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World of Genomics: Zimbabwe

Article written by Bethany Hanson, Science Communications Writer.

We’re heading to Southern Africa in this week’s World of Genomics, visiting the stunning nation of Zimbabwe!

The Republic of Zimbabwe, formally Rhodesia, is a vibrant country famous for its beautiful scenery and rare wildlife. The Zambezi River forms the country’s northwestern border and is home to the annual Liuwa Plain wildebeest migration, which attracts tourists from across the globe1. On its journey to the Indian Ocean, the River cascades over the 1,700m wide Victoria Falls, one of the Seven Wonders of the World. The fall’s name in the Tonga language translates to “boiling water.” Fun fact – in 1901, a 63 -year-old schoolteacher Annie Edson Taylor deliberately went over the Falls in an oak barrel and survived2!

The country has an ancient history and holds the largest collection of rock art and a UNESCO World Heritage Site. Plus, 300,000 paintings that are 20,000 years old are hidden in the Motobo Hills National Park!

The Population of Zimbabwe

Zimbabwe is a landlocked African country that borders South Africa, Botswana, Zambia and Mozambique. Its capital is Harare, which is the nation’s largest city. There are 16 different official languages, with the most common being Shona and Ndebele1.

Civilization in the region dates back to the Stone Age, and communities of Bantu-speaking people established communities in the desert regions between the 5th and 10th centuries. The British South Africa company took control of the region in 1889, renaming it Southern Rhodesia and establishing a self-governing British colony in 1923. In 1965, the country declared independence against the British government and became a self-governing Republic in 1970. The nation was officially granted independence and became Zimbabwe in 19801.

During the 1980s, the Mugabe government sought to address race inequality and redistribute land held by the white minority. They promoted economic development and established a strong healthcare system. However, the country saw rapid economic downturn in the 1990s due to unpaid debt and wide-spread corruption. The programme of land reassignment resulted in half of the country’s white farmers leaving their properties and tens of thousands of farm workers lost their jobs. Vacant farms were often claimed by political individuals rather than farmers, so agricultural productivity declined sharply1.

Ongoing instability regarding the political situation in Zimbabwe under the Mugabe regime led to a catastrophic economic crisis crippled the economy in 2008, resulting in food insecurity, rampant unemployment, hyperinflation and fuel shortages. This caused a mass exodus of skilled workers1. Since then, the political landscape has begun to stabilise.

Geographic and Demographic Information

Summary Statistics1

  • Land area:  391km2
    • Gross domestic product (GDP):
    • Total: $20.68 billion
    • Per capita: $1,267

Population Statistics3

  • Population size:  16,320,537
    • Birth rate: 27.7 per 1000 people
    • Death rate: 7.6 per 1000 people
    • Infant mortality rate: 34.1 per 1,000 live births
    • Average life expectancy: 59 years
    • Ethnicity:  99.4% African (Shona and Ndebele) and 0.6% other ethnicities.

Healthcare System

Historically, Zimbabwe boasted one of the strongest health systems in the region. It had a thriving teaching hospital network and a robust, accessible primary healthcare system implemented by the Mugabe dictatorship in the 1980s. This was staffed by a highly trained workforce, which by 1998 included 1,626 doctors and 15,476 nurses. However, in the 2000s, the health system saw chronic ethical and economic mismanagement. In 2008, the President denied the existence of a severe cholera epidemic, which resulted in the death of 4000 people.

Due to catastrophic economic collapse, national health spending dropped from 7% to 4% in 2007. This meant that some hospitals did not have supplies such as scalpels or pain medication and, in the worst cases, some did not have electricity or clean running water. The working conditions and low average salaries ($1 USD per month) drove medical professionals to leave the country for better opportunities. By the year 2000, Zimbabwe had only 742 doctors and 7795 nurses left4. The public health sector provides 65% of care services, therefore a shortage of public sector healthcare workers results in a huge impact on patients.

In 2015, Zimbabwe’s total health spending per capita ($104 USD) was higher than the sub-Saharan Africa average ($84 USD)5. However, this is because the high rates of out-of-pocket expenditure, paid by patients at point of care (24% of all health expenditure). Public health spending per capita is the lowest in the region and constitutes only 8.75% of all governmental spending. Furthermore, assistance from the international community accounts for 25% of Zimbabwe’s health spending, greater than the governments’ contribution of 21%5.

Health Priorities

The leading causes of death in Zimbabwe are HIV/AIDS (134 per 100,000 population), lower respiratory infections including TB (74) and neonatal conditions (65)6.

Zimbabwe implemented a series of health system reforms, switching to results-based finances and making maternal and child services free at point of access. This helped reduce maternal mortality by 23% between 2010 and 2017 and under-five mortality by 46% between 2010 and 20187. Furthermore, HIV infections decreased by 38% and AIDs-related deaths declined by 60%. This has been attributed to community engagement programmes and education, resulting in behavioural changes. Additionally, 91% of HIV patients in Zimbabwe now receive anti-retroviral treatments.

However, a 2018 study found that both outpatient and inpatient care is not equally accessible. High-income patients only accessed slightly more outpatient services but received 72% more inpatient admissions than low-income patients. This is likely due to hospitals chargin daily fees for in patient care. These hospital bills  can prevent people in need from using the services5.  Under-five mortality for the poorest Zimbabweans was 91 (per 1000 live births) compared to 51 for the highest earning quintile7.

The Zimbabwean health system works closely with the World Health Organisation (WHO). WHO programmes supplement the current reforms to improve a huge range of services including malaria surveillance, national TB strategies, integrating HIV care into family planning clinics and expanding primary care capacity. WHO also led the country’s COVID-19 testing strategy.

Zimbabwe is refocusing on the use of traditional medicine, especially in mental health services. There are only 10 practicing psychiatrists in the country, whilst 25% of adults accessing primary care report symptoms of mental health disorders. The Zimbabwe National Traditional Healers Association reports that patients respond better to care that meets their cultural expectations8. Programmes such as the Friendship Bench integrate traditional practises into mental health care and the training of new staff.

Genomic Medicine Capabilities

While genomic research is expanding in Zimbabwe, the country currently lacks the infrastructure and related funding to provide accessible genomic healthcare.

During the COVID-19 pandemic, Zimbabwe recorded five variants of the SARS-CoV-2 virus after the Ministry of Health and Childcare introduced genomic sequencing in May 2021. This was made possible due to the repurposing of available laboratory-based departments. In July 2022, the WHO ran a study to identify gaps in Zimbabwe’s genomic surveillance plans. They expanded Zimbabwe’s laboratory network, provided PCR machines and provided training in genomic sequencing for local scientists. They now aim to expand sequencing capacity beyond COVID-19 to include other emergent viruses in the region9.

In 2021, one of Zimbabwe’s foremost biomedical researchers, Dr Walter Chingwaru, founded the private Cell Biotech Institute (CBI). The centre aims to become a hub of knowledge where biomedical and clinical scientists can research, innovate, and train in the field of cellular biotechnology. Additionally, the CBI seeks to develop precision medicine using multi-omics. They currently run a diabetes clinic, a fertility clinic and provide cancer diagnoses and treatment. However, to be treated at the CBI patients must be referred by a family or hospital doctor, to which low-income patients face huge cost barriers10.

Genomic training is available in Zimbabwe. The African Institute of Biomedical Science and Technology (AIBST) based in the capital, Herare, offers a Master’s degree in Genomics and Precision Medicine11. In November 2022, the AIBST collaborated with Oxford University to launch a new training module focused on single-cell RNA sequencing and data analysis using the programming language R.

Notable Projects

  • The Genomics Inheritance Legal and Social Issues – A collaboration of social scientists and health professionals from both Zimbabwe and international institutions organised by H3Africa. The programme aims to examine the ethical, legal and societal issues related to the study of human genomics, in particular genetic data collection storage and sharing. The project aims to eventually provide guidance for stakeholder engagement and health policy in Zimbabwe.
  • The African Liver Tissue Biorepository (ALTBio) Consortium – A programme spread across three Southern African institutes, one of which is in Zimbabwe, that is biobanking liver samples. Donor DNA is genotyped and analysed for genetic variants unique to African populations. The programme aims to improve safety and efficacy of drug-based therapies for African patients.
  • WHO Project to Strengthen Genomic Surveillance – This project connected the Zimbabwean Ministry of Health and Childcare with WHO genomic experts. The project team examined the country’s current capacity for genomic surveillance and made recommendations for improvements. WHO provided new PCR machines and oversaw the expansion of laboratory capacity. Eventually, the project aims to expand genomic surveillance to cover Marburg virus and Moneypox, which are re-emerging in the region.

Notable Organisations and Companies

  • The African Institute of Biomedical Science and Technology – A research and education institute focusing on effective healthcare solutions for African nations. They provide postgraduate education and biomedical R&D training to Zimbabwean scientists, training 1280 scientists to date. It was founded in 2002 by Professor Colin Masimirembwa, initially focusing on drug discovery. In subsequent years, its research expanded to cover DNA sequencing, bioanalytics and diagnostic methodology in clinical trials.
  • ZimHealth – An international nonprofit and NGO founded by Zimbabweans living in Europe with the aim to provide support to health services in Zimbabwe. Registered in Geneva, they aim to educate, fundraise and raise awareness about the challenges facing this healthcare system. Additionally, they ensure that funds are equitably distributed into all areas of Zimbabwe. 

Notable Individuals

  • Professor Walter Chingwaru – One of Zimbabwe’s leading biomedical scientists. During a research sabbatical in Ireland, he studied cellular biotechnology, fluorescence microscopy and liquid handling platforms at the National University of Ireland, Galway. He used these skills to focus his research on cancer pathogenesis. He authored over 40 papers and spoke at international conferences, advocating for genomic research in African clinical care. In an effort to tackle the growing burden of non-communicable disease in Zimbabwe he founded the Cell Biotech Institute, which is bringing cutting-edge biotech tools to Zimbabwe.
  • Professor Collen Masimirembwa – a biomedical pharmacologist who specialises in genomic medicine. Following his completion of his BSc and DPhil in Biochemistry from the University of Zimbabwe, he spent 10 years as a Principal Scientist at AstraZeneca in Sweden before founding the African Institute of Biomedical Science and Technology. In his role as the President and CEO, he leads clinical genomics research and pharmacogenomics of African Populations.
  • Christopher Chetsanga – a renowned Zimbabwean scientist. His work identified two new enzymes involved in DNA repair and his research examined the role of RNA structure in cellular metabolism and pathogenesis. He is a member of the World Academy of Sciences and the African Academy of Sciences. He was the first President of the Zimbabwe Academy of Sciences after it’s formation in 2004. He used this position to advocate for the use of genetically modified crops to prevent food shortages in Africa.

The Future Genomics Landscape

There has recently been a steady increase in pharmacogenomics research in Zimbabwe, examining the risk of drug side effects in Zimbabwean communities. These studies aim to diversify the data used to calculate drug risks and provide patients with more accurate, precision care.

However, there has been a huge pan-African effort to bring genomic medicine to the continent. Organisations such as H3Africa, the CGTA and the Consortium for Genomics & Therapeutics in Africa are working across borders to accelerate the integration of genomic research into clinical practice. Zimbabwe already hosts the AIBST and works with the CGTA.

Currently, Zimbabwe does not have the ability to prioritise genomic medicine due to the huge challenges of out-of-pocket spending and the burden of long-term HIV/AIDs care. However, by using the opportunities provided by international collaborations, Zimbabwe could soon see rapid advancement of their genomic capabilities.

References

  1. Ingham, Kenneth , Sanger, Clyde William and Bradley, Kenneth. “Zimbabwe”. Encyclopedia Britannica, 1 Nov. 2023, https://www.britannica.com/place/Zimbabwe. Accessed 3rd November 2023.
  2. web.archive.org. (25 Oct. 2016). People: Anna Edson Taylor – Bay City, Bay County, MI / Bay-Journal. [online] Available at: https://web.archive.org/web/20161025032751/http:/bay-journal.com/bay/1he/people/fp-taylor-annie.html [Accessed 8 Nov. 2023].
  3. World Bank (2023). Zimbabwe . [online] The World Bank Data. Available at: https://data.worldbank.org/country/zimbabwe [Accessed 3 Nov. 2023].
  4. Chikanda, A. (2003). Skilled health professionals’ migration and its impact on health delivery in Zimbabwe . [online] University of Oxford : Centre on Migration. Available at: https://www.compas.ox.ac.uk/wp-content/uploads/WP-2004-004-Chikanda_Health_Migration_Zimbabwe.pdf [Accessed 8 Nov. 2023].
  5. Zeng, W., Lannes, L. and Mutasa, R. (2018). Utilization of Health Care and Burden of Out-of-Pocket Health Expenditure in Zimbabwe: Results from a National Household Survey. Health Systems & Reform, [online] 4(4), pp.300–312. doi:https://doi.org/10.1080/23288604.2018.1513264.
  6. World Health Organization (2020). Global health estimates: Leading causes of death. [online] World Health Organization. Available at: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death.
  7. Zimbabwe Network for Health: Annual Report 2019. (2017). [online] ZimHealth. Available at: https://zimhealth.org/wp-content/uploads/2020/06/ZIMHEALTH-ANNUAL-REPORT_2019_FINAL.pdf [Accessed 8 Nov. 2023].
  8. Kajawu, L., Chingarande, S.D., Jack, H., Ward, C. and Taylor, T. (2015). What do African traditional medical practitioners do in the treatment of mental disorders in Zimbabwe? International Journal of Culture and Mental Health, 9(1), pp.44–55. doi:https://doi.org/10.1080/17542863.2015.1106568.
  9. Mugarisi, V. (2022). Zimbabwe moves to strengthen genomic surveillance. [online] World Health Organization . Available at: https://www.afro.who.int/countries/zimbabwe/news/zimbabwe-moves-strengthen-genomic-surveillance [Accessed 8 Nov. 2023].
  10. Cell Biotech Institute. CBI Human Genomics – Cell Biotech Institute. [online] Available at: https://cell-biotech.com/cbi-human-genomics/ [Accessed 15 Nov. 2023].
  11. www.ndorms.ox.ac.uk. (n.d.). Empowering data science for single-cell analysis in Zimbabwe. [online] Available at: https://www.ndorms.ox.ac.uk/news/empowering-data-science-for-single-cell-analysis-in-zimbabwe [Accessed 15 Nov. 2023].