1358 research outputs found
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A prospective study of hypertension in pregnancy at Harare maternity hospital
No full textrat of patients during a one-month study within the Greater Harare Obstetric Unit. Pre-eclampsia was the most common type of hypertension present in 72 (33,6%) patients. The
:pidemiological characteristics of the patients with different forms of hypertension in pregnancy are presented.
The perinatal mortality for hypertensive patients was 79,4/1 000 compared to 26,2 /I 000 in tormotensive patients. Patients with prcgnancy- nduced hypertension had the lowest perinatal mortality at 18,2/1 000. Proteinuric hypertension | was associated with an increased perinatal mortality, the worst prognosis being in patients with chronic hypertension with superimposed preeclampsia. The percentage of patients with proteinuria increased as the maximal level of diastolic blood pressure increased.
The findings are discussed with reference to the literature
Posterior fossa tumours in children at Parirenyatwa hospital
No full textBackground: It is important to know the epidemiology of posterior fossa tumors in children.Groups at risk can then be identified and followed up with the aim of reducing late presentation and improving outcome. However larger, long term studies are needed to accurately achieve this.
Objectives: The aim was to describe the effect of demographics, social background and HIV on the occurrence of posterior fossa tumors.
Design: Prospective Cross sectional study of children treated for posterior fossa tumors at the Neurosurgical unit of Parirenyatwa referral hospital.
Setting: Neurosurgery unit, Parirenyatwa teaching and referral hospital.
Materials and methods: A total of 32 children admitted with imaging demonstrating a posterior fossa tumor were included after the parents gave consent for their children to participate in the study. No patients were excluded from the study. All patients were also tested for HIV using the antibody tests. Data was collected by administering a questionnaire.
Results: Most cases came from Manicaland province with mean age of the patients being 6.7(SD) years and age ranging from 2 – 12 years. Median time to presentation from symptom onset was 3.5[2 - 6] months. Most patients were of poor socio economic status. A total of 7(21.7%) were HIV positive.
Conclusion: Posterior fossa tumors at Parirenyatwa hospital occur more commonly in low income families from Manicaland. There was a higher HIV rate in the study patients compared to the pediatric population. The sample size was however too small to demonstrate a statistically significant correlation between HIV and posterior fossae tumor occurrence.
Keywords: posterior fossa tumor, epidemiology, socio-demographics, pediatric brain tu-
mors, HIVNECTA
A study to determine the relationship between level of woman empowerment and level of self-care among HIV positive pregnant women aged 15-49 years at Morgenster mission hospital in Masvingo province
No full textHuman immunodeficiency virus (HIV) continues to be a major public health problem locally, regionally and internationally (Arron, 2007). Global UNAIDS 2013 report stated that 35, 5-38, 8 million people were living with HIV by December 2012 and approximately 60% of them being women. HIV prevalence among women aged 15-49 years in Zimbabwe is 16.4%, Avert Zimbabwe (2014) reported. Zimbabwe like any other countries which adopted the June 2013 WHO new integrated HIV treatment guidelines recommending lifelong antiretroviral therapy Option B+ for all HIV positive pregnant women and lactating mothers for their own health and prevention of mother to child transmission. Culture, socioeconomic status, and religion have left HIV positive pregnant women vulnerable to inability in accessing health care services. The purpose of this research was to determine the relationship between empowerment and self-care among HIV positive pregnant women aged 15-49 years at Morgenster Mission Hospital Antenatal Clinic in Masvingo Province. The study utilised Orem’s self care model. A quantitative descriptive correlation design was used in the study, whichdescribes the relationship between variables only without exploring cause and effect relationships. A sample of 96 HIV positive pregnant women aged 15-49 years was selected conveniently. A structured interview schedule was used for data collection after a pre-run of the study instrument for validity and reliability. The questionnaire had closed and open ended questions which took 15 to 20 minutes to answer. Data was analysed using the statistical package for Social Science (SPSS -PC). The research questions were analysed using descriptive and inferential statistics. Linear regression analysis was used to test the strength of the relationship between empowerment and self care. Only 32 (33.3%) were empowered and 31 (31.3% could self care
Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy
No full textBackground: Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe. Aim: To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure. Objective: To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results. Design: Adescriptive cross-sectional survey. Setting: Harare Central Hospital adult opportunistic infections clinic. Participants: One hundred and eighteen (118) HIV positive participants on Is' line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovuume combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled. Main Outcome Measures: First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines. Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% Cl 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% Cl 1.3-14.7], Factors associated with lower odds of treatment failure were age =42 [OR 0.3; p-value 0.007; 95% Cl 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% Cl 0.05-0.8], time on ART >4 years [OR 0.6; p-value 0.02; 95% Cl 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% Cl 0.2-0.8], There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% Cl 3.6-21.2], Conclusion: Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failure
Factors influencing dietary patterns in Mt Darwin: a rural population of Zimbabwe, 2013.
No full textIntroduction: Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases (CVD) and cancer. CVD are increasing throughout the world and cause 16.7 million deaths each year. In Zimbabwe, hypertension is the top leading cause of outpatient chronic conditions and its proportion to the overall burden is 48.9%. In Mt Darwin hypertension (51.4%) remains the chronic condition with the highest burden. Eating a healthy diet such as high fruits and vegetables, low fat and low salt have been shown to substantially reduce CVD and increase quality of life. This study sought to determine factors influencing dietary patterns in Mt Darwin district.
Methods: The study was an Analytic Cross Sectional study and the sample size was 350. Data was collected by an Interviewer Administered Questionnaire targeting people in Mt Darwin that are over the age of 18 years. Multistage sampling was done. Epi info version 3.5.1 was used to create frequencies and proportions were calculated as well as Odds ratios to determine associations. Multivariate Logistic regression analysis was done to identify independent risk factors and to control for confounding variables.
Results: Three hundred and fifty (350) participants were included in the study. Being male or female [POR=3.97; 95% CI (2.28-6.89)], preferring fatty foods [POR= 2.1; 95% CI (1.11-3.99)], adding salt to served food [POR=0.42; 95% CI (0.26 -0.67)], boiling food as a method of preparation [POR=1.65; 95% CI (1.05-1.59)], and perceiving that a big body means one is healthy [POR=0.56; 95% CI (0.36-0.96)] were significantly associated with dietary patterns. Being male or female [AOR=0.23; 95% CI (0.13-0.40)], boiling food as a method of preparation [AOR=1.69; 95% CI (1.03-2.76)] and preferring fatty foods [AOR=2.56; 95% CI (1.29-5.06)], remained significant on logistic regression analysis.
Conclusion and Recommendations: Unhealthy dietary patterns have been found to be prevalent in Mt Darwin, especially among women. Taste and food preference, and image and body size were factors influencing dietary patterns in this study. Health education messages of diet should encompass all social and cultural context issues around food, including correction of myths
Morbidity changes between HIV unexposed uninfected and HIV exposed uninfected children in Harare –a secondary data analysis
No full textBackground: Optimising the survival of HIV exposed uninfected (HEU) infants is a major challenge. There is a significant swift increase in the HEU population due to the introduction of the highly active antiretroviral therapy (HAART). Infections may be more severe in the HEU children as compared to their HIV unexposed uninfected (HUU) counterparts. Longitudinal studies give an understanding of the morbidity patterns in HEU children and possible factors associated with the observed morbidity differences between HEU and HUU can be explained through a longitudinal model. Broadly, this study aims to assess morbidity trends and factors associated with change in morbidity between HEU and HUU children in a nine months follow-up period.
Materials and Methods: A cohort of index babies was followed up from delivery for nine months. The maternal HIV status during pregnancy set as the exposure status for this cohort. Morbidity outcomes, illnesses and admissions, were observed within the follow-up period between the HEU and HUU children. HIV exposed infected (HEI) index babies were excluded from the analysis. The follow-up time points were at six weeks, four months and nine months. Mixed effects logistic regression analysis was used to determine factors associated with change in morbidity between the HEU and HUU.
Results: The average child-specific intercept for the log odds of morbidity was 1.04. There was a 1.12 heterogeneity difference at baseline. A negative exposure change of 0.06 in the first sixteen weeks and a positive exposure change of 0.04 after sixteen weeks were observed. Being HEU had a protective effect with an odds ratio of 0.77 and a confidence interval of (0.38; 1.26) which is not statistically significant. .
Conclusion: Being exposed to HIV is protective with an odds ratio of 0.77 (0.38; 1.26). There is a significance difference in the heterogeneity of the groups at baseline. The unexposed group has a significant negative trend during the first sixteen weeks and a positive trend after sixteen weeks. The exposed group has a less negative and positive trend across time. The family size has a protective effect towards morbidity in children
Lipodystrophy among patients on antiretroviral therapy at Harare City Opportunistic Infections Clinics, 2010
No full textObjective: To determine factors associated with lipodystrophy among patients on anti-retroviral therapy (ART) at Harare City Opportunistic Infections Clinics
Design: Unmatched 1:1 case control study
Setting: Two ART initiating and referral hospitals belonging to Harare City Health Department in Zimbabwe
Subjects: Patients aged 12 years and above on ART at Harare City health facilities for at least 18 months
Main outcome measures: Type and severity of lipodystrophy, factors associated with lipodystrophy
Results: Out of all participants females constituted 84.3% of cases and 71.9% of controls. The median duration on ART was 48 months (Q1=25; Q3=61) for cases and 35.5 months (Q1=25; Q3=46) for controls. Lipodystrophy affected the legs in 194 (92.38%) cases. The most common type in females was the mixed type (74.8%) and lipoatrophy (53.13%) in males. Of the cases 150 (71.43%) perceived their condition as severe. The median HIV Outpatients Survey (HOPS) scale for the legs and buttocks each was 3 (3; 3). When lipodystrophy developed 197 (93.81%) cases were on a stavudine based combination and 11 (5.24%) on a zidovudine based combination.
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Factors associated with lipodystrophy were a stavudine based regimen (OR=9.84; 95% CI 5.47-16.44), difference between first repeat and baseline CD4 above 400 (OR=5.18; 95% CI 1.95-13.78), age above 40 years (OR=2.47; 95% CI 1.46-4.29), duration after testing HIV positive greater than 4 years (OR=2.37; 95% CI 1.43-3.94), WHO stage at initiation above 2 (OR=2.17; 95% CI 1.29-3.66), female sex (OR=2.16; 95% CI 1.29-3.59) and a baseline CD4 below 100 (OR=2.16; 95% CI 1.29-3.59). A baseline BMI below 20 (OR=0.53; 95% CI 0.31-0.91) was protective.
Conclusion: Stavudine based regimen was the most significant factor. Patients belonging to the high risk groups should not be initiated on stavudine whilst those already on stavudin
An Experimental Pharmacokinetic Computer Program to Predict Potential Drug-Drug Interactions
No full textPublisher's version available from http://aibst.com/pdf/Masimirembwa_TODMJ%5B1%5D.pdfPolypharmacy as a result of combating co-infections, or combination therapy for better efficacy and reducing
the emergency of drug resistance, is on the increase in the African clinical setting in the advent of HIV/AIDS, and tuberculosis
(TB) co-infections, and increasing incidences of malaria and other tropical infections. The clinicians and pharmacists
are therefore faced with the challenge of prescribing drugs in combinations that are likely to result in severe adverse
effects or compromising treatment success. The aim of this study was, therefore, to develop a simple stand alone or network
based experimental computational tool to assist doctors and pharmacists in detecting drug combinations likely to result
in undesirable metabolism based drug-drug interactions (DDIs) and offer alternate safe prescription options. The
mechanism of most drug-drug interactions is through inhibition and induction of drug metabolising enzymes. Models for
the prediction of reversible and irreversible inhibitors of the major drug metabolising enzyme system, cytochrome P450,
were used in developing the pharmacoinformatic tool. These models enable the prediction of likely in vivo drug-drug interactions
from in vitro data. In vivo drug-drug interaction data from the literature was also loaded into the software to
validate the system and to give clinical guidance on specific drug-drug interactions. In this first phase of the project, focus
was on medications used in the treatment of HIV/AIDS, TB, malaria and other diseases common in Africa. The prototypic
tool was based on a Standard Query Language (SQL) database with DELPHI 6.0 as the user interface. Its user friendly
pages lead the doctor or pharmacist through drug combination entry functions and gives warning if an interaction is likely.
Subsequent actions enable the operator to retrieve more information on the mechanism of interactions, the quantitative
measure of the interaction, access to published abstracts on studies, and possible prescription options to minimise DDIs.
The software currently has data for 50 drugs used in the design and focuses on the treatment of tropical diseases in addition
to classical cases of drug-drug interactions involving other general classes of drugs. The tool can be distributed on
Compaq Disk (CD) and be run on any Personal Computer (PC) on windows. We have successfully developed a pharmacokinetic-
based tool with a potential to assist clinicians and pharmacists in detecting and rationalizing DDIs. The tool has
proved very useful as a teaching tool on DDIs by using the more advanced functions that explore the performance of current
drug-drug interactions prediction models. From the available literature, it is clear that more studies need to be done to
establish the prevalence and mechanisms of DDIs in the treatment of infectious diseases. We are now adding more data,
validating the tool and finally testing the acceptability of this tool among clinicians and pharmacists for routine use
The relationship between cultural factors and initiation of antiretroviral therapy among HIV-positive people aged 18 to 49 years at Chitungwiza central hospital O/I clinic
No full textPeople living with HIV who are eligible for Anti Retro viral therapy at Chitungwiza Central hospital OI clinic appear to be delaying initiating ART. Late initiation of HIV positive people on ART poses a major public health challenge. Timely initiation of HIV positive people on Anti retro Viral Therapy (ART) has shown to improve clinical outcomes such as improving the quality of life, prolonging life, reduction of mortality and morbidity rates, prevention of development of opportunistic infection and transmission of HIV infections. It is possible that cultural factors are playing a major role in influencing the initiation of ART among HIV positive people who are eligible for ART.
The purpose of this study was to examine the relationship between cultural factors and initiation of ART among HIV positive people aged 18 years to 49 years. The health belief model was used to guide the study and a descriptive qualitative correlational study was used as the research design. 80 participants were recruited for the study and 20 being males and 60 being female. Non-probability convenience sampling was used to select the participants. A structured interviewers schedule was used to collect the data. The data was analysed using descriptive statistics such as averages, percentages, mean and standard deviation. Inferential statistic using Pearson’s correlation coefficient was used to examine the relationship between cultural factors and initiation of ART.
Analysis of the results on cultural factors and initiation of ART showed that there is no significant correlation (r=-219) between the cultural factors and ART initiation. This means that as cultural factors are addressed or reduced there is an increase in the rate at which ART is initiated. This therefore implies that the cultural factors that facilitate initiation of ART should be addressed and those that hinders should be removed so as to improve the quality of life of people living with HIV and AIDs. It also calls for the determination and addressing other issues that hinder early initiation of ART. This research seeks to establish the relationship between cultural factors and initiation of anti-retro viral therapy among HIV positive people attending OI clinic at Chitungwiza Central Hospital. The Human Immunodeficiency Virus (HIV) pandemic continues to be one of the most serious emergencies faced by most of the developing world. Late initiation of HIV positive people on Anti-retro viral therapy (ART) poses a major public health challenge and timely initiation of HIV positive people on ART has shown to improve clinical outcomes such as improving the quality of life, prolonging life, reduction of mortality and morbidity rate, prevents the development of opportunistic infections and reduces transmission of the HIV infection. Cultural factors play a major role in influencing the initiation of ART among HIV positive people