Tawanda Musarurwa
CHECK POINT DESK
IF you live in Harare, malaria is barely a worry, but if your home is in Binga, every mosquito bite could mean a fever that keeps your child from school for weeks.
Geography remains a key factor in health across the country.
The 2023/2024 Zimbabwe Demographic and Health Survey (ZDHS) lays this out with clarity.
Three diseases: hypertension, malaria and HIV shape important health outcomes in the country. Together, they expose both systemic progress and pockets of neglect.
Hypertension: A silent killer
Since last year, 62-year-old Mai Chikowore (not her real name) from Sanyati has been waking up with a headache, which she dismisses as tiredness from working the farm.
Last month, a nurse at an outreach clinic told her she has high blood pressure.
But, the clinic is far, transport costs are high and she still has not started treatment.
“I feel fine most days,” she says, unaware of the risks building up inside her.
Zimbabwe has a hypertension (high blood pressure) prevalence among adults aged between 30 and 79 years of 42 percent, according to the World Health Organisation (WHO).
But, how is this chronic disease spread out across the country?
According to the 2023/2024 ZDHS, hypertension prevalence among women peaks in Mashonaland West at 22 percent, dropping to 13 percent in Matabeleland South.
For men, Harare leads at 12 percent, while Bulawayo, Manicaland and Matabeleland North record just 3 percent.
Urban-rural divides are also clear: 59 percent of hypertensive women in urban areas and 49 percent in rural areas have been prescribed medication. Among men, 47 percent in urban and 36 percent in rural areas receive prescriptions.
Yet, actual treatment remains low, with only 21 percent of urban women and 16 percent of rural women taking medication, compared to 22 percent of urban men and 12 percent of rural men. These figures highlight gaps in detection and treatment, calling for targeted screening in low-prevalence provinces, improved rural access to medication and gender-sensitive awareness campaigns.
Malaria: Border districts in uphill battle
Malaria remains one of the country’s most entrenched public health threats.
Transmission peaks between November and May, with the highest rates typically from March to May, which aligns with the rainy season and ideal mosquito breeding conditions.
According to the 2023 Malaria Annual Parasite Incidence (API) map in the latest ZDHS, malaria shows significant geographic variation, with the highest burden in border and rural areas. Binga recorded extremely high incidence (API above 200), while Mount Darwin, Centenary, Mudzi, Rushinga and Mbire reported very high levels (API between 101 and 200), mostly along the Zambezi Valley and north-eastern regions.
In contrast, urban centres such as Harare, Bulawayo, Gweru and Masvingo reported very-low to low incidence (API between 0 and 20), reflecting better healthcare access and vector control.
Moderate incidence (API between 21 and 50) appeared in transitional zones like Hwange, Nyanga and Chimanimani, often near forests or rivers. These patterns underscore the need for geographically targeted interventions, but coverage remains uneven.
A comparison of the “Malaria Annual Parasite Incidence map” with the “Insecticide-treated net ownership by province map” shows worrying gaps. Manicaland (25 percent) and Mashonaland East (35 percent) have low insecticide-treated net ownership, despite moderate-to-high malaria incidence, increasing their vulnerability.
Binga, with the highest API, is in Matabeleland North, where insecticide-treated net coverage is only 48 percent. Mashonaland Central, which is home to high-incidence districts like Mount Darwin, Mbire, Mudzi and Rushinga, has relatively better coverage at 56 percent.
Urban areas such as Harare and Bulawayo show both low malaria burden and low insecticide-treated net ownership (27 percent each).
Meanwhile, provinces like Masvingo (48 percent) and Matabeleland South (41 percent) maintain higher-than-average insecticide-treated net coverage despite low incidence.
Insecticide-treated net access vs usage
In 2023/2024, only 39 percent of households owned at least one insecticide-treated net and just 21 percent met the universal coverage benchmark of one net per two people.
But ownership tells only part of the story.
Among households with an insecticide-treated net, just 13 percent of pregnant women and 13 percent of children under five – two of the most vulnerable groups – reported sleeping under a net the night before the survey.
Even in designated malaria insecticide-treated net zones, usage rose only modestly: to 21 percent for children and 38 percent for pregnant women.
Usage patterns reveal deep socio-economic divides. Net use among children was highest in Mashonaland Central (42 percent) and lowest in Matabeleland South (10 percent).
Among pregnant women, those in rural areas (16 percent) were more likely to use insecticide-treated net than those in urban settings (7 percent), likely reflecting differences in perceived risk.
While 83 percent of women knew malaria prevention methods, only 65 percent believed their communities were at risk and 37 percent still agreed with the misconception that malaria “isn’t a problem because it can be treated easily.”
This mismatch between knowledge and behaviour could be part of the reason insecticide-treated net are underused.
These gaps highlight the need to accelerate initiatives under the National Malaria Strategic Plan. In 2022, the WHO technically supported Zimbabwe in updating the Malaria Strategic Plan (2021-2026) and the Social Behaviour Change Strategy (2021-2026).
HIV: Geographical gaps in testing
Zimbabwe has made significant progress in HIV testing.
According to the 2023/2024 ZDHS, 83 percent of women and 71 percent of men aged 15 to 49 have ever been tested and received their results, up from just 22 percent and 16 percent, respectively, in 2005/2006.
However, recent testing (within the 12 months prior to the survey) is much lower: 46 percent for women and 33 percent for men, with clear-cut provincial differences.
In Harare, 94 percent of pregnant women were tested during antenatal care and received results, while in Manicaland the figure drops to 74 percent, highlighting unequal access to maternal HIV services.
Among women generally, the ZDHS shows higher testing rates in eastern and south-eastern provinces like Manicaland, Mashonaland East and Masvingo (12 percent to 17 percent), compared to the lowest rates in Matabeleland North and South (3 percent to 9 percent).
These gaps likely reflect differences in healthcare access, programme coverage and socio-cultural barriers like stigma.
Low testing rates suggest missed diagnoses, delayed treatment and increased community transmission in underserved areas, threatening national HIV targets such as the UNAIDS 95-95-95 goals and deepening regional health inequalities.
Targeted strategies, like mobile outreach, community-based testing and stigma reduction campaigns, can help close these gaps.
Mobile testing also aligns with Zimbabwe’s National HIV and AIDS Strategic Plan (2021–2025) pillar on differentiated service delivery.
Non-governmental organisations play a vital role as well. In 2024, DAPP Zimbabwe’s HOPE Bindura project reached 32 000 people with HIV information, prompting 808 individuals to get tested.
Where you live matters
Across all three health indicators, there is a strong correlation between health outcomes and one’s location. Critically, rural households consistently showed higher disease burden and limited access to treatment across all three indicators. The 2023/2024 ZDHS shows that if the country is to make deeper progress, its public health agenda must shift from national averages to neighbourhood realities.
Each untreated patient, untested person and unused net represents a life at risk. Bridging health disparities requires looking beyond averages to reach the communities they overlook.
ORIGINALLY PUBLISHED IN THE HERALD – https://www.heraldonline.co.zw/are-your-health-outcomes-written-into-your-address/