Harare - To ramp up testing for cholera in Zimbabwe, the World Health Organization (WHO) supported the Ministry of Health and Child Care with training of 986 nurses in antigen Rapid Diagnostic Test (RDT) testing. This shift in responsibility, known as task-shifting, addressed the critical staff shortage at rural health centers. Additionally, 44 laboratory personnel at provincial and district levels were trained in cholera culture, further strengthening the diagnostic capacity.

“The support we received from WHO has gone a long way in improving access and coverage to cholera testing in Zimbabwe. Successful outbreak response begins with timeous testing and case identification and the trainings were instrumental to ensure this happens. Health worker capacitation is also critical even as we prepare for future outbreaks and pandemics,” said Agnes Juru-Chibango, Zimbabwe National Microbiology and Reference Laboratory Coordinator.

Prior to the training programme, testing capabilities were limited. Between the outbreak's onset in February 2023 and 18 January 2024, only 2,090 antigen RDTs and 2,250 culture tests were conducted across 10 health centers. Following the training, the number of antigen RDT tests skyrocketed to 9,853, a staggering 371% increase. Culture tests also saw a significant rise, reaching 6,386, reflecting a 184% increase. This exponential growth signifies a four-fold increase in testing accessibility at rural health centers. In addition to the increase in numbers, early detection through RDTs allowed for quicker diagnosis and treatment, improving patient outcomes and reducing disease spread. Task-shifting to nurses freed up laboratory personnel to focus on more complex testing, improving efficiency.

Zimbabwe continues to respond to a cholera outbreak albeit on a downward trend of late. During the last week of March, 624 cases were recorded, a decrease from the 634 cases reported during the previous week ending 7 April 2024. As of 14 April 2024, a cumulative total of 31 912 suspected cholera cases, 87 laboratory confirmed deaths, 597 suspected cholera deaths and 3,931 laboratory confirmed cases were reported.

The success of the programme is attributed to the collaborative efforts of various stakeholders who include UNICEF, Higher Life Foundation, JHPIEGO, and World Vision International and WHO with MoHCC leading the efforts. Funding for the training activities came from the Health Resilience Fund (HRF), the UN Central Emergency Response Fund and the United States Department of the State (USDOS). HRF is a pool of funding from the European Union, Government of Ireland and United Kingdom as well as GAVI, The Vaccine Alliance.

A nurse from Chiredzi District Hospital lauded the training's timeliness and comprehensiveness, highlighting the importance of proper test administration and interpretation. Similarly, Marakia Manjengwa, a medical laboratory scientist, added, “The discussions and practicals equipped us with knowledge on laboratory identification of cholera, and I learnt more on the presumptive tests and timely reporting for national interventions.”

As part of the cholera response, WHO continues to play a critical role in strengthening Zimbabwe's laboratory response to the cholera pandemic. Apart from supporting trainings for laboratory personnel and nurses, financial contributions have covered transportation costs for crucial samples from local districts and provinces to the National Reference Laboratory. Furthermore, WHO supports on-site support and data harmonization efforts, leading to more accurate data collection at the ward level. These comprehensive contributions have significantly bolstered Zimbabwe's laboratory capacity to effectively diagnose and combat cholera.

“I am confident that the acquired knowledge and skills would significantly enhance diagnostic services, leading to earlier case detection, improved case management, and strengthened surveillance activities,” said Dr. Muchaneta Mugabe, WHO Laboratory Officer.