellitus 1 279.9 137 1.5 11 866 1.4 9 21. Other Endocrine & Metabolic Diseases & Imm.Disorders 497.3 83.9 2 831.3 6 22. Nutritional Deficiencies 1 76 1.2 337 3.6 18 912 2.3 11 23. Anaemias & Bloodforming Organ Diseases 1 163.8 225 2.4 1 294 1.2 9 24. Mental Disorders 1 35.9 58.6 2 24 2.4 15 25. Nervous System 879.6 81.9 1 145 1.2 12 26. Eye and Adnexae 1 6.7 8.1 3 197.4 3 27. Ear and Mastoid Process 166.1 5.1 775.1 5 28. Acute Rheumatic Fever & Rheum. Heart Dis. 1.1 19.2 1 749.2 17 29. Hypertensive Disease 2 656 1.8 246 2.6 15291 1.9 6 3. Ischaemic Heart Disease 51. 7.1 418.1 8 31. Cerebo-vascular Accidents 686.5 153 1.6 7 544.9 11 32. Pulmonary Circulation & other Circulatory. System Dis. 1 429 1. 278 2.9 12 549 1.5 9 33. ARI (Upper Tract) 2 346 1.6 127 1.3 9 631 1.2 4 34. ARI (Lower Tract) 12 249 8.5 212 12.8 68 33 8.2 6 35. Chronic Bronchitis & other Obstructive Pulmonary 1 25.9 7.7 6 62.8 5 36. Other Respiratory Diseases 1 98.8 76.8 4 257.5 4 37. Oral Cavity & Digestive System 2 179 1.5 216 2.3 14 171 1.7 7 38. Urinary System 722.5 54.6 4 745.6 7 39. Male Genital Organs 693.5 24.3 5 124.6 7 4. Salpingitis & Pelvic Tissue Inflammatory 1 39 1. 49.5 3 941.5 3 37

DISEASE / CONDITIONS Cases Patient Stay days Average Number % Deaths Number % Number % Patient Stay (days) 41. Other Female Genital Organs 565.4 16.2 3576.4 6 42. Abortion 4283 3. 26.3 18287 2.2 4 43. Direct & Indirect Obstetric Causes 11682 8.1 66.7 61456 7.4 5 44. Normal Delivery 4574 28.3 71.8 112865 13.7 3 45. Skin and Subcutaneous 2 782 1.9 59.6 2 26 2.4 7 46. Musculoskeletal Syst. & Connective Tissue 934.7 27.3 6 585.8 7 47. Congenital Anomalies 248.2 32.3 2 49.3 1 48. Certain Conditions orig. in the Perinatal period 1 885 1.3 483 5.1 18 28 2.2 1 49. Signs, Symptoms and ill-defined conditions 4 45 2.8 344 3.6 24 57 3. 6 5. Fractures 3 38 2.3 52.6 34 825 4.2 11 51. Intracranial & Internal Injuries, including nerves 2 368 1.6 53.6 17 851 2.2 8 52. Open Wounds & all Other Injuries 1 937 1.3 25.3 12 549 1.5 6 53. Burns 1 216.8 39.4 21 924 2.7 18 54. Poisoning & Toxic Effects 642.4 24.3 2 914.4 5 55. Complications & Late Effects of Injuries, Poisoning 1 641 1.1 34.4 832 1. 5 56. Other reasons for Contact with Health Services 171.1 4. 485.1 3 TOTAL 143 69 1. 9 446 1. 826 22 1. 6 EXTERNAL CAUSES External Causes of Injury and Poisoning DISEASE / CONDITIONS Cases Deaths Patient Stay days Number % Number % Number % Average Patient Stay (days) 1. Motor Vehicle & Road Traffic Accidents 2 347 36.7 83 44.1 12 36 34. 5 2. Other Transport Accidents 65 1.. 154.4 2 3. Accidental Poisoning 164 2.6 1 5.3 683 1.9 4 4. Accidental Falls... 5. Accidents by Fires and Flames 1 495 23.4 23 12.2 11 58 31.8 8 6. Other Accidents, incl. during Medical Care 778 12.2 27 14.4 4 62 12.7 6 7. Drugs, Medicaments Adverse Effects 9.1. 62.2 7 8. Suicide and Self-inflicted injury... 9. Homicide & Injury purposely inflicted by other Persons 61 9.5 27 14.4 1 388 3.8 2 1. Other Violence 932 14.6 18 9.6 5 521 15.2 6 TOTAL 6 4 1. 188 1. 36 224 1. 6 Source :Inpatient Quarterly Return s - T9 38

Table 4.2.3.3. Top 1 OPD Attendances Age Group, 211 Figure 4.2.3.3a: Under 1 HIV related / AIDS Rank Disease / Conditions Cases 1 ARI 4 215 2 Peri-natal conditions 1 451 3 Intestinal Infections 1 315 4 Malaria 57 5 Nutritional Deficiencies 48 6 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 472 7 Skin and Subcutaneous 352 8 Other Respiratory Diseases 338 9 Oral Cavity & Digestive System 191 1 HIV related / AIDS 134 Diagnosis Oral Cavity & Digestive System Other Respiratory Diseases Skin and Subcutaneous Signs, Symptoms and ill-defined conditions (ill-defined cond.) Nutritional Deficiencies Malaria Intestinal Infections Certain Conditions orig. in the Perinatal period (Perinatal... Cases ARI Figure 4.2.3.3b: 1-4 years 1 2 3 4 5 Number Rank Disease / Conditions Cases 1 ARI 3 713 2 Malaria 1 88 3 Intestinal Infections 1 596 4 Nutritional Deficiencies 1 9 5 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 535 6 Skin and Subcutaneous 523 7 Burns 512 8 Other Respiratory Diseases 332 9 Fractures 33 1 Open Wounds & all Other Injuries (All other inj) 268 Diagnosis Open Wounds & all Other.. Fractures Other Respiratory Diseases Burns Skin and Subcutaneous Signs, Symptoms and ill-.. Nutritional Deficiencies Intestinal Infections Malaria Cases ARI 1 2 3 4 Figure 4.2.3.3c : 5 Years and Over Number Rank Disease / Conditions Cases 1 Normal Delivery 4 574 2 Direct & Indirect Obstetric Causes (Obstetric causes) 11 682 3 Malaria 7 11 4 ARI 6 667 5 Abortion 4 283 6 Pulmonary TB 3 79 7 HIV related / AIDS 3 422 8 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 3 38 9 Intestinal Infections 3 32 1 Fractures 2 918 Diagnosis Fractures Intestinal Infections Signs, Symptoms and ill-.. HIV related / AIDS Pulmonary TB Abortion ARI Malaria Direct & Indirect.. Normal Delivery Cases 2 4 6 Figure 4.2.3.3d : All Age Groups Number Rank Disease / Conditions Cases 1 Normal Delivery 4 675 2 ARI 14 595 3 Direct & Indirect Obstetric Causes (Obstetric causes) 11 698 4 Malaria 9 425 5 Intestinal Infections 5 943 6 Abortion 4 35 7 Pulmonary TB 4 69 8 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 4 45 9 HIV related / AIDS 3 811 1 Fractures 3 38 Diagnosis Fractures HIV related / AIDS Signs, Symptoms and ill-.. Pulmonary TB Abortion Intestinal Infections Malaria Direct & Indirect Obstetric.. ARI Normal Delivery 1 2 3 4 5 Number Cases 39

Table 4.2.3.4. Top Ten Causes of Mortality by Age Group, Excluding Central Hospitals, 211 Figure 4.23.4a : Under 1 Rank Disease / Conditions Deaths 1 Peri-natal conditions 453 2 ARI 391 3 Intestinal Infections 167 4 Ill-defined conditions 99 5 Nutritional Deficiencies 96 6 Malaria 36 7 HIV related / AIDS 35 8 Other viral Diseases 32 9 Other Endocrine & Metabolic Diseases & Immunity Disorders 32 1 Meningococcal & other Meningitis 21 Diagnosis Meningococcal & other Meningitis Other Endocrine & Metabolic Diseases & Immunity Disorders Other Viral Diseases HIV related / AIDS Malaria Nutritional Deficiencies Signs, Symptoms and ill-defined conditions (ill-defined cond.) Intestinal Infections ARI 5 1 15 2 25 3 35 4 45 Number Figure 4.2.3.4b: 1-4 years Rank Disease / Conditions Deaths 1 Nutritional Deficiencies 214 2 ARI 163 3 Intestinal Infections 129 4 Malaria 36 5 HIV related / AIDS 32 6 Signs, Symptoms and ill-defined conditions (ill-defined 32 7 Other viral Diseases 27 8 Pulmonary TB 24 9 Other Respiratory Diseases 19 1 Oral Cavity & Digestive System 18 Diagnosis Oral Cavity & Digestive System Other Respiratory Diseases Pulmonary TB Other Viral Diseases Signs, Symptoms and ill-defined conditions (ill-defined cond.) HIV related / AIDS Malaria Intestinal Infections ARI Nutritional Deficiencies 5 1 15 2 25 Number Figure 4.2.3.4c: 5 Years and Over Rank Disease / Conditions Deaths 1 Pulmonary TB 895 2 ARI 788 3 Other viral Diseases 774 4 HIV related / AIDS 759 5 Meningococcal & other Meningitis 428 6 Intestinal Infections 383 7 Malaria 379 8 Pulmonary Circulation Heart, other Circul. System Dis. 275 9 Hypertensive Disease 246 1 Ill-defined conditions 213 Diagnosis Signs, Symptoms and ill-defined conditions (ill-defined cond) Hypertensive Disease Pulmonary Circulation & other Heart, other Circul. System Dis. Malaria Intestinal Infections Meningococcal & other Meningitis HIV related / AIDS Other Viral Diseases ARI Pulmonary TB 1 2 3 4 5 6 7 8 9 1 Number Figure 4.2.3.4d: All Age Groups Nutritional Deficiencies Rank Disease / Conditions Deaths 1 ARI 1339 2 Pulmonary TB 933 3 Other viral Diseases 833 4 HIV related / AIDS 826 5 Intestinal Infections 679 6 Peri-natal conditions 483 7 Meningococcal & other Meningitis 459 8 Malaria 451 9 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 344 1 Nutritional Deficiencies 337 Diagnosis Signs, Symptoms and ill-defined conditions (ill-defined cond.) Malaria Meningococcal & other Meningitis Certain Conditions orig. in the Perinatal period (Perinatal cond.) Intestinal Infections HIV related / AIDS Other Viral Diseases Pulmonary TB ARI 2 4 6 8 1 12 14 16 Number Source :Inpatient Quarterly Returns - T9 4

Table 4.2.3.5a Top 1 Causes of Hospital Bed Stay (All Ages Excluding Central Hospital), 211 Number of : Rank Disease/ Condition Cases Patient Stay Days Average Stay Days % Stay Days 1 Normal Delivery 4 675 112 865 3 13.7 2 ARI 12 249 77 664 6 9.4 3 Direct & Indirect Obstetric Causes (Obstetric causes) 11 698 61 456 5 7.4 4 Pulmonary TB 4 69 45 719 11 5.5 5 Malaria 9 425 37 69 4 4.6 6 HIV related / AIDS 3 811 35 87 9 4.2 7 Fractures 3 38 34 825 11 4.2 8 Intestinal Infections 5 943 33 337 6 4. 9 Other viral Diseases 2 652 32 65 12 3.9 1 Signs, Symptoms and ill-defined conditions (ill-defined cond.) 4 45 24 57 6 3. Total All Diseases 143 69 826 22 6 1. Source: Inpatient Quarterly Returns- T9 Table 4.2.3.5b. National Outpatient and Inpatient Cases and Deaths, Excluding Central Hospitals, 21 211 Year OPD INPATIENT (T9) Total New Cases Cases Deaths CFR % 21 12546518 294783 14539 4.9 22 1187371 34975 18329 5.4 23 1171342 25156 1556 6. 24 11189389 317728 17686 5.6 25 16877 326751 22918 7. 26 9176493 19211 14629 7.3 27 9349423 146373 1345 7.1 28 7479831 136258 778 5.2 29 8716376 112153 6867 6.1 21 - - - - 211 1182115 14347 9446 6.6 Source: T9 Quarterly Returns & T5(OPD) Monthly forms - Data not available for what reason? 41

Table 4.2.3.6. National Hospital Diagnoses, Including Central Hospitals. Causes of Hospital Admissions and Deaths for all Age Groups, 211 Diseases/Conditons Provincial Totals Central Hospitals National Totals Cases % Deaths % Cases % Deaths % Cases % Deaths % 1. Intestinal Infections 5 943 4.1 679 9.9 1 678 3.7 169 3.8 7 621 4. 848 7.5 2. Pulmonary TB 4 69 2.8 933 13.6 553 1.2 116 2.6 4 622 2.5 1 49 9.3 3. Extra-pulmonary TB 53.4 78 1.1 471 1.1 19 2.5 1 1.5 187 1.7 4. Meningococcal & other Meningitis 1 4.7 459 6.7 523 1.2 25 4.6 1 563.8 664 5.9 5. Other bacterial 236.2 22.3 145.3 41.9 381.2 63.6 6. Measles 235.2 6.1 14.. 249.1 6.1 7. HIV related / AIDS 3 811 2.7 826 12. 1 252 2.8 495 11.2 5 63 2.7 1 321 11.7 8. Other viral Diseases 2 652 1.8 833 12.1 115.3 11.2 2 767 1.5 844 7.5 9. Malaria 9 425 6.6 451 6.6 361.8 43 1. 9 786 5.2 494 4.4 1. Other Anthropod-borne 68. 13.2.. 68. 13.1 11. Venereal 185.1 11.2 6.1 2. 245.1 13.1 12. Other Infectious & Parasitic 574.4 166 2.4 53 1.1 181 4.1 1 77.6 347 3.1 13. Malignant Neoplasm of Oesophagus 39. 4.1 179.4 36.8 218.1 4.4 14. Kaposi's Sarcoma 32. 1. 124.3 41.9 156.1 42.4 15. Malignant Neoplasm of Female Breast 58. 9.1 14.2 15.3 162.1 24.2 16. Malignant Neoplasm of Cervix Uterine 241.2 24.3 542 1.2 74 1.7 783.4 98.9 17. Lymphomas & All Other Lymphatic, Haematopoietic Tissue 11. 1. 212.5 5 1.1 223.1 51.5 18. All Other Malignant Neoplasms 552.4 71 1. 1 38 2.3 147 3.3 1 59.8 218 1.9 19. Benign Neoplasms 638.4 39.6 633 1.4 13.3 1 271.7 52.5 2. Diabetes Mellitus 1 279.9 137 2. 68 1.5 93 2.1 1 959 1. 23 2. 21. Endocrine & Metabolic Diseases & Immunity Disorders 497.3 83 1.2 579 1.3 185 4.2 1 76.6 268 2.4 22. Nutritional Deficiencies 1 76 1.2 337 4.9 633 1.4 95 2.1 2 339 1.2 432 3.8 23. Anaemias & Bloodforming Organ Diseases 1 163.8 225 3.3 938 2.1 172 3.9 2 11 1.1 397 3.5 24. Mental Disorders 1 35.9 58.8 17.4 23.5 1 475.8 81.7 25. Nervous System (except meningitis) 879.6 81 1.2 1 345 3. 132 3. 2 224 1.2 213 1.9 26. Eye and Adnexae 1 6.7 8.1 359.8 5.1 1 365.7 13.1 27. Ear and Mastoid Process 166.1 5.1 26.1 4.1 192.1 9.1 28. Acute Rheumatic Fever & Rheum. Heart Dis. 1.1 19.3 1.2 15.3 2.1 34.3 29. Hypertensive Disease 2 656 1.8 246 3.6 592 1.3 112 2.5 3248 1.7 358 3.2 3. Ishaemic Heart Disease 51. 7.1 49.1 9.2 1.1 16.1 31. Cerebo-vasculars 686.5 153 2.2 555 1.2 188 4.2 1 241.7 341 3. 32. Pulmonary Circulation &other Circul. System Dis. 1 429 1. 278 4. 1 191 2.7 264 6. 2 62 1.4 542 4.8 33. ARI (Upper Tract ) 2 346 1.6 127 1.8 21.5 2. 2 556 1.4 129 1.1 34. ARI (Lower Tract) 12 249 8.5 1 212 17.6 1 761 3.9 197 4.4 14 1 7.4 1 49 12.5 35. Chronic Bronchitis & other Obstructive Pulmonary 1 25.9 7 1. 86 1.9 82 1.9 2 11 1.1 152 1.3 36. Other Respiratory Diseases 1 98.8 76 1.1 282.6 4.9 1 38.7 116 1. 37. Oral Cavity & Digestive System 2 179 1.5 216 3.1 748 1.7 168 3.8 2 927 1.6 384 3.4 38. Urinary System 722.5 54.8 1 685 3.8 254 5.7 2 47 1.3 38 2.7 39. Male Genital Organs 693.5 24.3 892 2. 147 3.3 1 585.8 171 1.5 4. Salpingitis & Pelvic Tissue Inflammatory 1 39 1. 49.7 496 1.1 13.3 1 886 1. 62.5 41. Other Female Genital Organs 565.4 16.2 42.9 7.2 985.5 23.2 42. Abortion 4 35 3. 26.4 2 62 4.6 12.3 6 367 3.4 38.3 43. Direct & Indirect Obstetric Causes 11 698 8.1 66 1. 3 171 7.1 7.2 14 869 7.9 73.6 44. Normal Delivery 4 675 28.3 71 1. 8 248 18.4 6.1 48 923 26. 77.7 45. Skin and Subcutaneous 2 782 1.9 59.9 421.9 14.3 3 23 1.7 73.6 46. Musculoskeletal Syst. & Connective Tissue 934.7 27.4 46 1. 24.5 1 394.7 51.5 47. Congenital Anomalies 248.2 32.5 284.6 22.5 532.3 54.5 48. Perinatal conditions 1 885 1.3 483 7. 1 37 2.3 85 1.9 2 922 1.6 568 5. 49Ill-defined conditions 4 45 2.8 344 5. 859 1.9 49 1.1 4 94 2.6 393 3.5 5. Fractures 3 38 2.3 52.8 1 93 2.4 112 2.5 4 41 2.3 164 1.5 51. Intracranial & Internal Injuries, including nerves 2 368 1.6 53.8 945 2.1 33.7 3 313 1.8 86.8 52. Open Wounds & all Other Injuries 1 937 1.3 25.4 855 1.9 5 1.1 2 792 1.5 75.7 53. Burns 1 216.8 39.6 876 2. 11.2 2 92 1.1 5.4 54. Poisoning & Toxic Effects 642.4 24.3 861 1.9 31.7 1 53.8 55.5 55. Complications & Late Effects of Injuries, Poisoning 1 641 1.1 34.5 35.8 15.3 1 991 1.1 49.4 56. Other reasons for Contact with Health Services 171.1 4.1 186.4 3.1 357.2 7.1 TOTAL 143 69 1. 6 867 1. 44 786 1. 4 429 1. 188 395 1. 11 296 1. Source :Inpatient Quarterly Returns - T9 42

Table 4.2.3.7. Top 1 In-patient Diseases and Conditions, Including Central Hospitals, 211 Cases, All Ages Rank Disease / Conditions Cases 1 Normal delivery 59 171 2 ARI 21 515 3 Obstetric causes (direct & indirect) 17 113 4 Hypertensive disease 11 232 5 Intestinal Obstruction 1 343 6 Malaria 1 154 7 Perinatal Conditions 9 164 8 Abortion 8 995 9 HIV related AIDS 6 681 1 Ill-defined conditions 6 518 Fig 4.2.3.7b Top Ten Causes of Hospitalisation ( Including Central Hospitals) Deaths, All Ages RankDisease / Conditions Deaths 1 ARI 2 94 2 HIV related AIDS 1 879 3 Perinatal Conditions 1 788 4 Pulmonary TB 1 22 5 Intestinal Obstruction 1 58 6 Other Viral 846 7 Pulmonary/heart/other circ.system diseases 759 8 Ill-defined conditions 75 9 Oral cavity & digestive system 692 1 Meningococcal Meningitis (+other meningitis) 665 Source :Inpatient Quarterly Returns - T9 Fig 4.2.3.7a Top Ten Causes of Hospitalisation (Including Central Hospitals) Signs, symptoms & ill-defined conditions HIV related AIDS Abortion Conditions originating in perinatal period Malaria Intestinal Obstruction Hpertensive Disease Obstetric causes (direct & indirect) ARI Normal delivery Diagnosis 2 4 6 8 Cases Meningococcal Meningitis (+other.. Oral cavity & digestive system Signs, symptoms & ill-defined conditions Pulmonary/heart/other circ. system.. Other Viral Intestinal Obstruction Pulmonary TB Diagnosis Conditions originating in perinatal period HIV related AIDS ARI 1 2 3 Deaths 43

Table 4.2.4.1. EPI Target Diseases: Inpatient Cases and Deaths by Province/City, 211 Province Cases Deaths Measles Diphtheria Manicaland Tetanus AFP Pertussis Mashonaland. Central Measles 23 1 Diphtheria Tetanus 2 AFP 3 Pertussis Mashonaland. East Measles 89 2 Diphtheria Tetanus AFP 1 Pertussis Mashonaland. West Measles 19 Diphtheria Tetanus AFP Pertussis Matabeleland. North Measles 81 2 Diphtheria Tetanus AFP Pertussis Matabeleland. South Measles Diphtheria Tetanus AFP Pertussis Midlands Measles 17 Diphtheria Tetanus AFP Pertussis Masvingo Measles Diphtheria Tetanus AFP 4 Pertussis Harare City Measles 13 1 Diphtheria Tetanus AFP Pertussis Bulawayo City Measles Diphtheria Tetanus AFP Pertussis National Measles 242 6 Diphtheria Tetanus 2 AFP 8 Pertussis Source : T9 forms 44

Table 4.2.4.2. Measles Cases Trend by Age Group, 2-211 Year Under 5 5 Yrs+ Total New Cases Rate per 1, population 2 391 1166 1557 11.9 21 149 11 25 1.8 22 218 574 792 5.7 23 228 277 55 4.3 24 382 711 193 9.2 25 42 172 574 4.8 26 176 13 279 2.3 27 156 95 251 2.4 28 42 26 68 1.9 29 117 185 36 2.4 21 292 28 572 4.7 211 114 128 242 1.9 Source: T9 returns. Table 4.2.4.3. Measles Inpatient Cases and Deaths by Age Group and Province/City, 211 Prov/City New Cases Deaths National Under 1 1-4 5yrs + Total Under 1 1-4 5yrs + Total Manicaland Mashonaland Central 1 9 13 23 1 1 Mashonaland East 15 3 44 89 2 2 Mashonaland West 3 5 11 19 Matabeleland North 26 14 41 81 1 1 2 Matabeleland South Midlands 4 2 11 17 Masvingo Harare City 3 2 8 13 1 1 Chitungwiza Bulawayo City Total 52 62 128 242 3 1 2 6 Source -T9 Returns 45

Table 4.2.4.4. Weekly Disease Surveillance Report, 21-211 Diarrhoea Cases Dysentery Cases 12 12 1 3 6 4 2 12 12 12 12 12 1 4 7 1 13 16 19 22 25 28 31 34 37 4 43 46 49 52 Week Number 211 21 12 1 4 7 1 13 16 19 22 25 28 31 34 37 4 43 46 49 52 Week Number 211 21 Malaria Cases Measles Cases 16 14 12 1 8 6 4 2 1 1 7 1 13 16 19 22 25 28 31 34 37 4 43 46 49 52 Week Number 211 21 6 5 4 3 2 1 1 4 7 1 13 16 19 22 25 28 31 34 37 4 43 46 49 52 Week Number Cases Cases Cases Cases 211 21 46

Table 4.3.1.1. New AIDS Cases by Sex and Age Group, 211 Age Group Male Female Total -9 9 68 9 234 18 32 1-24 9 81 16 495 26 35 25-49 55 681 13 121 158 82 5+ 18 612 27 378 45 99 Total 93 171 156 228 249 399 Source :T5 Figure 4.3.1.1. New AIDS Cases by Age Group and Sex, 211 12 1 New Cases 8 6 4 2-9 1-24 Age Group 25-49 5+ Male Female 47

Table 4.3.1.2. New Cases of AIDS and Related Diseases by Province/City, 211 Province AIDS Kaposi' Sarcoma TB STI Manicaland 28 594 362 9 97 43 99 Mashonaland Central 34 734 187 6 673 28 45 Mashonaland East 41 576 22 7 84 38 387 Mashonaland West 58 754 323 1 73 35 517 Matabeleland North 8 257 48 4 538 13 364 Matabeleland South 13 751 83 5 437 17 839 Midlands - - - 4 463 Masvingo 33 389 39 8 774 5 971 Harare 21 563 3 32 28 626 38 28 Bulawayo 8 781 123 4 631 12 47 National 249 399 4 957 87 156 318 993 Source: T5 returns Note: - Data not available Figure 4.3.1.2. New cases of AIDS and Related Diseases by Province/City, 211 New Cases 7 6 5 4 3 2 1 Manicaland Mash Central Mash East Mash West Manicaland Mat South Midlands Manicaland Harare Bulawayo Province AIDS Kaposi Sacoma TB STI 48

Table 4.3.1.3. HIV and Related Conditions by Year, 21-211 21 22 23 24 25 26 27 28 29 21 211 AIDS new cases 6 621 4 95 4 96 41 983 6 732 7 291 24 566 23 199 14 8 129 934 249 399 Kaposi's Sarcoma 4 52 42 353 41 8 3 918 6 731 9 187 5 627 3 67 1 632 2 781 4 957 STI episodes 661 426 535 777 69 313 721 185 828 876 828 876 453 964 315 59 174 118 23 91 318 993 TB new cases 43 311 39 28 43 892 44 987 43 762 47 77 143 154 11 31 48 12 62 445 87 156 Source: T5 returns 49

Table 4.3.1.4. HIV Sentinel Surveillance Data In Ante Natal Care Women by Year, 24-29 PROVINCE SITE 24 26 29 n % HIV+ n % HIV+ n % HIV+ Manicaland Murambinda Hospital 331 19.7 331 15.7 356 25.6 Sakubva Clinic 332 17.7 332 13.9 342 14.6 Mashonaland Central Karanda Hospital 34 12.1 34 9.4 336 11.3 Chipadze Clinic 351 24.6 351 13.7 34 14.4 Mashonaland East Mutoko Hospital 328 2.5 328 17.1 355 15.5 Sadza Hospital 397 22.9 397 17.6 355 11.8 Mash Cebtral Kadoma Hospital 34 21.9 34 22.4 359 1.9 Matabeleland North Binga Hospital 348 1.3 348 7.8 339 8.3 Chinotimba Hospital 338 35.8 338 25.4 345 26.4 Matabeleland South Gwanda Hospital 333 26 333 24.9 35 19.7 Beitbridge Hospital 332 26.3 332 25.6 353 23.5 Midlands Mkoba Clinic 333 19.9 333 18.6 351 18 Masvingo Chiredzi Hospital 348 17.8 348 2.4 351 25.1 Gutu Mission Hospital 391 23.4 391 17.1 335 14 Harare City Kuwadzana Clinic 552 19.7 552 15.6 59 12.2 Chitungwiza St Mary's Clinic 569 2.3 569 15.5 659 11.4 Bulawayo Nkulumane Clinic 597 18.1 597 17.3 574 14.1 SOURCE :- Antenatal Care Survey Report KEY :- n = Sample Size The rate is greater than 5% in pregnant mothers and thus we still have a generalised HIV epidemic. 5

Table 4.3.1.5. Tuberculosis New Cases by Province, Age Group and Sex, 211 Age Group Manicaland Mash. Central Mash. East Mash. West Mat. North Mat. South (Years) Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total -9 276 313 589 331 291 622 155 121 276 23 172 375 149 16 255 11 163 273 1-24 652 686 1 338 311 487 798 313 483 796 617 88 1 425 235 375 61 295 412 77 25-49 3 118 2 873 5 991 2 12 2 27 4 129 2 552 2 72 5 272 3 48 3 227 6 77 1 511 1 32 2 831 1 934 1 495 3 429 5+ 1 111 878 1 989 665 459 1 124 852 644 1 496 1 178 1 45 2 223 472 37 842 56 468 1 28 TOTAL 5 157 4 75 9 97 3 49 3 264 6 673 3 872 3 968 7 84 5 478 5 252 1 73 2 367 2 171 4 538 2 899 2 538 5 437 Year Pop. 1 715 916 1 88 684 1 357 788 1 339 44 77 992 714 236 TB INCIDENCE (/1) 5.8 6.1 5.8 8. 5.9 7.6 MALE RATIO.9 1. 1. 1..9.9 Age Group Midlands Masvingo Bulawayo City Harare City(Incl. Chitungwiza City) National (Years) Male Female Total Male Female Total Male Female Total Male Female Total Male % Female % Total -9 - - 264 262 526 268 23 471 842 688 1 53 2 598 5.8% 2 319 2.7% 4 917 1-24 - - 441 66 1 11 274 331 65 2 17 2 25 4 132 5 245 11.7% 6 267 7.2% 11 512 25-49 - - 2 564 2 831 5 395 1 537 1 332 2 869 9 748 8 882 18 63 28 546 63.8% 26 77 3.6% 55 253 5+ - - 914 838 1 752 412 274 686 2 165 2 169 4 334 8 329 18.6% 7 145 8.2% 15 474 TOTAL 4 183 4 591 8 774 2 491 2 14 4 631 14 862 13 764 28 626 44 718 1.% 87 156 1.% 87 156 Year Pop. 1 61 148 1 444 144 74 42 1 949 2 12 721 372 TB INCIDENCE (/1). 6.1 6.3 14.7 6.9 MALE RATIO - 1.1.9.9 1.9 - Data not available 51

Figure 4.3.1.5. Tuberculosis New Cases by Province, Age Group and Sex, 211 3 25 Incidence Rate 2 15 1 5-9 1-24 Age Group 25-49 5+ Male Female 52

Table 4.3.2.1. ARI Outpatient Cases by Age Group, Province/City, 211 Province/City Under Under 5 Population 5 yrs Under 5 yrs Cases All 5 yrs & Over Population 5 yrs & Over Cases Total Population Total Cases Manicaland 27513 219 19 1 445 43 29 629 1 715 916 59 819 Mashonaland Central 17133 161 192 917 381 22 966 1 88 684 364 158 Mashonaland East 24177 155 975 1 153 61 187 615 1 357 788 343 59 Mashonaland West 21746 135 4 1 137 657 174 344 1 339 44 39 384 Matabeleland North 13345 96 3 637 947 143 114 77 992 239 144 Matabeleland South 11169 79 73 63 167 142 759 714 236 222 489 Midlands 251998 158 287 1 349 15 212 573 1 61 148 37 86 Masvingo 222654 215 566 1 221 49 349 636 1 444 144 565 22 Harare City 237726 326 51 1 357 75 259 487 1 595 476 585 997 Chitungwiza City 5557 17 13 32 988 11 167 353 545 28 18 Bulawayo City 1366 87 316 636 436 7 69 74 42 157 925 Total 1958394 1 651 849 1 762 979 2 44 899 12 721 372 3 696 748 Source:- T5 Forms Figure 4.3.2.1. ARI Outpatient Cases by Age Group, Province/City, 211 Number of New Classes in Thousands 4 35 3 25 2 15 1 5 Man Mash Cent Mash East Mash West Mat North Mat South Midlands Masvingo Harare Chit Byo Under 5 yrs 5 yrs & Over 53

Table 4.3.2.2. OPD New ARI Breakdown by Province/City, 211 Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South ARI All Ages All Ages All Ages All Ages All Ages All Ages no. % no. % no. % no. % no. % no. % Ear, Nose, Throat 44 414 9 35 452 1 24 926 7 22 683 7 17 49 7 17 971 8 Mild 17 245 33 125 488 34 134 118 39 12 23 39 78 653 33 81 822 37 Moderate 283 256 56 197 762 54 176 1 51 158 935 51 14 236 59 119 734 54 Severe 11 94 2 5 456 1 8 545 2 7 563 2 2 846 1 2 962 1 TOTAL 59 819 364 158 343 59 39 384 239 144 222 489 1 3 Total New Gen Dis/Con 2 36 76 1 4 347 1 633 821 6 867 449 764 768 ARI % out total New Diseases/Conditions 1715915.916 22% 188683.85 26% 1357787.84 21% 133944 24% 77992 28% 714235.5421 29% Incidence Rate/1 population? 297 334 253 231 31 312 Midlands Masvingo Harare Chitungwiza Bulawayo NATIONAL ARI All Ages All Ages All Ages All Ages All Ages All Ages no. % no. % no. % no. % no. % no. % Ear, Nose, Throat 26 668 7 4 947 7 19 595 19 758 3 21 836 14 362 659 1 Mild 129 875 35 22 485 36 191 752 33 15 168 54 65 68 42 1 315 417 36 Moderate 26 118 56 313 818 56 263 789 45 9 632 34 65 648 42 1 934 929 52 Severe 8 199 2 7 952 1 2 861 4 2 622 9 4 833 3 83 743 2 TOTAL 37 86 565 22 585 997 28 18 157 925 3 696 748 Total New Gen Dis/Con 1 396 595 2 115 873 1 74 328 144 571 637 4 14 326 153 ARI % out total New Diseases/Conditions 161147.583 27% 1444143.594 27% 1595475.732 34% 353545 19% 7442 25% 12721372.19 26% Incidence Rate 232 391 367 8 213 291 54

Table 4.3.2.3. OPD New Cases of Acute Respiratory Infection by Age Group, 211 Years OPD New Ari Cases ARI Incidence Rate /1 Total New Disease/Condition Population Under 5 yrs Five yrs + All Ages Under 5 yrs Five yrs + All Ages ARI % Out of Total All Ages Under 5 yrs Five yrs + All Ages 24 1 89 29 62 97 1 79 999 826 61 144 2 11 659 215 1 319 199 1 152 739 11 865 453 25 1 74 157 2 2 48 3 76 637 58 198 257 31 1 6 877 1 851 29 1 133 77 11 984 16 26 997 812 1 95 451 2 93 263 534 185 24 32 9 176 493 1 867 522 1 295 418 12 13 953 27 548 524 1 295 27 1 843 551 291 125 151 17 11 35 178 1 886 47 1 338 578 12 224 984 28 684 122 1 412 534 2 96 655 36 135 17 28 7 535 174 1 9 584 1 446 649 12 347 233 29 61 142 1 78 13 1 688 272 318 12 135 19 8 716 376 1 919 591 1 551 272 12 47 862 21 1 348 217 1 983 944 3 332 161 695 186 265 29 11 577 785 1 938 786 1 656 786 12 595 418 211 1 651 849 2 44 899 3 696 748 843 19 291 25.8 11 82 979 1 958 394 1 762 979 12 721 372 Source: T5 returns. Figure 4.3.2.3a. ARI Outpatients cases 24-211 Figure 4.3.2.3b. ARI Incidence Rate, 24-211 9 8 7 6 5 4 3 2 1 24 25 26 27 28 29 21 211 Year Number of New Cases ARI Incidence Rate per 1 population 25 2 15 1 5 24 25 25 27 28 29 21 211 Year Under 5 yrs Five yrs+ Under 5 yrs Five yrs + All Ages 55

Table 4.3.2.4. ARI Inpatient Cases, Deaths and Case Fatality Rate (CFR) by Age and Province/Hospital, 211 Province ARI (Upper Tract) ARI (Lower Tract) Deaths CFR Cases CFR Cases Deaths < 5 yrs 5 yrs + All Ages < 5 yrs 5 yrs + All Ages % < 5 yrs 5 yrs + All Ages < 5 yrs 5 yrs + All Ages % Manicaland 12 172 274 74 62 136 24 36 6 4 Mashonaland Central 495 184 679 27 7 34 5 112 122 2124 95 136 231 11 Mashonaland East 26 21 461 16 1 26 6 1581 1422 33 13 176 36 1 Mashonaland West 34 88 392 32 9 41 1 888 719 167 94 125 219 14 Matabeleland North 234 127 361 13 3 16 4 519 597 1116 51 99 15 13 Matabeleland South - - Midlands 144 191 335 3 7 1 3 2134 2171 435 63 158 221 5 Masvingo 2 5 7 143 165 38 6 19 25 8 Harare - - Bulawayo - - Total 1 541 968 2 59 91 36 127 5 7 17 6 716 13 823 463 749 1 212 9 Source : T9 Forms 56

Table 4.3.3.1. Malaria Cases: Suspected, Tested, Positive and Positivity Rate by Province, 211 Province / City Suspected/Clinical Cases Tested Cases Positive Cases Positivity Rate Manicaland 429 659 174 847 127 683 73. Mashonaland Central 113 47 55 125 48 318 87.6 Mashonaland East 236 188 17 698 61 827 57.4 Mashonaland West 121 677 53 852 27 866 51.7 Matabeleland North 64 694 22 612 7 44 31.2 Matabeleland South 16 412 6 884 1 799 26.1 Midlands 48 45 19 453 3 693 19. Masvingo 1 531 39 312 37 843 96.3 Harare City 13 848 6 123 3 384 55.3 Chitungwiza 3 796 923 351 38. Bulawayo City 774 124 15 84.7 National 1 149 391 486 953 319 913 Less than 5% of all suspected malaria cases were tested due to the non/irregular availability of test kits and slide microscopy 57

Table 4.3.3.2. Confirmed Malaria New Cases by Province and Age Group, 211 PROVINCE / CITY New Cases Incidence New Cases Incidence New Cases Incidence Under 5 yrs Rate/1 5yrs and Above Rate/1 All Ages Rate/1 Manicaland 24 992 92.4 12 691 71. 127 683 74.4 Mash Central 7 82 41.3 41 236 44.9 48 318 44.4 Mash East 8 122 39.8 53 75 46.6 61 827 45.5 Mash West 3 636 18. 24 23 21.3 27 866 2.8 Mat North 677 5.1 6 367 1. 7 44 9.1 Mat South 2.2 1 779 2.9 1 799 2.5 Midlands 417 1.7 3 276 2.4 3 693 2.3 Masvingo 4 82 18.3 33 761 27.6 37 843 26.2 Harare City 427 1.8 2 957 2.2 3 384 2.1 Chitungwiza 91 1.8 26.9 351 1. Byo. City 1.1 95.1 15.1 National 49 556 25.3 27 357 25.1 319 913 25.1 source - OPD returns excluding the Central Hospitals Figure 4.3.3.2a. Confirmed Malaria Incidence Rate, All Ages Incidence Rate Per 1 8. 7. 6. 5. 4. 8. 2. 1.. Manicaland Mashonaland Central Mashonaland East Mashonaland West Matebeleland North Matebeleland South Midlands Masvingo Harare Totals Chitungwiza Totals Bulawayo Totals Figure 4.3.3.2b. Confirmed Malaria Incidence Rate by Age Group 25.35 25.3 25.25 Incidence Rate Per 1 25.2 25.15 25.1 25.5 25 Under 5 years 5 years and Above Age Group 58

Table 4.3.3.3a. Confirmed Malaria Cases and Rainfall by Year Year Malaria Cases Rainfall 2 1 533 96 13 68 21 1 564 342 11 424 22 1 348 137 5 616 23 1 547 177 8 64 24 1 83 181 8 4 25 1 484 91 5 76 26 1 585 723 5 64 27 1 25 555 5 832 28 1 18 43 6 263 29 146 664 7 48 21 268 559 7 784 211 319 913 7 914 Cases (Thousands) 2 14 18 12 16 14 1 12 8 1 8 6 6 4 4 2 2 2 21 22 23 24 25 Malaria 26 Year 27 28 29 21 Rainfall 211 Rainfall NB-Data from 29 and onwards include confirmed cases only while for 28 and backwards included suspected and confirmed cases Malaria incidence peaks in March, the themed-rainy season when tall grasses, puddles of water, high temperatures and other environmental conditions promote mosquito breeding; then it falls to its lowest in the dry months of August and September. Table 4.3.3.3b. Monthly Trends of Confirmed Malaria Cases, 211 Month All Cases Positive Cases January 95 762 37 485 February 13 112 42 962 March 186 915 79 123 April 161 775 62 84 May 14 881 37 483 June 69 43 19 622 July 48 35 8 937 August 3 618 3 692 September 32 546 4 523 October 49 74 7 76 November 51 46 8 29 December 42 48 7 961 National 1 2 89 319 913 Cases (Thousands) 9 8 7 6 5 4 3 2 1 JAN FEB MAR APR MAY JUN Months JUL AUG SEP OCT NOV DEC 59

Table 4.3.3.4. Malaria Inpatient Cases and Deaths by Province, 211 A B C D E PROV/CITY MALARIA MALARIA MALARIA HOSPITAL MALARIA Hospitalisation AS % OF ALL IP CASES IP DEATHS HCFR HGCFR DEATHS Rate/1 pop MANICALAND 2 956 46 1.56 3.65 7.96 7.7 MASH CTRAL 1 113 49 4.4 6.39 2.74 9.1 MASH EAST 2 188 113 5.16 7.24 4.55 11.5 MASH WEST 1 478 185 12.52 12.59 5.37 15.4 MAT NORTH 1 895 24 1.27 5.97 2.78 38. MAT SOUTH.... MIDLANDS 229 12 5.24 4.55.79 7. MASVINGO 144 22 15.28 7.58 4.57 1.5 HRE CITY 1. 19.27..1 NATIONAL 1 4 451 4.51 7. 4.2 9.98 HCFR - Hospital Crude Fatality Ratio expressed as deaths per 1 patients discharged with the condition HGCFR -Hospital General Crude Fatality Ratio for all conditions The very high CFR for malaria for Masvingo and Mashonaland West will need further investigation to look at the factors influencing it. Figure 4.3.3.4a. Hospital Crude Fatality Ratio 25 H.C.F.R as a percentage 25 25 25 25 25 MAN MAC MAE MAW MATN MAN MID MASV MAN NAT Province / National Figure 4.3.3.4b. Provincial Hospitalization Rate 4 35 3 Percent 25 2 15 1 5 MAN MAC MAE MAW MATN MATS MID MASV HRE NAT Province / National 6

Table 4.3.3.5 Malaria Top 2 Districts, 211 Ranking District Incidence/1 1 Nyanga 22.7 2 Mudzi 173.55 3 Mutasa 164. 4 Mutoko 163.56 5 Chimanimani 11.9 6 Chiredzi 85.42 7 Mt Darwin 73.75 8 Chipinge 6.55 9 UMP 59.6 1 Mutare 57.39 11 Guruve 57.18 12 Rushinga 55.95 13 Hurungwe 52.72 14 Shamva 48.59 15 Bikita 38.5 16 Kariba 35.55 17 Bindura 33.91 18 Makoni 25.4 19 Centenary 24.93 2 Binga 22.79 Figure 4.3.3.5a. Malaria Incidence Rate/1 Population, Top 2 Districts, 211 25 2 Cases 15 1 5 Nyanga Mudzi Mutasa Mutoko Chimanimani Chiredzi Mount Darwin Chipinge UMP Mutare Guruve Rushinga Hurungwe Shamva Bikita Kariba Bindura Makoni Centenary Binga District 61

Figure 4.3.3.5b. Malaria Incidence Rates/1 Population, Top 2 Districts, 211 Hurungwe Guruve Centenary Mt Darwin Rushinga Kariba Mudzi Uzumba Maramba Pfungwe Bindura Mutoko Binga Nyanga Makoni Mutasa Mutare Rural Chimanimani Bikita Chipinge Chiredzi Malaria Incidence 211 Less than 5 5-99 1-149 15 and more 62

Table 4.3.4.1. National Diarrhoea and Dysentery Cases and Incidence Rates by Province, 211 Diarrhoea Dysentery Province/City Cases Incidence Incidence Cases Incidence Incidence per 1 District Range per 1 District Range Manicaland 16 544 73.7 45.8-73.7 9 374 6.5 3.1-1.3 Mashonaland Central 8 27 87.5 46.8-94.4 9 548 1.4 7.4-11.4 Mashonaland East 87 65 76. 23.9-112.9 5 843 5.1 2.1-12.1 Mashonaland West 82 813 72.8 38.3-96.8 7 164 6.3 4.2-15.5 Matebeleland North 47 853 75. 45.3-88.4 5 462 8.6 4. - 13.2 Matebeleland South 28 392 47.1 21.4-66.3 1 452 2.4 1. - 2.9 Midlands 86 929 64.4 44.1-77.7 6 54 4.8 2.3-6.5 Masvingo 14 526 85.6 38.8-97.9 9 621 7.9 2.4-12.8 Harare 46 397 34.8 2 123 1.9 Chitungwiza 19652 64.9 389 1.3 Bulawayo 1 156 16. 674 1.1 Total 71 182 65.1 58 154 5.4 Figure 4.3.4.1. National Diarrhoea and Dysentery Cases and Incidence Rates by Province, 211 1. 9. 8. 7. 6. 5. 4. 3. 2. 1.. Manicaland Mash. Central Mash. East Mash. West Mat. North Mat. South Midlands Masvingo Harare Chitungwiza Bulawayo Diarrhoea Incidence Rate Dysentery Incidence Rate Source: T5 Returns 63

Table 4.3.4.2. Monthly Trends of Diarrhoea and Dysentery, 211 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Diarrhoea 52 225 5 51 45 433 39 274 4 449 61 24 69 827 54 228 58 98 71 22 87 13 72 88 Dysentery 5 595 4 49 3 565 3 126 3 291 4 332 4 51 3 846 4 498 5 921 8 43 7 9 Figure 4.3.4.2. Monthly Trends of Diarrhoea and Dysentery, 211 1 9 8 7 Thousands 6 5 4 3 2 1 Diarrhoea Dysentery Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Source: T5 Returns Table 4.3.4.3. National Diarrhoea and Dysentery Cases, 25-211 25 26 27 28 29 21 211 Diarrhoea 564 59 517 72 531 415 485 272 36 574 442 845 71 182 Dysentery 75 868 66 448 61 19 42 626 22 88 36 121 58 154 Figure 4.3.4.3. National Diarrhoea and Dysentery Cases, 25-211 8 7 6 5 4 3 2 1 25 26 27 28 29 21 211 Diarrhoea Dysentery Source: T5 Returns 64

Table 4.3.4.4. Diarrhoea and Dysentery Incidence Rates by District, All Ages, 211 Province District Diarrhoea Cases Diarrhoea Incidence Dysentery Cases Dysentery Incidence Rate Per 1 Rate Per 1 Buhera 14 664 6.9 1 55 6.4 Chimanimani 9 294 73.7 1 299 1.3 Chipinge 21 779 7.2 2 237 7.2 Manicaland Makoni 12 417 45.8 1 25 3.8 Mutare 26 69 61.9 1 754 4.1 Mutasa 13 74 65.4 1 18 5.3 Nyanga 8 77 63. 41 3.1 Bindura 11 11 71.4 1 215 7.8 Centenary 6 946 58.9 1 4 8.5 Guruve 19 128 94.4 2 318 11.4 Mashonaland Central Mazowe 17 712 83.1 1 446 6.8 Mt. Darwin 1 243 46.8 1 622 7.4 Rushinga 6 522 88.8 837 11.4 Shamva 8 618 8.4 1 16 1.3 Chikomba 8 189 62.3 383 2.9 Goromonzi 1 818 55.6 51 2.6 Marondera 4 37 23.9 363 2.1 Mudzi 12 688 9.5 565 4. Mashonaland East Murewa 9 217 52. 881 5. Mutoko 14 88 97.4 83 5.7 Seke 8 34 38.5 73 3.4 U.M.P 12 88 112.9 673 5.9 Wedza 7 699 99.6 935 12.1 Chegutu 14 457 58.7 1 7 4.3 Hurungwe 13 1 38.3 1 44 4.2 Mashonaland West Kadoma 18 713 72.4 1 126 4.4 Kariba 6 224 96.8 995 15.5 Makonde 13 871 73.2 1 33 6.9 Zvimba 16 547 68.5 1 23 5.1 Binga 9 17 69.4 1 728 13.2 Bubi 2 872 54.9 414 7.9 Matabeleland North Hwange 12 8 88.4 1 75 7.4 Lupane 4 884 45.3 661 6.1 Nkayi 5 632 45.9 617 5. Tsholotsho 7 343 56.1 643 4.9 Umguza 5 215 64.4 324 4. Beitbridge 6 473 57.1 115 1. Bulilima 4 247 41.2 36 3. Gwanda 5 671 66.3 166 1.9 Matabeleland South Insiza 3 44 21.4 298 2.1 Mangwe 2 925 31.2 152 1.6 Matobo 3 725 34.2 314 2.9 Umzingwane 2 37 34.3 11 1.5 Chirumanzu 4 54 58.5 288 3.7 Gokwe North 11 463 48.9 1 11 4.7 Gokwe South 14 164 44.1 1 126 3.5 Midlands Gweru 18 969 77. 573 2.3 Kwekwe 14 237 45.6 1 236 4. Mberengwa 8 95 44.6 1 33 6.5 Shurugwi 5 877 6.8 276 2.9 Zvishavane 8 765 77.7 61 5.3 Bikita 16 87 97.9 2 22 12.8 Chiredzi 23 68 9.1 1 163 4.5 Masvingo Chivi 6 68 38.8 1 115 6.6 Gutu 15 926 73.3 521 2.4 Masvingo 19 96 69.1 1 844 6.4 Mwenezi 1 437 75.6 1 2 7.3 Harare City 11 72 57.9 1 774 8.8 Chitungwiza City 46 397 41.4 2 123 1.6 Bulawayo City 19 652 55.6 389 1.1 National 71 182 55.1 58 154 4.6 65

Figure 4.3.4.4a. Top Ten Diarrhoea Incidence Rate (per 1) by District, All Ages, 211 12. 112.9 Incidence Rate/ 1 Population 1. 8. 6. 4. 2. 99.6 97.9 97.4 96.8 94.4 9.5 9.1 88.8 88.4. U.M.P Wedza Bikita Mutoko Kariba District Guruve Mudzi Chiredzi Rushinga Hwange Figure 4.3.4.4b. Top Ten Dysentery Incidence Rate (per 1) by District, All Ages, 211 Incidence Rate per 1 Population 18. 18. 18. 18. 18. 18. 18. 18. 18. 18. 15.5 Kariba 13.2 12.8 Binga Bikita 12.1 Wedza 11.4 11.4 1.3 1.3 Guruve Rushinga Shamva Chimanimani Zaka 8.8 8.5 Centenary District 66

Table 4.3.5.1. Leprosy Cases by Province, 211 Province/ City Cases Manicaland 8 Mashonaland Central 16 Mashonaland East Mashonaland West 2 Matebelwland North 2 Matebeleland South 1 Midlands Masvingo Harare 3 Bulawayo 98 Total 13 Table 4.3.5.2. National Leprosy New Cases, 23-211 Year Cases 23 76 24 381 25 564 26 43 27 38 28 2 342 29 185 21 13 211 136 Source:T5Returns Figure 4.3.5.2. Leprosy New Cases, 23-211 25 2 Cases 15 1 5 23 24 25 26 27 28 29 21 211 Year 67

Table 4.3.6.1. Schistosomiasis Cases by Age Group and Province/City, 211 Under 5 Years Population 5 Years and Above Population 5 Years and Above Cases All Ages Under 5 Total Incidence Province Years Population per 1 Manicaland 2 5137 1 36 1 445 46 19 921 1 715 916 21 227 12 Mashonaland Central 171 33 2 329 917 381 19 11 1 88 684 21 43 2 Mashonaland East 24 177 757 1 153 61 16 235 1 357 788 16 992 13 Mashonaland West 21 746 834 1 137 657 14 486 1 339 44 15 32 11 Matabeleland North 133 45 117 637 947 2 133 77 992 2 25 3 Matebeleland South 111 69 12 63 167 2 751 714 236 2 871 4 Midlands 251 998 584 1 349 15 13 838 1 61 148 14 422 9 Masvingo 222 654 1 697 1 221 49 29 425 1 444 144 31 122 22 Harare 237 726 3 1 357 75 217 1 595 476 247 Chitungwiza 5 557 112 32 988 36 353 545 472 1 Bulawayo 13 66 26 636 436 1 584 74 42 1 844 2 National 1 958 394 8 146 1 762 979 12 51 12 721 372 128 197 1 National Incidence per 1 4. 11. 1. Figure 4.3.6.1a.Schistosomiasis Incidence Rates by Province/City, 211 Incidence rate per 1 25 2 15 1 5 Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare Chitungwiza Bulawayo Province/City Figure 4.3.6.1b. Schistosomiasis Incidence Rates by Age Group 12 Incidence rate per 1 1 1 1 1 1 1 Under 5 Years 5 Years and Above All Ages Age Group 68

Table 4.3.6.2. Schistosomiasis (Bilharziasis) Outpatient Cases by Year and Age Group 25-211 OPD New Cases 5 Years and Above All ages Under 5yrs Incidence Rate/1 5 Years and Above All ages Rainfall Oct- Apr/mm Years Under 5yrs 25 5 959 145 184 151 143 3.2 14.7 12.6 5 76 26 4 169 16 445 11 614 2.2 11.8 9.1 5 64 27 6 233 139 979 146 212 3 16. 12. 5 832 28 4 189 95 627 99 816 2 1. 8. 6 263 29 3 996 96 878 1 874 2.1 9.4 8.1 7 343 21 62 444 67 836 26 56 5.2 6. 21 7 784 211 8 146 12 51 128 197 4.2 11.2 1.1 7 914 Figure 4.3.6.2. Schistosomiasis (Bilharziasis) Outpatient Incidence Rates by Year, 24-211 16 14 12 1 18 16 14 12 Incidence Rate / 1 24 25 26 27 28 29 21 211 Under 5 yrs 5 yrs and Above All ages The incidence is high in the active group of 5yrs and above as they get more contact with water when swimming in rivers and fetching water for household and gardening activities. 69

Table 4.3.6.3. Schistosomiasis Incidence Rates and Rainfall Trends, 21-211 Year OPD New cases Incidence Rate/1 Rainfall(mm) (Oct-Apr) 21 84 378 6 11 424 22 16 565 5 5 616 23 115 869 1 8 64 24 136 268 1 8 4 25 151 143 13 5 76 26 11 614 9 5 64 27 146 212 12 5 832 28 99 816 11 6 263 29 7 756 8 7 343 21 11 95 6 7 784 211 128 197 1 7 914 Figure 4.3.6.3. National Schistosomiasis Cases and Rainfall Figures, 21-211 Schistosomiasis Cases - All Ages in Thousands 16 14 12 1 8 6 4 2 21 22 23 24 25 26 27 28 29 21 211 12 1 8 6 4 2 Years OPD New Cases (All Ages) Rainfall (mm), (Oct-Apr) 7

Table 4.3.6.4. Schistosomiasis New Cases by Month, 211 Month January February March April May June July August September October November December Total Out Patient 8 594 11 983 12 184 9 6 1 588 12 332 1 496 9 84 11 263 12 392 11 413 7 512 128 197 Figure 4.3.6.4. Schistosomiasis New Cases by Month, 211 14 12 1 8 6 4 Number of new cases in Thousands 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Months 71

Table 4.3.7.1. Injuries by Age Group and Province/ City, 211 Manicaland Mashonaland Central Mashonaland East -4 Yrs 5+ Yrs -4 Yrs 5+ Yrs -4 Yrs 5+ Yrs N % n % n % n % n % n % Burns & Scalds 4 149 27.8 3 964 5.9 2 667 26.4 2 621 5.8 2 826 26.1 2 911 6.3 All Other Injuries 1 412 69.7 58 372 87.4 6 993 69.2 39 83 86. 4 7 683 71. 39 616 85.2 Road Traffic Accidents 372 2.5 4 448 6.7 443 4.4 3 57 7.8 319. 3 971 8.5 Total 14 933 1 66 784 1 1 13 1 45 211 1 1 828 97. 8 46 498 1 Mashonaland West Matabeleland North Matabeleland South -4 Yrs 5+ Yrs -4 Yrs 5+ Yrs -4 Yrs 5+ Yrs N % n % n % n % n % n % Burns & Scalds 2 762 3.1 2 861 6.2 1 368 3.5 1 47 5.8 1 126 28.1 1 323 5.7 All Other Injuries 5 997 65.2 38 93 82.7 3 2 67.2 22188 87. 5 2 749 68.7 2 418 87.2 Road Traffic Accidents 432 4.7 5 134 11.1 14 2.3 1 71 6.7 127. 1 672 7.1 Total 9 191 1 46 88 1 4 492 1 25 368 1 4 2 96.8 6 23 413 1 Midlands Masvingo Harare Under 5Yrs 5Yrs+ Under 5Yrs 5Yrs+ Under 5Yrs 5Yr+ N % n % n % n % n % n % Burns & Scalds 2 772 28.9 2 731 5.7 3 113 27.2 3 51 6.4 6 156 29.7 4 749 8.8 All Other Injuries 6 48 67.6 41 15 86. 8 19 7.1 46 839 86. 1 14 99 67.9 43519 8.7 Road Traffic Accidents 332 3.5 3 971 8.3 31 2.6 4 68 7.5 52. 5 674 1.5 Total 9 584 1 47 717 1 11 433 1 54 48 1 2 757 97.6 1 53 942 1 Province National Chitungwiza Bulawayo Under 5Yrs 5Yrs+ Under 5Yrs 5Yrs+ Under 5Yrs 5Yr+ N % N % n % Burns & Scalds 532 22.7 667 14.5 968 22.1 794 7.4 28 439 27.9 27 592 6.5 All Other Injuries 1 553 66.2 3 188 69.2 3 343 76.3 9 313 86.3 7348 68.9 361 644 85.1 Road Traffic Accidents 26 11.1 753 16.3 72 1.6 685 6.3 3 264. 35 593 8.4 Total 1. 1. 1. 1 1. 12 424 1. 2 345 4 68 4 383 792 51 96.8 829 72

Figure 4.3.7.1. Injuries by Age Group Thousands 45 4 35 3 25 2 15 18 26 36 42 36 <5 Yrs 5 Yrs+ 1 5 3 Burns and Scalds Road Traffic Accidents All other Injuries 73

Table 4.3.7.2. Common Causes of Injury Cases and Deaths Among Inpatients by Age and Province/City/Hospital, 211 Province Manicaland Mashonaland Central Mashonaland East INJURY TYPE < Yrs 5 Yrs + All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths Fractures 6 438 444 3 Intracranial/internal injuries 6 41 416 7 Open wounds & other injuries. 8 292 3 4 Burns 26 112 138 7 Poisoning & Toxic Effects 1 98 99 Complications of injuries.& poisoning 3 199 22 3 Total injuries 5 1549 1599 24 Province Mashonaland West Matabeleland North Matabeleland South INJURY TYPE < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths Fractures 4 229 233 9 1 1979 1989 1 intracranial/internal injuries 3 287 29 9 2 141 143 4 Open wounds & other inj. 5 174 179 4 7 591 598 1 Burns 14 7 84 3 46 11 147 3 Poisoning & Toxic Effects 5 5 2 82 84 3 Complications of injuries.& poisoning 6 239 245 1 12 39 51 2 Total injuries 32 1 4 1 36 35 79 2 933 3 12 14 Province Midlands Masvingo City Of Harare INJURY TYPE < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths Fractures 11 615 626 8 intracranial/internal injuries 5 385 39 11 Open wounds & other inj. 7 484 491 9 Burns 21 13 151 22 Poisoning & Toxic Effects 14 14 3 Complications of injuries.& poisoning 38 38 1 Total injuries 44 1 666 1 71 54 Province Harare Bulawayo National INJURY TYPE < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths < Yrs 5 Yrs+ All Ages Deaths CFR CFractures - - - - - - - - 15 844 859 17 2. intracranial/internal injuries - - - - - - - - 8 672 68 2 2.9 Open wounds & other inj. - - - - - - - - 12 658 67 13 1.9 Burns - - - - - - - - 35 2 235 25 1.6 Poisoning & Toxic Effects - - - - - - - - 19 19 3 15.8 Complications of injuries.& poisoning - - - - - - - - 6 277 283 11 3.9 Total injuries - - - - - - - - 76 2 67 2 746 89 3.2 1.CFR = Number of deaths due to a specific cause X 1/Total number of cases of that specific cause 2.CFR Represents Hospital based Case Fatality Rate Only. 3.T9 By Age not available. 4.##:-Data Not Submitted in Breakdown 5. - No Submission 6. - 74

Table 4.4.1. Life Expectancy at Birth by Year and Sex Year 1986 1988 199 1995 28 Male 61 61 58 52.6 4.8 Female 61 63 62 57.2 46.2 Average 61 62 61 55 43.5 Source: CSO Zimbabwe 1992 National Census Report CSO; Zimbabwe 1992 National Census Report CSO; 28 Inter-Censal Demographic Survey(ICDS); The decrease in life expectancy is largely attributed to the HIV pandemic. Figure 4.4.1. Life Expectancy at Birth by Year and Sex Life Expectancy at Birth 7 6 5 4 3 2 1 1986 1988 Male 199 1995 28 Female 75

Table 4.4.2 Infant Mortality Rates by Year Year 1988 199 1994 1995 *1999 *25/6 28 29 21/11 Infant Mortality Rate ( IMR) 61 66 53 8 65 6 63.5 6 57 Source: Zimbabwe National Statistics Agency * Zimbabwe Demographic and Health Survey 1999 25/6, 21/11 Multiple Indicator Monitoring Survey Figure 4.4.2 Infant Mortality Rates by Year Cases 9 8 7 6 5 4 3 2 1 1988 199 1994 1995 1999 25 28 29 21 Year 76

Table 4.4.3. Hospital Based Institutional Perinatal Deaths, 211 SOURCE: T5 T9 routine forms ENM Rate Perinatal PM Rate T9 Perinatal Year Live Births SB SB Rate END T9 Perinatal In as % of Institution Deaths x 1 Deaths HIMR 23 26 832 3 83 14.5 2 871 1.9 6 71 25.3 59 2.3 24 27 463 5 299 19.2 2 82 1.1 5 869 23.2 63 2.8 25 252 747 7 764 29.8 4 665 18.1 12 429 47.7 79 3.7 26 248 359 4 899 19.3 3 392 13.5 8 291 32.7 83 3.9 27 264 987 4 364 16.2 4 365 1.1 9 678 35.9 19 4.6 28 279 846 5 261 18.5 4 532 15.9 9 238 38.4 95 4.2 29 18 332 3 649 32.6 1 192 1.9 318 2.8 6 867 21 135 978 3 84 22.2 2 478 17.9 372 2.7 7 647 211 32 939 7 145 21.8 5 339 16.4 12 484 39.4 Table 4.4.4. Institutional Mortality by Age Group and Year, 211 Source:T9 HS3/5 and Central Hospitals Annual Reports Key: H-IMR = Hospital Based Infant Mortality Rate Under 5 y MR = Under five Mortality Rate H-CrudeMR = Hospital based Crude Mortality Rate Under 5 y MR x 1 T9 Deaths All Ages HS3/HS5 Deaths All Ages Year Deaths Under 1 y Live Births H-IMR x 1 Deaths 1-4 y 23 2 597 26 832 1. 2 74 17.9 15 51 32 178 3.8 24 2 479 24 519 1.3 1 965 18.5 17 686 2 531 3.2 25 1 487 878 634 1.7 1 677 3.6 16 25 42 228 3.7 26 1 572 241 61 6.5 1 562 13. 16 92 25 63 3.9 27 1 346 264 987 5.1 968 8.7 15 639 28 796 4.1 28 1 268 279 846 4.5 897 7.7 12 678 26 987 3.8 29 886 154173 5.7 1234 13.8 6867 764 21 111 168914 6.6 596 1.1 7647 215 Table 5.1.1. Health Facilities in Zimbabwe, 211 Provinces Primary Level First Referral Level Second Referral Level KEY 1. Primary Level = Clinics and rural health centres 2. First Referral Level = District mission and rural hospitals 3. Second Referral Level = Provincial hospitals = Central hospitals and infectious diseases 4. Third Referral Level H-CrudeMR x 1 Third Referral Level Harare 47 7 54 Manicaland 251 36 1 288 Mashonaland Central 132 13 1 146 Mashonaland East 17 22 1 193 Mashonaland West 128 22 1 151 Matabeleland North 93 17 11 Matabeleland South 15 18 1 124 Midlands 27 28 1 236 Masvingo 172 23 1 196 Bulawayo 34 7 41 TOTAL 1 339 179 7 14 1 539 Total 77

5.1.2. Rural Hospitals and Clinics/Rural Health Centres by Ownership and Provinces / Major Cities, 211 1. RURAL HOSPITALS Province Total Govt/Public Sector Rural Councils Municipality ZRP/Army Mission Private Manicaland 11 11 Mashonaland Central 2 2 Mashonaland East 5 5 Mashonaland West 7 7 Matabeleland North 2 2 Matabeleland South 5 5 Midlands 4 4 Masvingo 5 5 Harare City Chitungwiza City Bulawayo City Total 41 41 2. CLINICS/RURAL HEALTH CENTRES Province Govt/Public Sector Rural Councils Municipality ZRP/Army Mission Private Total Manicaland 82 132 12 4 31 3 288 Mashonaland Central 61 63 3 3 6 1 146 Mashonaland East 76 84 5 3 16 9 193 Mashonaland West 52 63 12 5 7 12 151 Matabeleland North 54 28 2 1 12 13 97 Matabeleland South 57 36 2 4 7 4 11 Midlands 81 73 22 4 2 23 223 Masvingo 85 63 4 2 26 16 196 Harare City 1 39 3 52 Chitungwiza City 1 5 1 1 8 Bulawayo City 3 2 18 41 Total 562 542 126 27 125 139 1 464 SOURCE: Provincial Health Profiles and City Health Department data 78

5.1.3. Provincial Health Institution Distribution by Referral Level, 211 Manicaland Mash Central Mash East Mash West Cities Facilities Beds Facilities Beds Facilities Beds Facilities Beds Facilities Primary Level Clinic/RHC 251 1 327 132 45 17 453 128 645 Rural Hospitals 11 645 2 56 5 195 7 351 TOTAL 262 1 972 134 56 175 648 135 996 Secondary Level District Hospitals 8 7 8 535 9 594 7 636 Other Referral hospitals 11 356 4 447 5 57 6 722 (District and other) TOTAL 19 1 56 12 982 14 1164 13 1358 Tertiary Level (Provincial and General) Provincial Hospitals 1 21 1 12 1 1 164 1 443 General Hospitals 1 285 3 TOTAL 2 495 1 12 1 1 164 1 443 3 Specialised Hospitals Quartenary Hospitals Central Hospitals 5 GRANT TOTAL 42 3 238 133 168 174 2976 157 2797 8 1 88 Mid Year Population 1 715 916 684 1 357 788 1 339 44 Area/sqkm 36 459 25 346 32 23 57 441 DENSITY/CLINIC 47 1 9 237 127 POP/CLINIC 6 836 9 149 9 237 1 546 POP/SECONDARY LEVEL FACILITIES 285 986 155 526 226 298 223 234 POP/SECONDARY LEVEL BEDS 4 268 8 186 7 759 8 531 POP/TOTAL BEDS 53 677 648 479 Beds 757 757 4 173 493 Mat North Mat South Midlands Masvingo Total Facilities Beds Facilities Beds Facilities Beds Facilities Beds Facilities Beds Primary Level Clinic/RHc 93 466 97 21 172 73 1 462 4 71 Rural Hospitals 4 26 12 332 21 213 23 447 TOTAL 97 726 19 332 222 213 195 1177 1 462 4 71 Secondary Level District Hospitals 7 667 7 516 9 594 7 75 45 4 947 Other Referral hospitals 7 628 11 1 354 7 1 34 73 6 641 (District and other) 2 69 1 739 121 12 3 TOTAL 7 667 14 1144 2 4638 14 3478 239 23888 Tertiary Level (Provincial and General) Provincial Hospitals 1 178 1 466 1 15 686 General Hospitals 7 18 267 TOTAL 1 178 1 466 1 15 686 7 18 267 Specialised Hospitals Quartenary Level Central Hospitals GRANT TOTAL Mid Year Population 77 992 714 236 1 61 148 1 444 144 Area/sqkm 75 25 54 173 5 523 56 566 DENSITY/CLINIC 1 13 32 26 POP/CLINIC 3 121 5 176 8 995 8 752 POP/SECONDARY LEVEL FACILITIES 64 249 12 34 145 559 26 36 POP/SECONDARY LEVEL BEDS 2 64 4 329 7 148 7 114 POP/TOTAL BEDS 151 258 31 71 SOURCE: Provincial Health Profiles 79

Table 5.1.4. Government and Mission Hospitals by District, 211 Province District Government Hospital Mission Manicaland Buhera 1 Chimanimani 1 1 Chipinge 1 3 Makoni 1 2 Mutare 1 2 Mutasa 1 4 Nyanga 1 4 Mashonaland Central Bindura Centenary 1 Guruve 1 Mazowe 1 Mt Darwin 1 Rushinga 1 1 Shamva 1 Mashonaland East Chikomba 1 Goromonzi 1 UMP 1 Hwedza 1 Marondera Mudzi 1 Murewa 1 2 Mutoko 1 Seke 1 Mashonaland West Chegutu 1 Hurungwe 1 Kariba Makonde 1 Mhondoro Sanyathi 1 Zvimba 1 Matabeleland North Binga 1 Bubi 1 Hwange 1 Lupane Nkayi 1 Tsholotsho 1 Umguza 8

Table 5.1.4. Government and Mission Hospitals by District, 211 Province District Government Hospital Mission Matabeleland South Beit Bridge 1 Bulilimamangwe 1 2 Gwanda Insiza 1 Matobo 1 2 Umzingwane 1 Midlands Chirumhanzi 1 3 Gokwe North 1 2 Gokwe South 1 1 Gweru 1 1 Zvishavane 1 Kwekwe 1 1 Mberengwa 1 2 Shurugwi 1 Masvingo Bikita 2 Chiredzi 1 Chivi 1 Gutu 1 Masvingo 1 Mwenezi 1 Zaka 1 SOURCE: Provincial Health Profiles 81

Table 5.2.1. Hospital Beds Distribution by Function, 211 Function Of Manicaland HOSPITAL BED Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland TOTAL South Midlands Masvingo Bulawayo Harare General(G) 1 845 654 1164 1 339 76 949 3 675 1 983 1 622 1 56 15 497 Maternity(M) 444 219 334 31 233 321 1497 463 27 332 4 36 Paediatric 482 212 313 333 242 263 736 453 45 446 3 885 TOTAL 2 771 1 85 1 811 1 982 1 181 1 533 5 98 2 899 2 234 2 338 23 742 Population 1 715 915 1 88 683 1 357 787 1 339 43 77 991 714 235 1 61 147 1 444143 74 42 1 949 21 1 2 721 372 Expected Pregnant women 55 589 35 269 43 987 43 391 24 977 23 138 51 871 46 784 23 974 63 14 412 12-4 yrs population 27 512 171 33 24 177 21 746 133 45 111 68 251 997 222 653 13 65 288 283 1 958 389 5+ yrs Population 1 445 43 917 38 1 153 61 1 137 657 637 946 63167 1 349 15 1 221 49 636 437 1 66 738 1 762 978 5+ Popilation/G+S BED 783 1 43 991 85 94 636 367 616 392 1 65 8 6 PREGANTS/MAT.BEDS 125 161 132 14 17 72 35 11 116 156 1 144-4 POP/ Paeds. Beds 561 88 652 66 55 422 342 492 256 646 5 336 SOURCE: HS3/5 The rate for adult hospital beds of 14 per 1 is below the world average of 3 per 1. 82

5.2.2. Waiting Mother Shelters (WMS) by Province, 211 Satistics Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Waiting Mother's Shelter Buildings 82 1 22 33 29 29 11 59 275 Total Expected Pregnant Women 55 589 35 269 43 987 43 391 24 977 23 138 51 871 46 784 325 6 Area(sp km) 36 459 25 346 32 23 57 441 75 25 54 173 51 992 56 566 389 232 PREGNANTS /WMS 678 353 1 999 1 315 861 798 4 716 793 11 513 SqKm/WMS 445 2 535 1 465 1 741 2 587 1 868 4 727 959 16 325 SOURCE: Provincial Health Profiles and City Health Department data SqKM/WMS refers to Waiting Mother Shelters per Square Killometer 83

Table 5.2.3. Facilities in Health Institutions by Province/City, 211 PROVINCE No. Built BEFORE 198 Manicaland Mashonaland Central Mashonaland East Mashonaland West Matabeleland North Matabeleland South Midlands Masvingo Sub Total CITY Chitungwiza Harare Bulawayo Sub Total Grant Total No. OF WMS No WITH SOLAR or ELECTRICTY COVERAGE WITH SOLAR/ ELECTRICITY (%) No WITH PIPED WATER COVERAGE WITH PIPED WATER (%) No WITH RADIO OR TELEPHONE COVERAGE WITH COMMUNICATION (%) NUMBER FENCED GRANT TOTAL 14 82-77. 256 95.5 223 83.2 245 186 59 1-53.4 78 58.3 78 58.6 79 69 115 22 63 36.2 15 6.3 15 86.2 118 137 93 33 134 85.4 125 31. 131 83.4 129 126 68 29 64 59.3 8 74.1 72 66.7 83 97 43 29 44 39.3 9 8.4 68 6.7 9 72 167 11 27 27. 92 35.9 124 48.4 144 178 115 59 71 56.4 151 83.4 144 79.6 174 764 275 547 39.7 721 52.4 767 55.7 643 1 39 2 4 1. 4 1. 4 1. 4 2 39 31 1. 31 1. 31 1. 31 39 27 27 1. 27 1. 35 1. 17 27 68 62 43.7 62 43.7 7 49.3 142 68 832 55 1 218 4.7 1 566 52.8 1 674 15. 1 57 2 214 The national coverages for safe water, piped water, electricity, communication and fencing are still low 84

Table 5.2.4. Total X-Ray Performance by Level; District, Provincial and Main Hospitals, 211 STATISTICS DISTRICTS MISSIONS GENERALS PROVINCIALS CENTRALS NATIONAL Number Number Number Number Number Number Attendencies 35 198 46 5 7 18 29 829 45 665 198 352 Routine X-Rays 23 531 25 815 4 62 32 62 34 726 139 645 No. of Films 42 561 53 465 7 58 4 55 126 126 38 741 Ultrasound Scan 767 4 575 1 22 3 813 9 812 29 292 C.T. Scans 153 27 1 596 1 937 TOTAL 12 21 13 382 2 33 16 29 217 925 677 967 85

Table 5.2.5. Distribution of Pharmacies by Province/City, 211 Government Private Manicaland 38 2 Mash Central 15 1 Mash East 25 15 Mash West 24 21 Mat North 22 5 Mat South 2 5 Midlands 25 28 Masvingo 21 13 Harare 3 218 Chitungwiza 2 32 Bulawayo 4 5 Total 199 417 Figure 5.2.5. Distribution of Pharmacies by Province/City, 211 25 2 15 1 5 MANICALAND MASH CENTRAL MASH EAST MASH WEST MAT NORTH MAT SOUTH MIDLANDS MASVINGO Harare Chitungwiza Bulawayo Government Private Government facilities exclude primary health care facilities and show all hospitals in the country (mission hospitals inclusive), where there is a pharmacy professional. The City Health Departments are included as one entity for each urban authority. Private Pharmacy distribution is concentrated in the metropolitan provinces with the highest numbers in Harare. In all provinces urban settlements and resort areas have private pharmacies. The dataset includes dispensing medical doctors. 86

5.2.6 Summary of Staff Return 29-211 Category Establishment In post Dec 29 Vacant as of Dec 29 % vacant Dec 29 In post Dec 21 Vacant as of Dec 21 % Vacant Dec 21 In post Dec 211 Vacant as of Dec 211 % Vacant Dec 211 Top Management Team 81 16 65 8 44 37 46 45 36 44 Doctors 1 767 738 1 29 58 916 851 48 1 54 713 4 Nurses Grades 19 356 13 699 5 657 29 17 29 2 327 12 17 22 2 334 12 Environmental Health Department 2 48 1 157 1 323 53 1 433 1 47 42 1 775 75 28 Pharmacy 585 332 253 43 472 113 19 467 118 2 Radiography 466 261 25 44 26 26 56 241 225 48 Physiotherapy 47 368 12 22 377 93 2 378 92 2 Nutrition 1 3 787 243 24 95 125 12 858 172 17 Orthopaedic 49 35 14 29 33 16 33 32 17 35 Oral Health 324 181 143 44 239 85 26 255 69 21 Laboratory 572 317 255 45 417 155 27 433 139 24 Research Officers 46 36 1 22 24 22 48 23 23 5 Health Information 225 145 8 36% 166 59 26 165 6 27 Health Promotion 73 38 35 48 45 28 38 54 19 26 Hospital Equipment 194 85 19 56 15 89 46 112 82 42 Administration General 5934 5879 55 1 4998 936 16 5347 587 1 Program Managers 9 3 6 67 1 8 89 1 8 89 Total 33 661 24 77 9 584 28 27 41 6 251 19 28 262 5 399 16 Comment: There is a notable improvement in the staffing levels in all departments and across all disciplines from 29 to 211. 87

5.3.2. Vote 15. Ministry of Health and Child Welfare Budget, 211 ADMINISTRATION AND GENER AL 211 $ A Employment costs 1,94, B Goods and services 4,298, C Maintenance 161, D Current transfers 1,92, E Acquisition of fixed capital assets 19,155, F Capital transfers 3, 27,54, MEDICAL CARE SERVICES A Employment costs 91,671, B Medical supplies and services 79,4 C Maintenance 5, D Current transfers 52,967, E Programme 16,6 F Hospital and health centres 21,66, G Acquisition of fixed capital assets 3,26, H Capital transfers 8,1, Sub Total 178,884, PREVENTIVE SERVICES A Employment costs 9,98, B Goods and services 1,7, C Medical supplies and services 2, D Maintenance 65, E Current transfers 4,436, F Programmes 2,486, G Acquisition of fixed capital assets 8, H Capital transfers 11, Sub Total 19,642, RESEARCH A Employment costs 5,454, B Goods and services 447, C Maintenance 41, D Current transfers 39, E Programmes 367, F Acquisition of fixed capital assets 2, Sub Total 6,368, GRAND TOTAL 232,398, 89

Table 5.3.3. Ministry of Health and Child Welfare Expenditure by Sector, 211 SECTOR EXPENDITURE Administration and General 16,411,378 Medical Care Services 12,172,452 Preventive Services 1,182,794 Research 3,217,327 Total 149,983,951 Source: Health Expenditure Section (MoHCW) Figure 5.3.3. Ministry of Health and Child Welfare Expenditure by Sector, 211 Preventive Services 7% Research 2% Administration and General 11% Medical Care Services 8% 9

Table 5.3.4. Vote 15. Ministry of Health And Child Welfare, 211 ORIGINAL REVISED UNAUDITED BUDGET BUDGET EXPENDITURE BUDGET ESTIMATE ESTIMATE TO OCTOBER ESTIMATE Amount Amount Amount Amount 21 21 21 211 US$ US$ US$ US$ I. ADMINSTRATION CURRENT EXPENDITURE Employment costs 1,23, 1,23, 1,585,923 1,94, Goods and services 1,755, 1,755, 5,845,12 4,298, Maintenance 1, 1, 198,23 161, Current transfers 952,72 977,72 1,732,982 1,92, CAPITAL EXPENDITURE Acquisition of fixed capital assets 15,829, 15,829, 6,545,15 19,155, Capital transfers 3, 54, 3, 19,866,72 2,191,72 16,411,378 27,54, II. MEDICAL CARE SERVICES CURRENT EXPENDITURE Employment costs 42,32, 57,11, 52,813,55 91,671, Medical supplies and services 2,, 2,, 2,687,572 79,4 Maintenance 1,2, 1,2, 21,18 5, Current transfers 38,13, 38,13, 28,99,818 52,967, Programme 25, 25, 6,82 16,6 Hospital and health centres 28,2, 3,2, 27,342,166 21,66, CAPITAL EXPENDITURE Acquisition of fixed capital assets 5,632, 5,632, 2,566,88 3,26, Capital transfers 4,575, 4,325, 5,771,996 8,1, 122,19, 138,748, 12,172,452 178,884, III. PREVENTIVE SERVICES CURRENT EXPENDITURE Employment costs 4,87, 4,87, 6,319,996 9,98, Goods and services 242, 242, 164,31 1,7, Medical supplies and services 4, 4, 84,19 2, Maintenance 7, 7, 72,68 65, Current transfers 1,641, 1,641, 2,195,813 4,436, Programmes 5,, 5,, 1,346,498 2,486, CAPITAL EXPINDUTIRE Acquisition of fixed capital assets 12, 12, 8, Capital transfer 11, 12,28, 12,28, 1,182,794 19,642, IV. RESEARCH CURRENT EXPINDITURE Employment costs 2,59, 2,59, 3,2,147 5,454, Goods and services 178, 178, 55,615 447, Maintenance 4, 4, 1,562 41, Current transfers 2, 2, 6, 39, Programmes 2, 2, 125,3 367, CAPITAL EXPINDUTIRE 15, 15, Acquisition of fixed capital assets 2,962, 2,962, 3,217,327 6,368, TOTAL 157,127,72 174,181,72 149,983,951 232,398, Source: BUDGETS ESTIMATES for the year ending December 31 211 91

Table 6.1.1. Ante-natal and Post-natal Care by Province/City, 211 ANC & PNC STATISTICS Manicaland Mash. Cent Mash. East Mash. West Mat. North Mat. South Midlands Masvingo Harare Chitungwiza Byo National First ANC visits - Under 16 wks 7 359 4 736 3 158 5 477 2 643 2 21 5 366 8 941 1 678 78 688 42 145-16 - 27 wks 34 248 24 679 2 725 27 74 16 256 13 939 29 331 33 467 16 322 3 88 5 748 226 227-28 wks & over 21 758 17 24 19 978 17 565 8 29 7 623 22 644 15 725 27 247 6 159 9 35 173 543 Total 63 365 46 619 43 861 5 746 27 189 23 583 57 341 58 133 45 247 1 45 15 786 441 915 Repeat ANC visits 141 664 85 446 91 59 97 687 66 525 54 28 98 115 161 915 111 64 27 526 37 799 974 34 ANC referrals 8 51 2 12 4 64 3 671 3 929 3 33 6 958 7 611 9 12 998 4 16 54 651 PNC visits - 1 days 21 318 14 55 17 836 25 346 11 37 11 752 18 14 18 791 4 569 6 362 16 339 166 22 PNC visits - 6 Weeks 19 984 15 99 19 333 22 94 1 654 11 958 18 725 16 51 13 47 3 659 16 25 168 195 T.T. 1st Dose 23 117 18 48 16 436 18 484 11 634 9 942 2 15 23 77 2 879 5 89 4 72 154 638 T.T. 2nd - 5th Doses 36 259 26 94 26 239 32 748 16 159 13 761 29 652 39 3 36 18 6 233 9 416 272 392 HIV test done ANC total 55 335 42 477 41 214 45 12 24 542 21 924 51 898 55 828 44 797 9 989 13 691 46 815 HIV test positive ANC total 4 956 4 24 5 246 5 858 3151 3 954 6 167 5 692 4 882 1 218 2 8 47 372 Vital Drugs 13 75 5 421 9 217 7 491 4 664 16 882 11 636 1 376 16 1 26 147 8 329 Essential Drugs 9 97 4 389 7 774 5 867 3 598 11 191 8 175 7 36 1 127 74 59 139 Necessary Drugs 17 541 6 58 11 455 11 85 5 897 23 12 15 233 15 752 29 1 359 14 18 875 RPR test done Total 42 829 29 758 36 355 32 243 21 328 2 356 36 668 34 85 43 427 8 346 11 478 317 593 RPR test positive total 418 497 529 611 693 659 73 474 19 216 39 5 245 Institutional live births 38 194 26 143 33 163 32 11 18 327 14 732 36 275 41 877 48 311 11 84 2 822 32 939 Live births at home 8 813 7 239 7 623 1 72 3 959 3 244 6 84 4 597 2 57 71 1 76 56 815 Total reported live births 47 7 33 382 4 786 42 713 22 286 17 976 43 79 46 474 5 368 11 785 21 898 377 754 Expected live births 47 874 25 257 32 723 35 762 2 663 17 642 43 551 42 313 33 26 8 945 14 949 322 75 Expected pregnant women 55 589 35 269 43 987 43 391 24 977 23 138 51 871 46 784 51 687 11 453 23 974 412 12 Expected women of child bearing age 424 959 262 277 338 2 322 242 181 12 168 345 394 685 358 24 48 442 9 57 193 817 3142 42 1st ANC COVERAGE (general) vs Exp Preg. Woman (%) 114. 132.2 99.7 117. 18.9 11.9 11.5 124.3 87.5 87.7 65.8 17.2 HIV Prevalence Rate (%) 9. 1. 12.7 13. 12.8 18. 11.9 1.2 1.9 12.2 14.7 11.6 TT 1st dose Cov vs exp. Preg women (%) 41.6 52.2 37.4 42.6 46.6 43. 38.8 5.7 5.6 5.7 17. 37.5 1st PNC COVERAGE vs Expect Live Births (%) 44.5 57.4 54.5 7.9 55. 66.6 41.4 44.4 13.8 71.1 19.3 51.5 2nd PNC COVERAGE vs Live Births (%) 42.5 47.9 47.4 51.7 47.8 66.5 43.5 35.5 25.9 31. 74.2 44.5 1st ANC vs 1st PNC DROP OUT (%) 33.6 31.1 4.7 49.9 41.8 49.8 31.4 32.3 1.1 63.3 13.5 37.6 Only 9.5% of pregnant women had their first ANC visit before 16 weeks this figure is too low and PNC visits are also low the barriers need to be identified. 92

Figure 6.1.1. Antenatal and Postnatal Care by Province, 211 14 14 14 14 14 14 14 14 MANICALAND MASH CENT MASH EAST MASH WEST MAT NORTH MAT SOUTH MIDLANDS MASVINGO HARARE CHITUNGWIZA BYO NATIONAL Province / City 1st ANC Coverage 1st PNC Coverage TTI Coverage Percentage 93

Table 6.1.2. Post-natal Care by Year; 27-211 ANC & PNC STATISTICS 27 28 29 21 211 First ANC visits - Under 16 wks 54 28 1 94 23 54 27 526 42 145-16 - 27 wks 119 528 7 137 11 445 149 79 226 227-28 wks & over 67 662 8 292 88255 122 42 173 543 Total 241 47 16 523 222 24 299 277 441 915 Repeat ANC visits 787 43 51 672 412 318 48 537 974 34 ANC referrals 52 171 2 787 27 219 45 433 54 651 PNC visits 16 818 18 317 334 397 T.T. 1st Dose 168 365 7 88 35 65 267 154 638 T.T. 2nd - 5th Doses 31 733 24 74 141 448 16 758 272 392 HIV test done ANC total - - - 165 742 46 815 HIV test positive ANC total - - - 21 374 47 372 Vital Drugs - - 51 648 59 475 8 329 Essential Drugs - - 35 628 41 92 59 139 Necessary Drugs - - 23 76 29 678 18 875 PAP Smear Tests Done - - 1 81 3 536 2 617 Institutional live births 215 666 23 288 18 332 173 658 32 939 Live births at home 2 18 23 288 45 841 55 473 56 815 Total reported live births 415 684 46 576 154 173 229 131 377 754 Expected births 52 14 51 242 545 117 319 51 322 75 Expected pregnant women 567 174 74 684 578 574 43 58 412 12 Expected women of child bearing age 3 59 881 3 9 479 3 121 384 3 152 599 3 184 125 INDIVIDUAL AVERAGE ANC VISITS.. 2.9 2.4 3.2 1st ANC COVERAGE (%) 42.6 22.1 38.4 74.2 17.2 FIRST ANC EARLY BOOKING <16 WKS (%) 22.5 6.6 1.6 9.2 9.5 ANC REFERRALS (%) 21.6 16.9 12.2 15.2 12.4 TT1 Vaccination cover vs exp preg women (%) 29.7 9.4 15.3 16.2 37.5 TT2+ Vaccination cover vs CBA women (%) 9.9.8 4.5 3.4 8.6 PNC COVERAGE vs Expect. Births %.. 29.5 56.4 13.6 PNC COVERAGE vs Live Births %.. 14.3 78.7 88.5 ANC-PNC DROP OUT (%).. 27.6 39.7 24.3 Source: T5 returns Figure 6.1.2. Post-natal Care by Year; 27-211 12. 1. 8. Percentage 6. 4. 2.. 27 28 29 Year 21 211 ANC PNC TT2 94

Table 6.1.3. Maternity Care by Province/City, 211 DELIVERY CARE Manicaland STATISTICS Mash Cent Institutional Live births < 25g 2 872 2 545 Total Institutional Live births 38 194 26 143 - by trained Live births at home TM 4 328 3 278 - by others 4 485 3 961 Mash East 3 394 33 163 2 333 5 29 Mash West 2 762 32 11 4 315 6 387 Mat North 1 752 18 327 1 574 2 385 Mat South 1 451 14 732 1 87 2 157 Midlands 2 843 36 275 2 947 3 857 Masvingo 2 619 41 877 1 664 2 933 Harare 5 53 48 311 12 1 937 Chitungwiza 1 219 11 84 116 585 Bulawayo National 2 621 29 131 2 822 32 939 299 22 61 777 34 754 Total 8 813 7 239 7 623 1 72 3 959 3 244 6 84 4 597 2 57 71 1 76 56 815 Total live births 47 7 33 382 4 786 42 713 22 286 17 976 43 79 46 474 5 368 Still births - - Fresh 477 259 354 Macerated 372 171 293 Total 849 43 647 Total institutional (live & still) births 39 43 26 573 33 81 32 86 18 643 14 971 37 57 42 637 49 579 Total (live & still) births 47 856 33 812 41 433 43 58 22 62 18 215 43 861 47 234 51 636 Early neonatal deaths 517 35 443 Maternal deaths 138 195 249 Maternal referrals out 4 586 1 494 3 88 432 363 795 481 222 2 849 149 167 316 231 28 838 122 117 239 138 26 1 35 398 384 782 592 181 3 664 42 358 76 56 72 2 21 33 965 1 268 1 251 166 1 23 11 785 21 898 377 754 332 258 59 169 3 397 3 3 748 469 7 145 11 674 21 291 328 84 12 375 22 367 384 899 36 38 2 68 524 5 339 67 1 382 4 144 36 8 Expected births 47 874 25 257 32 723 35 762 2 663 17 642 43 551 42 313 33 26 8 945 14 949 322 75 Women of child bearing age 15-49 yrs 415 938 25 4643 327 634 32 117 174 63 165 23 384 436 352 227 56 883 86 23 196 185 3 184 125 GENERAL FERTILITY RATE (x 1) 113 131 124 133 128 19 112 132 99 137 112 119 INST.LOW BIRTH WEIGHT RATE (x 1) 8 1 1 9 1 1 8 6 1 11 13 9 INST.DELIVERY COVERAGE (x 1) 82 15 13 92 9 85 85 11 15 131 142 12 TRAINED TM DELIVERY RATE (%) 9 1 6 1 7 6 7 4 1 1 6 INST. STILL BIRTH RATE (x 1) 22 16 19 24 17 16 21 18 26 51 22 22 INST. PERINATAL MORT. RATE (x1) 29 23 26 29 24 21 31 27 49 72 44 32 MATERNAL REFERRAL OUT RATE (x 1) 1 4 7 7 4 7 8 4 19 17 19 9 MATERNAL MORTALITY RATE (x 1) 294 584 611 52 126 145 42 155 33 322 36 366 15% of live births were delivered at home. There is need to identify the barriers to institutional deliveries. 95

Figure 6.1.3a. Low Birth Weight Rate (1) by Province/City, 211 14 12 1 8 6 4 2 13 1 11 1 1 1 1 9 9 8 8 6 Low Birth Weight Rate (x 1) Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare Chitungwiza Bulawayo National Province / City Figure 6.1.3b. Maternity Care by Province/City, 211 1 12 Inst. Delivery Coverage % Perinatal Mortality Rate (x 1) 8 6 4 2 1 8 6 4 2 Manicaland Mash Central Mash East Mash West Mat North Mat South Midlands Masvingo Harare Chitungwiza Bulawayo National Province / City Inst. Delivery Coverage Perinatal Mortality Rate Still Birth Rate 96

Table 6.1.4. Maternity Care by Year, 27-211 DELIVERY CARE STATISTICS 27 28 29 21 211 Institutional Live births < 25g 22 118 16 387 9 685 15 724 29 131 Total Institutional Live births 215 666 182 575 18 332 173 658 32 939 Live births at home -by trained TM 37 137 33 321 22 453 24 484 22 61 -by others 37 378 38 293 23 388 3 989 34 754 Total 74 515 71 614 45 841 55 473 56 815 Total live births 29 181 254 189 154 173 229 131 377 754 Institutional Still births -Fresh 3 276 3 44 2 125 2 299 3 397 -Macerated 2 771 2 46 1 524 2 124 3 748 Total 6 47 5 45 3 659 4 423 7 145 Total institutional (live & still) births 221 713 188 25 111 981 178 81 328 84 Total (live & still) births 296 228 259 639 157 822 233 554 384 899 Institutional Early neonatal deaths 2 938 2 94 1 192 2 759 5 339 Maternal deaths 325 316 22 828 1 382 Maternal referrals out 21 484 17 411 1 254 19 97 36 8 Expected births 52 14 525 135 545 117 319 51 322 75 Women of child bearing age 15-49 yrs 2 96111 3 59 881 3 9 479 3 121 384 3 152 599 GENERAL FERTILITY RATE ( x 1) 94.8 82.2 49.4 72.7 118.6 INST. LOW BIRTH WEIGHT RATE (x 1) 7.6 6.4 6.3 9.1 7.7 INST. DELIVERY COVERAGE (x 1) 42.6 35.8 2.5 55.7 11.7 TRAINED TM DELIVERY RATE (%) 12.5 12.8 14.2 1.5 5.7 INST. STILL BIRTH RATE (x 1) 27.3 29. 32.6 24.8 21.8 INST. PERINATAL MORT. RATE (x 1) 4.5 4.1 23.1 18.9 38.1 MATERNAL REFERRAL OUT RATE (x 1) 7.3 6.7 6.5 8.5 9.4 MATERNAL MORTALITY RATE (x 1) 112. 124.3 131. 369.4 365.8 Source: T5 returns. Figure 6.1.4. Maternity Care by Year 27 211 4 369.4 365.8 35 3 25 21.8 2 15 124.3 112. 11.7 1 5 42.6 4.5 35.8 4.1 2.5 55.7 23.1 18.9 38.1 27 28 29 Year 21 211 Inst. Delivery Coverage (x 1) Inst. Perinatal Mortality Rate (x1) Maternal Mortality Rate (x1) 97

Table 6.1.5a. Maternal Mortality Ratio/1 by Province/City, 22-211 22 23 24 25 26 Province/City/Hospital No. Of Ratio / No. of Ratio / No. Of Ratio / No. of Ratio / No. of Ratio / Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Manicaland 46 36 941 124.52 48 35 55 135.2 523 35 762 1462.45 246 13 911 187.91 42 2 679 23.1 Mash Cent. 37 28 464 129.99 29 26 188 11.74 33 27 188 121.38 9 89 766 1.26 14 13 931 1.5 Mash East 23 28 548 8.57 24 27 844 86.19 28 28 37 98.92 99 96 213 12.9 24 14 77 163.19 Mash West 64 3 267 211.45 56 27 875 2.9 61 31 57 193.61 18 97 992 183.69 17 14 139 12.23 Masvingo 2 1 499 19.49 3 14 726 23.72 23 17 175 133.92 81 54 234 149.35 18 7 66 234.99 Mat North 14 17 389 8.51 14 17 572 79.67 17 19 834 85.71 66 52 95 124.75 8 8 346 95.85 Mat South 17 54 527 31.18 32 36 99 88.65 38 39 512 96.17 213 12 339 177. 24 15 567 154.17 Midlands 53 38 251 138.56 52 35 427 146.78 37 39 2 94.39 141 123 75 113.94 14 19 299 72.54 Chitungwiza Hosp. 14 4 427 316.24 1 1 278 78.25 3 4 354 68.9 54 35 76 153.95 1 5 268 189.83 Harare Hosp. 162 13 36 1212.57. 27 9 79. 315 68 817 457.74 12 3 595 333.8 Parirenyatwa Hosp. 9 3 955 117.56 1 3 195 312.99 7 3 114 224.79 63 18 69 337.8 13 2 74 48.77 Harare Urban - 12 471 -. 3 24 994 3 71 736 4.18 3 9 193 32.63 UBH 12 2 556 469. - - - - - - - - - - - - Mpilo 55 9 867 557.41. 22 1 58. 12 3 699 332.26 28 6 927 44.22 Bulawayo Urban 3 8 14 36.855369 6 722 5 66 25 545. 3 838. TOTAL 3 273 63 19.64 296 232 476 127.32 822 295 6 278.8 1 653 116 673 162.59 227 145 853 155.64 27 28 29 21 211 Province/City/Hospital No. Of Ratio / No. of Ratio No. Of Ratio No. of Ratio / No. of Ratio / Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Deaths Deliveries 1 Manicaland 61 38 294 159.29 41 35 278 116.22 55 26 659 26.31 36 3 939 177.77 138 47 7 293.57 Mash Cent. 35 29 234 119.72 36 26 148 137.68 16 16 813 95.16 45 29 96 6.8 195 33 382 584.15 Mash East 32 31 284 12.29 39 28 1 139.28 25 18 883 132.39 31 31 329 252.16 249 4 786 61.5 Mash West 41 32 356 126.72 56 3 778 181.95 26 11 773 22.84 32 19 587 995.56 222 42 713 519.75 Mat North 27 17 45 154.73 26 15 817 164.38 17 8 82 193.14 19 12 422 14.65 28 22 286 125.64 Mat South 4 16 925 23.63 24 15 194 157.96 13 1 546 123.27 9 11 529 69.39 26 17 976 144.64 Midlands 31 31 622 98.3 2 25 612 78.9 14 16 192 86.46 4 22 654 317.82 181 43 79 42.16 Masvingo 34 39 771 85.49 6 38 434 156.11 32 24 294 131.72 2 28 785 21.49 72 46 474 154.93 Chitungwiza Hosp. 11 9 213 119.4 11 6 293 174.8 5 176. 72 9 9 828.28 38 11 785 322.44 Harare Hosp. 1 435 229.89 - - - - - - - Parirenyatwa Hosp. 5 1 214 411.86 - - - - - - - Harare Urban 2 11 112 18. 2 12 453 16.6 2 9 365 21.36 6 2 117 377.79 166 5 368 329.57 UBH 11 898 1224.94 - - - - - - - Mpilo 19 3 719 51.89 - - - - - - - Bulawayo Urban 11 4 287 256.59 1 3 623 27.6 2 5 67 35.27 1 11 99 83.97 67 21 898 35.96 TOTAL 325 267 814 121.35 316 237 631 132.98 22 154 173 131.2 338 229 131 361.37 1 382 377 754 365.85 The maternal mortality rate remains high and is increasing instead of decreasing as per MDG targets. 98

Table 6.1.5b. Major Causes of Maternal Mortality, 211 RANK CONDITION NUMBER PERCENT (%) 1 Eclampsia 21 7.8 2 Post Partum Haemorrhage 12 4.5 3 Septicaemia 1 3.7 4 Hypovolaemic shock 9 3.3 5 Puerperal Sepsis 9 3.3 6 Malaria 8 3. 7 Severe Anaemia 8 3. Haemorrhagerepeated see 2? 8 APH 7 2.6 9 Aspiration pneumonia 6 2.2 Disseminated Intravascular 1 Coagulation 6 2.2 Other 173 64.3 Figure 6.1.5b. Major Causes of Maternal Mortality, 211 Major Causes of Maternal Mortality, 211 Haemorrhage 7% Aspiration pneumonia 6% D.I.C 6% Eclampisia 22% Severe Anaemia 8% Malaria 8% Post Partum Haemorhage 14% Pueperal Sepsis 9% Septicaemia 11% Hpovolaemic shock 1% 99

Table 6.1.5c. Comparison of Reported Maternal Deaths by Notification Forms vs T5 Forms by Year Year 24 25 26 27 28 29 21 211 Maternal Notification Forms 121 29 322 244 189 299 291 269 T5 Form 822 1653 243 325 316 22 338 1382 % of Notified Deaths 55.7 19.83 86.1 132.51 99.8 148. 86.9 19.46 Figure 6.1.5c. Maternal Deaths Reports by Notification Forms and T5 Forms, 24-211 18 18 18 18 Number of Forms / Deaths 18 18 18 18 18 18 24 25 26 27 28 26 21 211 Year Notification Forms T5 Form The discrepancy in the maternal deaths reporting by mortality forms and the T5 forms could be due to the non availability of the maternal mortality forms, lack of training on their use and hence laxity in conducting maternal deaths audits; and needs to be addressed at all levels. 1

Table 6.1.6b. Family Planning (New and Repeat) Visits by Province/City, 211 FAMILY PLANNING MANICALAND MASH. MASH. MASH. MAT. MAT. MIDLANDS MASVINGO HARARE CHITUNGWZA BULAWAYO NATIONAL STATISTICS CENTRAL EAST WEST NORTH SOUTH TOTAL New Clients 5 892 36 174 37 877 39797 24716 27457 55926 4826 15756 3191 1625 35617 Repeat Visits 273 75 225 859 2 284 214933 19834 858 331654 259989 4751 9816 12546 1764496 TOTAL 324 642 262 33 238 161 25473 13455 112537 38758 38195 5657 137 23171 2115113 % NEW CLIENTS 15.7 13.8 15.9 15.6 18.4 24.4 14.4 15.6.. 45.9 16.6 12

Table 6.1.7. Methods of Contraception by Number Issued and Province/City, 211 Conversion MANICALAND MASH. CENTRAL MASH. EAST MASH. WEST MAT NORTH MAT SOUTH METHOD factor Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Issued Number % Issued Number % Issued Number % Issued Number % Issued Number % Issued Number % ORAL PILLS CONDOMS INJECTABLES IUDs NORPLANT OTHERS.77 938 23 72 169 45.4 739 512.11 3 646 877 39 966 25.1 5 21 518.25 12 693 25 673 16.1 63 674 56 886 36.7 499 455 55 3 35.5 3 77 784 15 919 1.3 66 369 2.5 8 2.1 69 173.1 178 5. 1 526 7 63 4.8 736 12.5 17 13 375 8.4 1 862 3 68 2.4 5 93 23 275 15. 545 38 42 3.6 76 2 33 729 26.8 4 316726 16 592 13.2 86 475 445.4 17 29 65 23.6 3 188 6 813 5.4 184 54 38 38.3 337 47 37 33.4 475 2 175 329 21 619 15.3 46 978 268.2 26 15 94 11.2 1 81 2 3 1.6 137 25 96 37.5 186 759 14 366 17.6 23 839 34.4 2 498 21 27 378 33.6 11 745 16.9 56 372 14 93 17.3 65.9 111 278.3 5 45 7.8 4 844 24 22 29.7 1 713 2.5 97 1 213 1.5 TOTAL 15913 1. TOTAL 154 962 1. TOTAL 125 649 1. TOTAL 141 741 1. TOTAL 69 311 1. TOTAL 81 547 1. Conversion MIDLANDS MASVINGO HARARE CHITUNGWIZA BULAWAYO NATIONAL METHOD factor Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP ORAL PILLS CONDOMS INJECTABLES IUDs NORPLANT OTHERS Issued Number % Issued.77 882 41 67 877 39.7 941 46.11 4 474 377 49 34 28.7 2 64 8.25 19 19 27 298 16. 89 621 2.5 92 23.1 4 161 5. 4 644 23 22 13.6 2 783 12.5 275 3 438 2. 4 96 Number % Issued 72 42 36.3 144 781 28 932 14.5 1626 358 22 45 11.2 15 759 1 43 5.2 13 915 7. 36 51 2 25.7 1 524 Number % Issued 11 137 2.8 12 872 17 823 33.3 256 8 3 94 7.4 6 842. 35 1 53 2.9 1 114 19 5 35.6 724 Number % Issued 99 4.9 21 364 2 86 13.9 1 545 31 1 711 8.5 8 932 88.4 69 5 57 27.6 661 9 5 44.8 4 66 Number % 1 643 2. 5 Issued Number % 41 284 416 176 33.1 16 932 2.5 31 278 217 342 775 27.2 2 233 2.7 652 95 163 226 13. 173.2 5 162 12 95 1. 3 35 4. 26 813 134 65 1.7 58 25 7.6 15 174 189 675 15.1 TOTAL 17196 1. TOTAL 199274 1. TOTAL 53 48 1. TOTAL 2 214 1. TOTAL 82 536 1. TOTAL 1 258 822 1. Note that Unit considered is "cycle" for ORAL PILLS "pieces of " for CONDOMS "vial" for INJECTABLES "device" for IUDs "operation" for STERILIZATIONS; methods of contraception are compared by the total of Couple Years of Protection (CYP) offered by each method 13

Figure 6.1.7. Methods of Contraception by Province/City, 211 NATIONAL BYO CHIT HRE MAS MID MAT. S MAT. N Province / City MASH. W MASH. E MASH. C MAN 1 2 3 4 5 6 7 8 9 1 Percentage of CYP Supplied ORAL PILLS CONDOMS INJECTABLES IUDs OTHERS NORPLANT 14

Table 6.1.8. Methods of Contraception by Year Conversion 28 29 21 211 METHOD factor Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Number Equivalent CYP Issued Number % Issued Number % Issued Number % Issued Number % Oral Pills.77 5 434 79 418 6 48.3 3 12 98 418 6 48.3 3 939 211 418 6 48.3 5 41 284 418 6 48.3 Condoms.11 19 97 152 29 284 24.2 13 56 747 29 284 24.2 19 8 431 29 284 24.2 31 278 217 29 284 24.2 Injectables.25 833 37 28 259 24. 498 482 28 259 24. 497 272 28 259 24. 652 95 28 259 24. Iuds 2.5 4 19 1 48 1.2 7 686 1 48 1.2 1 23 1 48 1.2 5 162 1 48 1.2 Norplant 5. 3 192 15 96 1.8 4 41 15 96 1.8 41 15 96 1.8 26 813 15 96 1.8 Others 12.5 381 4 763.5 1 66 4 763.5 11 79 4 763.5 15 174 4 763.5 TOTAL 866 319 1. TOTAL 866 319 1. TOTAL 866 319 1. TOTAL 866 319 1. Notes: unit considered is "cycle" for ORAL PILLS "vial" for INJECTABLES "device" for IUDs "operation" for STERILIZATIONS; methods of contraception are compared by the total of Couple Years of Protection (CYP) offered by each method and mention what the conversion factor is for? 15

Figure 6.1.8. Contraception by Year 28-211 4. 2. Percentage of CYP Supplied. ORAL PILLS CONDOMS INJECTABLES IUDs NORPLANT OTHERS YEARS 28 29 21 211 16

Table 6.1.9. Vaccination Type by Age Group and Province/City, 211 IMMUNIZATION MANICALAND STATISTICS -11 1+ BCG 68 Polio 1 63 Polio 2 59 Polio 3 56 month year 64 415 269 63 113 1382 1945 MASH. CENTRAL -11 month 4541 433 39299 3869 1+ year 14 115 11 MASH. EAST -11 month 5348 49668 47328 45814 1+ year Polio booster 6578 42984 56557 Pentavalent 1 63 18 452 Pentavalent 2 58 652 653 Pentavalent 3 57 79 913 DT 1 85 141 43911 47 328 45 975 122 DT 2 77 396 88 82 88 72 49 797 49797 47328 DT booster 26867 182 2221 Measles 56875 437 38454 392 181 515 6 11 469 87 34 39 473 23 14 144 79 473 MASH. WEST -11 month 5742 5346 5849 48185 53717 5867 4823 43 28 48974 1+ year 196 242 476 6964 16 93 198 536 165 24235 165 MAT. NORTH -11 month 2425 23 21939 2679 22685 21643 21125 265 29 2376 1+ year 219 76 1718 29592 65 138 384 1666 432 12858 215 MAT. SOUTH -11 month 19895 2745 19721 1985 2587 19589 1965 33 9 19135 1+ year 65 136 272 29657 34 65 37 818 241 11688 1292 MIDLANDS -11 month 6111 54886 51317 49434 54457 5676 49591 162 161 47866 1+ year 755 1535 325 54248 171 221 62 3236 1435 2926 4951 MASVINGO -11 month 56338 56728 52396 5329 56424 5247 5364 134 3 5316 1+ year 42 519 1174 6185 124 175 297 2253 613 246 3113 HARARE CHITUNGWIZA BULAWAYO TOTAL -11 month 55858 5874 5576 54421 57311 55148 5348 6 52769 1+ Year 45 27 62 65993 3 7 12 218 19 2681 296-11 month 15174 13915 13566 13664 13934 14857 1366 26 8 1269 1+ year 14281 214 55 512 221-11 1+ -11 1+ month year month year 2498 48953 21369 335 459226 3374 2844 249 43164 4945 2263 419 42659 9456 29513 51717 21324 1 457255 1511 285 431781 1463 2219 1 422396 253 25 88 955 11767 13 279 46 3895 12138 2414 2124 948 41447 19826 Adverse Effects 2 66 4 2 7 9 48 14 1 3 228 Expected children < 1 yr 56554 3742 42739 43256 28916 2281 5377 45422 5155 11313 22941 415485 BCG COVERAGE < 1 yr 121.4 121.4 125.1 131.9 83.1 87.2 113.3 124. 19.4 134.1 18.9 115.8 POLIO 3 COVERAGE < 1 yr 1.1 13.4 17.2 111.4 71.5 87. 93.1 116.7 16.6 12.8 88.3 11.2 Pentavalent 3 COVERAGE < 1 yr 12.2 16. 11.7 111.5 73.1 85.9 93.4 116.8 14.7 12.7 88.1 12. MEASLES COVERAGE 1.6 12.8 17.7 113.2 7.5 83.9 9.2 11.8 13.4 111.5 91.6 99.7 POLIO 1-POLIO 3 DROP OUT (%) 1.7 1.6 7.8 9.9 1.1 4.3 9.9 6.5 7.4 1.8 5.2 8.4 Penta 1-Penta 3 DROP OUT (%) 8.4 9.7-2.9 1.2 6.9 4.8 8.9 6. 6.7 2. 5.2 6.6 POLIO 3- MEASLES DROP OUT (%) -.4.6 -.4-1.6 1.5 3.6 3.2 5.1 3. 7.7-3.8 1.5 17

Figure 6.1.9. Vaccination Type by Age Group and Province/City, 211 BCG bars not provided, review legend 16 14 12 1 8 6 Percentage 4 2 MANICALAND MASH CENTRAL MASH EAST MASH WEST MAT. NORTH MAT. SOUTH Province / City MIDLANDS MASVINGO HARARE CITY BCG Coverage POLIO 3 Coverage Pentavalent 3 Coverage MEASLES Coverage CHITUNGWIZA CITY BULAWAYO CITY 18

Table 6.1.1. Vaccination Type by Year and Age Group, 211 BCG STATISTICS Polio 1 Polio 2 Polio 3 27 28 29 21 211-11 1-4 -11 1-4 -11 1-4 -11 1-4 -11 1-4 month years month years month years month years month years 347 316 228 278 48 157 1 389 619 988 229 359 788 817 953 32 322 224 276 459 244 4 675 81 3 154 699 4 775 417 3 671 226 3 374 283 284 196 245 431 63 3 463 413 4 19 68 3 583 45 3 41 64 4 945 263 259 178 227 42 867 5 32 196 954 471 6 528 192 669 984 5 957 264 747 874 5 2 174 296 659 9 456 51 717 Polio booster 173 Pentavalent 1 - - - - 35 228 457255 1 511 155 Pentavalent 2 - - - - 915 184 431781 1 463 149 Pentavalent 3 - - - - 232 283 422396 2 53 33 12 DPT 1 275 1 627 78 431 892 4 371 36 633 476 795 297 11 DPT 2 99 2 523 7 655 1 189 34 94 237 462 19 321 279 1 DPT 3 55 4 27 65 188 2 148 32 214 21 99 37 576 217 186 15 14 312 DPT booster 982 25 284 47 552 1 11 DT 1 352 6 965 4 584 2 974 3 236 955 767 DT 2 1 857 4 599 1 673 1 574 866 46 3 895 158 128 128 75 24 DT booster 462 442 442 42 14 264 16 252 17 26 23 1 414 19 Measles 472 981 977 657 32 262 269 47 826 Adverse Effects 4 612 3 569 2 385 228 Expected children 41 43 47 411 415 < 1 yr 38 134 165 236 485 BCG COVERAGE < 1 yr 86.6 78.5 56.1 67.8 115.8 POLIO 3 COVERAGE < 1 yr 65.8 64.4 44. 55.4 11.2 Pentavalent 3 COVERAGE < 1 yr... 36.3 11.7 MEASLES COVERAGE 65.9 62.8 5.6 56. 99.7 POLIO 1-POLIO 3 DROP OUT (%) 17.6 19.6 2.3 17.6 8.4 Penta 1-Penta 3 DROP OUT (%) - - - 13.8 7.6 POLIO 3- MEASLES DROP OUT (%) -.2 2.5-15.1-1. 1.5 19

Table 6.2.1. OPD Utilisation Rates by Province/City, 211 OPD STATISTICS Manicala nd Mashonal and Central Mashonal and East Mashonal and West Matabelel and North Matabele land South General 1 719 627 1 648 92 1 585 523 1 518 114 784 69 735 12 Midlan ds Masvin go 1 69 83 1 529 659 Harare Chitungwi za Bulawa yo Annual Average 1 8 46 634 876 76 35 1 189 315 New EPI 553 55 571 246 125 83 454 614 1 736 514 44 454 5 445 Diseas es Chronic 4 927 3 962 4 62 3 464 2 324 2 462 4 846 4 529 1 625 6 849 6 745 4 566 54 795 Total New Diseases 785 347 651 559 59 156 521 824 486 58 336 647 614 13 532 82 893 47 337 239 36 35 393 911 Repea t Visit General 313 346 266 42 277 698 164 67 17 124 14 473 172 991 18 726 266 275 16 872 211 188 197 346 2 17 82 Follo w Ups Chronic 156 997 112 137 153 335 14 56 69 24 72 532 124 759 166 741 159 855 12 919 5 527 98 616 1 183 386 Total Repeats 47 343 378 179 431 33 268 627 176 148 177 5 297 75 347 467 426 13 119 791 261 715 295 962 3 354 188 Referrals Out 18 84 6 84 13 55 12 585 5 313 7 461 14 891 17 582 27 948 1 17 8 684 11 167 134 Total New 1 396 1 74 13 92 Diseases 2 36 76 1 4 347 1 633 821 1 3 6 867 449 764 768 595 2 115 873 328 144 571 213 92 1 158 517 24 Total Patients 1 32 (All Ages) 1 14 957 1 15 323 1 214 547 1 3 464 758 411 598 14 51 275 96 389 96 15 867 48 81 719 334 8 632 8 Total Attendences (All Ages) 1 343 927 1 4 916 1 25 725 52 162 499 814 281 829 686 23 793 7 914 991 6 465 557 973 655 741 7 868 895 Period Considered (Days) 365 365 365 365 365 365 365 365 365 365 365 365 365 Provincial 1 61 1 595 13 253 population 1 715 916 1 88 684 1 357 788 1 339 44 77 992 714 236 148 1 444 144 476 353 545 1 272 137 1 14 456 47 Visits Daily Average 3 682 2 753 3 33 1 425 1 369 772 1 88 2 173 2 57 166 1 529 1 797 21 559 Average Visit per Patient 1 1 1 1 1 1 1 1 4 1 1 1 % Repeats Visits 35 38 36 52 35 63 43 44 47 198 47 45 43 OPD Attendences Rate (x 1) 78 92 89 39 65 39 43 55 57 17 44 59 96 Total 14 271 783 14 332 23 Source: T5 and HS3/5 Returns 11

Table 6.2.2. NHIS Completeness of the Data Submission by Province/City, 211 OPD STATISTICS 27 28 29 21 211 New Diseases General 8 835 979 8,87,916 9 125 36 7 321 635 14,271,783 EPI 844 453 113 214 544 342 239 5,445 Chronic 38 89 31,198 37 123 33 742 54,795 Total New Disease Conditions 9 719 241 8,119,227 9 376 73 7 697 616 14 332 23 Repeat Visits/Follow ups General 2 519 352 1,837,115 1 956 125 1 624 127 97,82 Chronic 946 778 724,189 844 563 689 239 1,183,386 Total Repeat Visits/Follow -up 3 466 13 2,561,34 2 8 688 2 313 366 2,154,188 Referrals Out 34 28 216,3 31 22 265 314 134, Total New Diseases 1 544 6 17,743,499 15 522 321 18 236 148 13,92,24 Total Patients (All Ages) 6 259 43 3,933,84 4 482 125 4 361 233 4,882,8 Total Attendances (All Ages) 11 523 88 3,715,637 3 936 21 3 695 125 3,938,895 Period Considered (Days) 365 365 365 365 365 National Population 12 224 988 12,21,717 12 47 79 12 595 418 12 721 372 Visits Daily Average 31 572 23,878 34 166 36 235 19,11 Average Visits Per Patients 17 1 1 1 1 % Repeats Visits 36 69 71 63 55 OPD Attendences Rate (x 1) 95 93 89 92 96 Source: T5 and HS3/5 Returns 111

Table 6.2.3. National Workload (OPD Attendances-all services; Inpatient Referrals Discharge and Deaths) by Level of Institution, 211 Rural Hospitals, Government All Total for All Provincial Whole All National Rural Clinics & District Mission Districts Hospitals Provincial Central Totals Health Centres Hospitals Hospitals (excl. Prov. Hosps.) Only Totals Hospitals New Diseases/conditions (Prov & City) 6 255 53 467 549 737 623 7 46 675 65 329 7 526 4 11 133 147 Patients (Central Hospitals) 9 799 65 136 1. Total New Diseases 3 819 96 467 549 737 623 7 46 675 65 329 7 526 4 29 391 14 326 153 Population all ages 12 721 372 12 721 372 Attendance rate 77 77 2. Referrals Out 187 652 2 22 5 922 195 776 225 196 1 279 22 365 - Patients OPD Register (Prov. & City) 1 76 36 582 597 816 194 322 755 13 229 425 984 71 2362 - Number of Patients (Centrals & Chit.G.H.) 9 799 33 323 3. Total Patients All Ages 1 516 7 582 597 816 194 322 755 13 229 425 984 9 799 888 28 - Total Attendances (Prov. & City) 3 33 194 112 88 112 88 3 258 954 129 88 3 388 42 343 1785 - Total Attendances (Centrals + Chit. G H.) 33 148 3 3148 4. Total Attendances A ll Ages 3 33 194 112 88 112 88 3 258 954 129 88 3 388 42 33 148 693 8895 OPD Preventative Services (Attendances) 7 839 492 488 215 971 411 7 325 147 66 145 9 365 263 119 323 936 5263 Preventative Services as % of OPD Grand Total 72 81 9 69 34 73 78 47.5 5.OPD GRAND Total (All Services) 1 872 686 61 95 1 84 291 1 584 11 195 233 9 753 35 152 471 11 82 979 6. In-Patient Deaths 4 86 4 317 4 76 4 271 21 713 25 984 574 26 253 7. In-Patient Referrals Out 6 961 3 397 4 375 14 733 1 25 15 983 47 23 258 8. In-Patient Discharges 146 98 77 352 82 454 35 94 29 386 335 29 11 366 354 365 9. In-Patient Total Discharges (inc. Deaths) 141 292 81 669 87 214 31 175 51 99 361 274 11 94 399 236 112

Table 6. 2.4. National Workload (OPD Attendances-All Services; Inpatient Referrals Discharge and Deaths) by Year, 211 25 26 27 28 29 21 211 New Diseases/conditions (Prov & City) 11 765 99 1 882 334 9 359 636 7 526 4 7 566 32 9 633 14 11 133 147 Patients (Central Hospitals) 156 385 334 28 86 216 9 799 36 322 43 896 65 136 1. Total New Diseases 1 192 484 1 882 334 9 359 636 7 526 4 1 548 333 1 231 478 14 326 153 Population all ages 11 984 18 12 13 949 12 224 988 12 347 238 12 47 79 12 595 418 12 721 372 Attendance rate 1 9 77 27 63 62 77 2. Referrals Out 356 568 39 995 261 128 196 1 23 539 312 548 223 65 - Patients OPD Register (Prov. & City) 4 413 275 5 678 974 2 365 214 425 984 6 523 236 7 125 478 7 12 362 - Number of Patients (Centrals & Chit.G.H.) 156 385 334 28 86 216 9 799 125 32 214 322 333 23 3. Total Patients All Ages 4 413 275 5 678 974 2 365 214 425 984 3 235 147 8 14 236 8 882 8 - Total Attendances (Prov. & City) 8 894 61 1 231 525 4 274 11 3 388 42 6 147 698 6 412 258 3 431 785 - Total Attendances (Centrals + Chit. G H.) 191 897 346 155 12 52 24 672 266 145 365 12 33 148 4. Total Attendances All Ages 9 841 74 1 577 68 4 274 11 3 388 42 7 34 632 9 215 478 6 938 895 OPD Preventative Services (Attendances) 1 62 434 1 277 766 12 277 6 11 32 511 12 451 321 12 421 325 9 365 263 Preventative Services as % of OPD Grand Total 52 49 59 63 54 67 47 5. OPD Grand Total (All Services) 2 462 138 2 855 446 2 825 622 18 96 595 19 263 451 19 563 478 19 735 943 6. In-Patient Deaths 42 228 37 976 26 832 25 984 25 22 33 256 26 253 7. In-Patient Referrals Out 26 594 19 347 17 479 15 983 18 263 2 325 23 258 8. In-Patient Discharges 545 417 324 154 343 892 335 29 341 687 322 145 354 365 9. In-Patient Total Discharges (inc. Deaths) 587 645 475 528 37 724 361 274 382 364 412 362 399 236 SOURCE:T5 and HS3/5 Returns 113

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