1358 research outputs found
Sort by
Duodenal diverticula and their complications
No full textDuodenal diverticula are rare. A patient with a solitary duodenal diverticulum complicated by ipper gastrointestinal haemorrhage is presented, rhe clinical features and complications of this condition are discussed
Bilharzioma of the fallopian tube: A case report
No full textSchistosomiasis, also known as bilharzia is an infection caused by trematode flatworms of any species of the genus Schistosoma. At least 261 million people in 74 countries are infected, and of these, 90% are in Sub- Saharan Africa.' In Zimbabwe, the prevalence is 38,2% for S. haematobium and 8,3% for S. mansonu A “bilharzioma” is a localised mass of fibrous and inflammatory tissue, which contains numerous eggs frequently involving the serosa and mesentery.1'4 Schistosomiasis caused by Schistosoma haematobium generally is asymptomatic, and if symptomatic, presents with terminal haematuria and rarely with other symptoms.5 Even in endemic areas, very rarely, will Schistosomiasis result in formation of a “bilharzioma”.3 The most commonly reported site is the intravesical part of the ureter resulting in stricture formation, but rarely bilharziomas are found in other sites including the female genital tract. Here we report a case of a “Bilharzioma” masquerading as a malignant tumour with seedlings in the fallopian tube
Factors associated with tumour stage at presentation in invasive cervical cancer
No full textObjective: The main objective of the study was to determine the demographic, social, clinical, laboratory and histologic factors associated with late stage presentation in cervical cancer. Design: A cross sectional study. Setting: Government tertiary referral institutions, Harare. Zimbabwe Study Population: One hundred consecutive cases of histology proven cervical cancer that presented Ku treatment between November 2001 and April 2002. Main Outcome Measures: The patients were categorized as early invasive cancer (stage 1 and 11) and late invasive cancer (stage III and IV). Results: The median age of the patients was 48 years (01=39 and Q3= 60). Eighty percent presented with late stage disease. Squamous cell carcinoma was the commonest histology (96%) with adenocarcinoma constituting only 4% of all tumours. Poorly differentiated tumour histology and no history of prior cervical cancer screening were found to be significantly associated with late tumour stage at presentation. The odds of presenting with late stage disease in women with a poorly differentiated tumour were 12.97 (95% Cl 2.03 to 82.55; p = .007), whilst the odds of late stage presentation in the absence of a history of screening were 11.13 (95% Cl 1.33 to 93.21; p = .026). Conclusions: Intrinsic tumour characteristics were the most important in this population in determining late stage at diagnosis and the value of screening was also highlighted by the results. The odds ratios had wide 95% confidence intervals, thus limiting their usefulness as point estimates
Risk factors for mortality in low birth weight infants at Harare hospital (maternity unit)
No full textBackground: Research evidence highlights that in low income countries half the infants born before 32 weeks gestation continue to die. More than 75% preterm infant deaths can be prevented without ICU care as these infants die from preventable causes such as hypothermia and hypoglycemia. According to WHO estimates, Zimbabwe is one of the 11 countries with a high preterm birth rate of over 15%.
Methods: In the current prospective cohort study, the researchers followed up infants less than 2000g at birth through the first 28 days of life to determine the mortality rate and age related risk factors for mortality in the follow up period.
Results: The overall mortality rate in the first 28 days was 51.2%. Mortality in the ELBW was 91.1%, VLBW – 54.4% and LBW – 28.8%. More than half the deaths (53%) happened in the first 48 hours of life predominantly in the first 12 hours. The independent risk factors for mortality in the first 12 hours of life were Respiratory Distress Syndrome (RDS), (RR 1.58 (95% CI 1.039 - 2.405) and infants born to mothers with Diabetes Mellitus (RR 2.31 (95 % CI 1.46 - 3.65). The late preterm infant had a significant risk of dying between day 3 and end of first week of life compared to other time periods (RR 3.14; 95% CI 1-18 - 4.30).
Conclusion: Our study demonstrates that neonatal mortality rate in this cohort was very high. The majority of the deaths occurred within 12 hours of birth and were largely due to extremely low birth weight. Use of life support mechanisms is very low at this unit due to resource constraints and shortage of nurses. Interventions to reduce mortality should address these issues in particular to improve treatment and monitoring during the initial critical 12 hours of life.
1Maternal and Child Health Integrated Program (MCHIP
The study to determine the relationship between perceptions of PMTCT and PMTCT uptake among antenatal women aged 18 – 40 years attending Highfield polyclinic.
No full textThe Zimbabwe MOHCH Annual Report (2007) highlighted that despite achievements in PMTCT, the national uptake remained fluctuating and low due to social-cultural and economic challenges, lower social status of women, increasing levels of poverty leading to sex work, ignorance and stigmatization. The same Annual Report highlighted that the national PMTCT uptake for Zimbabwe was 71% whilst that of Highfield Clinic was 65%. This is an area of grave concern for the nursing midwifery practice. The purpose of this study is to examine the perceptions of PMTCT and PMTCT uptake among antenatal women aged 18 to 40 years. The study was guided by King’s Goal Attainment Theory (1981). A descriptive correlational study was used to examine the relationship between dependent and independent variables. Probability, simple, random sampling of 86 subjects were recruited for quantitative data. Data was collected through face to face interview using a structured questionnaire developed by the investigator. The research instruments comprised of demographic, PMTCT uptake and perceptions of PMTCT prograrmme sections. Data analysis was done using descriptive and inferential statistics of Pearson Correlation coefficient for quantitative data. The findings reflected high PMTCT uptake for 75 (87.2%) respondents. The respondents’ perceptions of PMTCT were high,54 (62.8%). Pearson correlation analysis showed a statistical positive significant weak correlation (r = .242* p <0.05) of perceptions of PMTCT and PMTCT uptake among antenatal women indicating that when perceptions of PMTCT increase, PMTCT uptake increases. The regression coefficient was .059 showing that the importance of the perceptions of PMTCT is 5.9% in terms of contribution to the PMTCT uptake. This shows that perception of PMTCT had some effect to a little extent, on positively affecting PMTCT uptake. Further research needs to be done to find out the variance of the effect of perceptions of PMTCT on PMTCT uptak
Malaria in pregnancy
No full textIt is estimated that, nearly five billion episodes of clinical malaria occur worldwide each year. The disease causes about three million deaths annually with Africa suffering 90% of this burden.'it is also estimated that 25 million women fall pregnant in the malaria-endemic areas of Africa each year.2 Most o f the deaths due to malaria in Africa are in pregnant women and children under the age of five years.3 Plasmodium falciparum causes the most severe malarial illness and most cases in Africa are caused by this species of the malaria parasite.3The prevalence of Plasmodium falciparum infection among pregnant women in rural areas in parts o f Africa can be very high. Verhoff and co-workers found a prevalence ofplasmodium falciparum malaria of 35.3% among primigravidae and 13.6% in multigravidae in a study done among pregnant women in rural Malawi.4 Women who live in areas of high or moderate (stable) malaria transmission have a degree of immunity to malaria whereas women who live in areas of low (unstable) malaria transmission usually have no immunity to the disease.5 Pregnancy is known to cause a lowered capacity for type 1 immune response.6 This reduces immunity to diseases such as malaria, tuberculosis and leishmaniasis
The iron status of Zimbabwe blood donors
No full textBackground Transfusion medicine is a distinct and expanding discipline with a vital role in the health care system, according to the permanent secretary in the ministry of health and child welfare. In Zimbabwe the number of people who failed the copper sulphate test (haemoglobin screening test) shot up from 1249 in 2011 to 2360 in 2012 (89% increase). Failing this screening test is caused among other things by low haemoglobin levels which in turn are caused by low iron levels in the body. Checking haemoglobin levels alone is not enough to check the status of the donors, but a complete iron profile is necessary to ascertain the actual status of the blood donors. Aim To find out the iron status of blood donors in Zimbabwe. Materials and Methods A cross sectional study was done on 190 blood donors at the National Blood Service Zimbabwe (NBSZ). Left over samples were analysed for serum iron, serum ferritin, TIBC (total iron binding capacity) and transferrin saturation at Premier Clinical Laboratory. Donors recruited into the study ranged from first time donors to donors who had donated up to 8 times in the past two years. Results
A total of 190 (109 males and 81 females) blood donors participated in this study. The median age was 23 years and the inter quartile range was 19.0-27 years. The range of the age was from 16 years to 67 years. The median number of donations was 4 and the interquartile
iii
range was 5-6 units over the two year period under study. The median serum iron levels was 13 μmol/L with the inter quartile ranges from 10.0-17.8 μmol/L. For ferritin the median value was 30 ng/ml with the inter quartile ranges from 18.0-56.8 ng/ml. The median for TIBC was 74.1 μmol/L with the inter quartile ranges from 63.3-82.3 μmol/L. For transferrin saturation the median was 17.6 μmol/L with the inter quartile ranges from 12.0-26.9 %. The statistical analysis was done by the ANOVA test. As for serum ferritin levels there was statically significant differences in the mean ferritin levels between group 1 and groups 6,7 and 8 (p<0.01) for men. For females there was statistically significant difference in the mean ferritin levels between the control group and group 6 and 7 (p <0.05). The overall prevalence of iron deficiency in the study population was 13.2% and the prevalence of reduced iron stores was 37.4 %. Conclusion These findings suggest that repeated blood donation causes a reduction in the iron stores of the blood donors in Zimbabwe and there is need to include biochemical markers, (serum iron, serum ferritin, TIBC and transferrin saturation) in the screening of blood donors, especially from the fifth unit
Preoperative anxiety levels in obstetric patients receiving spinal anaesthesia: Does an information booklet reduce anxiety and improve quality of anaesthesia?
No full textOBJECTIVE: To look at levels of preoperative anxiety in patients who are to have caesarian section under spinal anaesthesia and determine if availing an information booklet to the patients would reduce anxiety.
MATERIALS AND METHODS: One hundred and twenty patients were included on baseline assessment of anxiety. The anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Shona version of it was validated. Patients randomly selected into group A received the information booklet the day before surgery while those in group B did not. Anxiety was reassessed on the day of surgery. The day after surgery a survey of the patients’ satisfaction with the spinal anaesthesia was done.
RESULTS: Three patients out of the 120 were lost to follow-up for unforeseen reasons. Baseline anxiety assessment showed that 38 out of 60 patients in group A and 45 out of 60 patients in group B were anxious and this was statistically significant (p=0.000). There was an increase in the number of anxious patients in groups A and B on the day of surgery from 38 to 43 and from 45 to 48 respectively. This increase however was not statistically significant (p=0.1307 group A, p=0.1500 group B). Regarding need for information, those with none or little need for information were 42.7% (p=0.099), average need for information 18.8% (p=0.031) and with high need for information 38.5% (p=0.001). Regarding the relationship between anxiety and need for information there was a positive correlation for both group A and B(r=0.638, p=0.000 and r=0.797, p=0.000 respectively). One hundred and eleven (94.9%) of patients were satisfied with the spinal anaesthesia and 110(94.0%) were willing to have it if they were to have subsequent
caesarian section.
CONCLUSION: There was preoperative anxiety in patients scheduled for caesarian section. The information booklet did not reduce anxiety. The high need for information was significant in the group that did not have access to the booklet. Patients were however satisfied with spinal anaesthesia
Prevalence and the correlates of postnatal depression in an urban high density suburb of Harare
No full textIntroduction: Postnatal depression is a common cause of morbidity but is rarely diagnosed or adequately managed in busy primary care settings in most resource limited countries like Zimbabwe.
Objectives: This study sought to determine the prevalence of postnatal depression and establish factors associated with postnatal depression.
Methods: The study utilized a cross-sectional descriptive design where 295 consenting women (mean age=25.4 years; SD= 5.6 years) attending post natal care services at Mbare Polyclinic were recruited. Data were collected using the validated Shona version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Associations between variables were computed using the chi-square test statistic and where appropriate the Fisher's exact statistic.
Results: Prevalence for postnatal depression was 34.2% among women in the study. Univariate analysis revealed that there were no statistically significant associations between mother's age (p=0.120), parity (p=0.396), marital status (p=0.523), level of education (p=0.805), and age of child (p=0.489) and postnatal depression.
Conclusion: Findings from this study indicate that there is a high prevalence of postnatal depression in women in Mbare, Zimbabwe. This therefore calls for further studies to identify and address the causes of postnatal depression among women attending postnatal care in Zimbabwe
Distal Hypospadias Repair: Comparison of Snodgrass versus Modified Mathieu Procedures: A Randomized Clinical Trial
No full textBackground
Hypospadias is defined as the presence of abnormal meatal opening along the ventral aspect of the penile shaft or into the perineum. Of the many operative techniques for distal hypospadias repair, two techniques have particularly attracted the attention: the Snodgrass (TIP) and the Modified Mathieu Procedure (MMP). The effectiveness of the two techniques in terms of success and complication rates remains controversial.
Objectives
The primary objective of the study is to compare the success rates between the two procedures, MMP (Modified Mathieu Procedure) versus TIP (Tubularised incised plate, Snodgrass).
The secondary objectives of the study are:
1. To compare the complication rates between the two procedures.
2. To compare the operative time between the two procedures.
Methods
Eligible boys were randomly assigned with equal probability to undergo one of the techniques of hypospadias repair: the Snodgrass procedure (tubularized incised plate technique, TIP) or the modified Mathieu procedure (parameatal based flap, MMP). We enrolled 118 patients, 59 in each arm, from January 2006 to February 2008. The patients were assessed at the first dressing at day seven and discharged. They were reviewed monthly up to three months post operatively and the complications, namely stenosis (MS), urethral stricture (US), urethrocutaneous fistula (UCF), urethral diverticulum (UD), penile curvature (PC) and wound breaking (WB) were recorded. Success was defined as the absence of the mentioned complications.
Findings
In this study, 83 patients were enrolled. They were aged between 2 years and 13 years, mean age 7.5 years. The success rates were 68.29%, 95% CI (54.20-84.5) for TIP versus 74.35%, 95% CI (57.18-89.91) for MMP. The following complications were recorded: MS (9.75%), US (14.65%), UCF (9.75%) for TIP versus MS (5.12%), US (5.12%), UCF (7.69%), UD (5.12%) for MMP. The complication rates were 34.14%, 95% CI (20.08-50.59) for TIP versus 23.07%, 95% CI (11.13-39.33) for MMP. The mean operative time was 90 ± 24minutes versus 110 ± 25 minutes (P0.05) for TIP and MMP respectively.
Conclusion
The difference of success rates between the two interventions was not statistically significant. The same conclusion was reached in terms of complication rates between the two techniques. The mean operative time was shorter for TIP as compared to the MMP. Both techniques are equally used. The choice being influenced by surgeon’s skills