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ANALYSIS ON THE BURDEN OF HELMINTHS-Plasmodium falciparum POLYPARASITISM, EFFECT ON ANAEMIA AND THE ROLE OF INTEGRATED SCHOOL BASED PARASITE CONTROL AND HEALTH EDUCATION IN ZIMBABWE.
No full textIntroduction: Globally, 207 million; 2 billion and 243 million people are infected with schistosomiasis (SCH), soil transmitted helminths (STH) and Plasmodium falciparum (P.f) respectively. Many of the affected people are primary school age children. Clinical outcomes of these parasitic infections include anaemia, impaired cognition and malnutrition. Although these parasites have different mechanisms through which they cause anaemia, data is scarce on the extent of helminths –Plasmodium polyparasitism and their effect on anaemia. We determined the extent of helminths-Plasmodium co-infections, their effect on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anaemia among primary schoolchildren in rural and farming areas in Zimbabwe.
Overall objective: To determine the prevalence of single and helminths–Plasmodium co-infections among primary schoolchildren living in rural and commercial farming areas, the effect of co-infections on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anemia.
Settings: The study was conducted in Nyamaropa rural area, Shamva districts and Burma Valley commercial farming areas in Mutare district, Zimbabwe.
Study design: The study was a longitudinal intervention trial, which involved treatment of infected children at baseline, 6, 12 and 33 months follow up surveys.
Methodology: Enrolled participants were screened for anaemia; schistosomiasis; STHs and P. falciparum (P.f) using the Hemocue machine, urine filtration technique, a combination of the Kato Katz and formal ether concentration techniques and Giemsa staining respectively at each survey.
Results: Helminths- Plasmodium co-infections were heterogeneously distributed and were observed in the commercial farming area only. Overall, the prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, that of S. mansoni was 12.4% and 22.7%.. P. f, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Hookworm and S. mansoni infections were associated with P. f (P < 0.001, OR = 2.48, 95% CI: 1.56-3.93 and P = 0.005, OR = 1.85, 95% CI: 1.20-2.87). Of the 475 children screened for all parasites and anaemia, received combined treatment at baseline and successfully followed up to 33 months post treatment survey, 11.2%; 10.9%; 1.3% and 5.1% had SCH + STHs; SCH + P. f; STH + P. f; SCH+ STH + P. f co-infections respectively at baseline. These co-infections declined to 6.3%; 2.1%; 0.4; 1.1%, respectively at 33 months follow up survey. Overall, anaemia declined from 45.7% at baseline to 15.4% at 33 months follow up survey after treatment intervention, p < 0.001. School health education increased the knowledge of grade 3 children about causes of helminths and P. falciparum
Conclusions: There is heterogeneity in the distribution of helminths –Plasmodium co-infections in diverse communities. Co-infections have a multiplicative effect on anaemia. Biannual combined school based treatment intervention reduces the prevalence of helminths-Plasmodium co-infections and anaemia. Determination of the extent of helminths –Plasmodium co-infection should be prioritized in planning allocation of limited resources for control. The Government of Zimbabwe nationalized this PhD work. The work also contributed towards the national policy formulation for the control of schistosomiasis, STH and other neglected tropical diseases in Zimbabwe.WHO/TDR & Essential National Health Research funding (Health and Child Welfare
Single dose metrifonate in the treatment of urinary schistosomiasis in an area of low prevalence and intensity of infection
No full textUrine specimens from 638 primary school children in Gokwe Communal Land were examined for S. haematobium ova, and the 187 (29%) children who were excreting eggs were treated with a single lOmg/kg dose of metrifonate. Futher urine samples were collected from all children, whether treated or not, 48 weeks later, and examined for ova.
The overall cure rate was 50,8%, and in children not cured egg excretion was reduced by an average 59,9%. Only 12,1% of children were excreting > 50 eggs per ml of urine before treatment, and after this was reduced to 3,9%.
Increased egg excretion following treatment was noted in 15 (8,0%) of the infected children, while 21 (4,7%) children with negative urines, and therefore not treated, were excreting eggs 48 weeks later.
Thus even in an area where the prevalence and intensity of infection is low, single-dose metrifonate may play a cost-effective role in the control of urinary schistosomiasis
Annular subvalvular left ventricular aneurysm: A case report
No full textAnnular subvalvular left ventricular aneurysm is a curious condition that has predominantly been seen in Africans. We describe a 36 year old man who presented with chest pain, recurrent syncope and left ventricular failure, and was found to have a typically located annular subvalvular left ventricular aneurysm. The aneurysm initially perforated into the left atrium and terminally ruptured along its free wall. The lesion was fully defined by colour doppler echocardiography and later confirmed at autopsy. Such aneurysms are not uncommon in Africa and need to be considered in the differential diagnosis of cardiac presentations, as appropriate and timely treatment can be effective
SIDE LAB MANUAL
No full textThe laboratory has become more essential in the clinical
examination of patients. However there has been a
tendency for the clinician to relegate even simple tests to
specialist laboratory workers. This has its disadvantages.
First, the clinician has less insight into the meaning and
potential errors of the test. Second, depending on the main
lab the test results may become available later than if the
tests were done in a ward side-lab. Finally, the side-lab
tests may be the only results available to the clinician
during an emergency at night.MEP
The relationship between knowledge level on self-care and occurrence of aggression in schizophrenic patients aged 18-45 years attending the out patients department at Parirenyatwa hospital psychiatric unit Annex
No full textThe Parirenyatwa Group of Hospitals Psychiatric Unit is a government referral hospital for psychiatry for all the provinces in Zimbabwe. The extent of occurrence of aggression was 11.1% for 2012 which is a cause for concern. In Ethiopia the prevalence of aggression in the community is 19.6% whereas in America 80.9% of aggression in schizophrenic patients . The purpose of the study was to examine the relationship between knowledge level on self-care and occurrence of aggression in schizophrenic patients attending the Outpatients clinic at Parirenyatwa Group of Hospitals Psychiatric Unit in April/May 2013. Orem’s self-care conceptual model was used to guide the study particularly that the model emphasises on empowering the self-care agency. A descriptive correlational study design using a probability simple random sampling method was used to select a sample of 80 subjects from the Outpatient’s clinic attendances. A structured interview schedule was used to collect data. The instrument used had three sections, demographic, occurrence of aggression and knowledge on self-care data questionnaires. SPSS version 10 was used for statistical analysis. Descriptive statistics were used to analyse demographic , occurrence of aggression data, knowledge on self care data. Inferential statistics were used analyse knowledge on self care. Sixty percent of the participants were aged between 25-45 years, (52.5%) were women, and (41.2%) were married. Though the majority (95%) had gone through formal education (90%) of these were from the lower socio-economic class . Fifty percent had 1-5 episodes of aggression. Pearson’s coefficient correlation showed a moderate negative correlation between knowledge level and occurrence of aggression (r= -.390, p< .01). Regression analysis of occurrence of aggression data indicated a moderate linear relationship R – Squared=0.16(F=0.159) at p<0.01 therefore only 16% of aggression is accounted for by level of knowledge on self care. Patients require more input from nurses on self care to reduce the occurrence of aggression
Genotypic characteristics of rotavirus strains detected in children aged less than five years with gatroenteritis hospitalized at the three sentinel sites: Parirenyatwa central hospital, Harare central hospital and Chitungwiza central hospital; Zimbabwe, 2010
No full textA total of 784 faecal samples collected during the 7 months period, January to July 2010 from children under 5 years old with diarrhoea who were admitted at the 3 referral hospitals; Parirenyatwa Hospital, Harare Hospital and Chitungwiza hospital, were tested for presence of rotavirus antigen using enzyme immune-assay (EIA). Fifty faecal samples from children without diarrhoea were also tested for rotavirus antigen. Sixteen (32 %) of 50 non-diarrhoeal samples and 515 (65.7 %) diarrhoea samples were rotavirus positive. The association between diarrhoea and detection of rotavirus in faecal samples was statistically significant with an overall odds ratio of diarrhoea patients of 4.08 (p<0.0001). The rotavirus diarrhoea prevalence (59.4 %) was high in children ≤ 18 months old diarrhoea patients. The high prevalence of rotavirus diarrhoea was found during the dry cool season in diarrhoea patients < 59 months of age. Fifty rotavirus positive isolates from diarrhoea patients were genotyped using reverse-transcription polymerase chain reaction. A large proportion of samples could not be genotyped; 28.6 % did not produce G genotype result, and 43.2 % did not produce P genotype result. Of the strains that could be genotyped, G9 (24.3 %) was more predominant, followed by G2 (10.9 %), and P[6] (31 %) was more predominant followed by P[4] (14.3 %. The G and P combinations which were more predominant were G1P[6], G9P[6] and G8/G12P[4]. The RNA electrophoresis of the rotavirus genome was performed on 30 rotavirus positive samples, 90 % produced migration patterns typical of the group A rotavirus: 70.4 % were long electropherotypes and 22.2 % were short electropherotypes. The identification of unusual P and G combinations in Zimbabwe may affect the efficacy of currently available rotavirus vaccine formulations and may contribute to the design and development of a broadly reactive rotavirus vaccine for use in African countries
Molecular detection and identification of genital human papillomavirus genotypes in female college students by polymerase chain reaction and DNA sequencing in Harare
No full textIntroduction and objectives: The human papillomaviruses (HPVs) are the most common sexually transmitted infections worldwide and are a major cause of morbidity and mortality amongst women. World-wide, data on HPV infection in young women is scarce. It is thus important to determine the prevalence of HPVs per region as the distribution of genotypes differs according to geographic location, race and the genetic make-up of individuals. The objective of the study was to detect and identify genital human papillomaviruses in young female college students in Harare, and to assess their knowledge, attitudes and practices (KAP) with regards to HPV infection.
Materials and methods: Self-collected vaginal swab specimens from female college students aged 20-25 years were processed and genomic DNA extracted. Human papillomavirus-DNA was amplified by consensus polymerase chain reaction (PCR) with two pairs of primers (MY09/MY11 and GP5+/GP6+). PCR products were visualised by gel electrophoresis and positive specimens genotyped by DNA sequencing. A socio-demographic questionnaire was also administered to the students.
Results: One hundred and fourteen out of 125 swabs had genomic DNA successfully extracted. Of the 114, 36 (31.58%) tested positive for HPV-DNA with the MY09/MY11 primer set and 26 (22.80%) with the GP5+/6+ primer set. MY09/11 primers showed higher sensitivity in HPV-DNA detection. The most prevalent HPV genotypes identified by sequencing were high-risk HPV (16, 18, 45, 58) and low-risk HPV (6 and 81) all detected at a prevalence of 7.69 %. The age range of participants recruited was 20-25 years. They collectively had a mean age of first sexual activity of 19.22 years. There was a lack of HPV related knowledge in the study population.
Conclusion: A high prevalence of HPV infection in young college women in Harare was observed. Demographic data and HPV prevalence also suggested a statistical link between HPV infection and multiple sexual partners, having more than one previous sexual partner and an early onset of sexual activity. The KAP survey showed poor knowledge on HPV issues amongst the study participants
Fetomaternal outcomes of pregnant women admitted with malaria at Parirenyatwa hospital and in Mashonaland East province of Zimbabwe
No full textINTRODUCTION
There are 300million to 500million people who are infected with malaria worldwide every year and the disease kills about 3million yearly. 90% of the cases occur in Sub-Saharan Africa where HIV is also prevalent. Malaria is one of the major contributing factors to fetal and maternal morbidity and mortality causing severe anemia, cerebral malaria, renal failure, miscarriage, stillbirth and low birth weight. Zimbabwe has made significant achievements in reducing the incidence of malaria in the general population according to the data from the Ministry of Health and Child Welfare Department of Malaria Control but the disease burden remains high[Figure 1]. Malaria is the fifth leading cause of maternal mortality in Zimbabwe [6]. However, there is limited data on the impact of the disease on high risk groups like pregnant women in Zimbabwe.
This was done as a cross sectional descriptive survey to evaluate the effect of malaria on pregnant women and their fetuses.
OBJECTIVE
Main objective
1) To evaluate maternal and fetal outcomes of malaria in pregnancy
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Other objectives
1) To assess factors which influence maternal and fetal outcomes.
METHOD
A cross sectional descriptive survey was done on pregnant women admitted with malaria over a period of 8 months (September 2011-April 2012).
An interviewer administered questionnaire was used to gather information on women admitted in the antenatal or labour ward with a diagnosis of malaria.
District hospitals (Mutoko, Murewa, Mudzi) in moderate to high seasonal malaria transmission located in Mashonaland East Province of Zimbabwe and one tertiary hospital, Parirenyatwa Hospital, were identified for the survey.
RESULTS
Of the 103 cases of malaria in pregnancy studied, there were 2(2%) maternal deaths, 6(6%) cases of severe anaemia and two cases of cerebral malaria. Maternal adverse outcome were influenced by booking status, human immunodeficiency virus(HIV) status, use of intermittent presumptive therapy(IPT), insecticide treated bed nets(ITNS) and late presentation to hospital. Ninety three cases were discharged from hospital without major complications.
There were 24(23%) live term babies, 10(10%) preterm deliveries, 10(10%) cases of low birth weight, 6(6%) stillbirths, 9(9%) miscarriages and two cases of threatened miscarriages. Fifty two percent of the participants were still pregnant when they were
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discharged from hospital. There was under utilization of IPT (45%) and ITNs (45%) by participants.
CONCLUSION
Malaria infection had adverse effects on both mother and foetus. It was associated with maternal mortality and morbidity. Anaemia, cerebral malaria and maternal death were the main maternal complications encountered in this survey. Maternal adverse outcomes were influenced by booking status, HIV status, use of IPT, ITNS and time taken to present to hospital after onset of disease. There was significant fetal wastage (15%) resulting from miscarriages (9%) and stillbirths (6%). Malaria infection was also associated with low birth weight (28%) and preterm delivery (10%).
The survey also revealed that there was underutilization of prevention strategies (IPT and ITNs) by 45% of participants which was mainly due to failure to book or late booking for antenatal care (ANC). Case management was generally according to standard guidelines but participants were not adequately investigated in terms of other parameters such as complete blood count and renal function
Prevalence and risk factors for hypertension among Bulawayo City Council employees, 2010
No full textPrevalence and risk factors for hypertension among Bulawayo City Council employees
Introduction: An increase in the number of employees with raised blood pressure during routine medical examinations from less than two in every ten to four in every ten during the third quarter compared to the first and second quarters of 2009 prompted an investigation on the prevalence of hypertension and risk factors among Bulawayo City Council employees.
Methods and Materials: Analytical cross-sectional study was carried out. Three hundred and two participants were selected by systematic random sampling from employee registers. Questionnaire adapted from World Health Organization STEPwise approach to Surveillance non communicable disease instrument was used to collect data on risk factors. Blood pressure and anthropometric measurements were taken as per World Health Organization STEP guidelines. Hypertension was defined as systolic blood pressure of ≥140mmHg and/or diastolic blood pressure of ≥90mmHg.
Results: Mean systolic BP was 134.1±18.6mmHg and mean diastolic BP was 83.3±19mmHg. Prevalence of hypertension was 38.4% (116). The prevalence of hypertension was higher in females than males. Prevalence of undiagnosed hypertension was 14.2% (43). Seventy three (80%) of hypertensive participants were on treatment but only 21 (39%) of them had well controlled BP. Independent risk factors for hypertension were being aged 40 years or older (AOR 5.95, 95% CI 3.29; 10.77), being obese (AOR 3.66, 95% CI 1.89; 7.06), current tobacco smoking (AOR 3.26, 95% CI 1.05; 10.10), family history of hypertension (AOR 2.87, 95% CI 1.56; 5.28) and being married (AOR 1.95, 95% CI 1.03; 3.67).
Conclusion: There was a high prevalence of both diagnosed and undiagnosed hypertension. Despite high percentage of treatment among hypertensive participants, majority were at risk of developing complications because of poor control. Health education on hypertension and setting up of a surveillance system for hypertension and its risk factors are necessary to reduce the burden of hypertension and related illnesses. Further studies on factors associated with obesity and poor control of blood pressure among hypertensive people on treatment are needed.
Key words: Prevalence, hypertension, risk factors, Bulawayo City employees, Zimbabw
