1358 research outputs found
Sort by
Voluntary testing and counselling for HIV. “Are adults in rural communities ready to test?” A descriptive survey
No full textAbstract
Objective: To describe rural adult preparedness to test for HIV, perceived susceptibility, response to peer group opinion, perceived positive and negative outcome expectations of testing.Design: Cross sectional descriptive study. Setting: Mashonaland West Province, Zimbabwe. Subjects: Purposive convenience sample; 204 adults, 102 females, aged 18 to 50. Main Outcome Measures: Stage of preparedness to test for HIV, perceptions of susceptibility, response to peer group opinion, negative and positive expectations about testing. Results: None of the 204 participants had knowingly been tested for HIV prior to the study; 55.8% had heard about Voluntary Counselling and Testing (VCT) and 21.0% had thought about testing. Of these, 15 (34.8%) had already talked to somebody about testing. When compared with married respondents, significantly more singles expressed preparedness to test for HIV in the next six months (p=0.040). Only 14.2% of respondents expressed willingness to pay for a test. Females worried more than males about “getting HIV in the future" (p=0.019). Singles were more likely to worry about their partners’ current HIV status than married and once married respondents (p<0.001). When compared with women, men showed more likelihood of responding to pressure from friends to test for HIV (p=0.039). Strongly articulated fears about testing included being seen by friends at a VCT centre, stigmatisation, violence and stress. Significantly more women than men were fearful that an HIV test would be painful (p=0.006). Similarly, women were more fearful than men about taking an HIV test (p=0.007), the possibility of waiting for the result (p=0.022) and returning for results (p=0.020). Anticipated positive outcomes of testing included getting assistance in the early stage of the disease. Conclusion: Knowledge of HIV status acquired voluntarily in a psychologically and socially supportive environment will be a significant motivator for individuals and their partners to initiate and maintain safer sexual behaviour. Our study showed some preparedness among adults from two rural communities to test for HIV. While current strategies to promote VCT in urban areas reflect sensitivity to many of the fears of adults expressed in this study, the initiative must be expanded to embrace rural communities. There is a need to build on positive perceptions about testing and embrace a strategy that disables fear, particularly among women. The initiative must go beyond the individual as the primary target and be promoted within the broader context of the community with the assistance of credible opinion leaders. It should also link closely with other services that offer primary prevention, pilot treatment and support activities
Oh no, not Nitric Oxide!
No full textNitric oxide (NO) is a unique, endogenous regulatory molecule that is involved in a wide variety of physiological processes in multiple organ systems. This simple gas functions as a cellular messenger in a broad range of biological activities that include blood pressure regulation, immunomodulation and neurotransmission. It has also been implicated in a number of homeostatic functions in the cardiovascular system: it is a significant determinant of basal vascular tone and, in addition is thought to regulate myocardial contractility and platelet aggregation. Dysregulation of NO mediated effects have been implicated in the pathogenesis of essential hypertension, atherosclerosis, and the hypotension associated with septic shock. This review will focus on these multiple effects of NO in the cardiovascular system
Trends in cancer pain management
No full textBackground: Pain is a prevalent symptom in cancer patients, affecting up to 50% of patients undergoing active cancer treatment and up to 90% of those with advanced disease. Although adequate relief can be achieved in the majority of cancer patients, pain is often treated inadequately in traditional settings and sometimes even under the management of more specialised units.
In this review the authors use their experience and that of others to review the evaluation and diagnosis of pain syndromes and the principles of management. This is in keeping with increasing recognition by bodies such as the World Health Organization and other governmental agencies who have recognised the importance of pain management as part of routine cancer care. Conducting a comprehensive assessment, competently providing analgesic drugs, and communicating with the patient and family allow effective management of pain in the cancer patien
Genetic polymorphism of drug metabolizing enzymes in the Shona and the San in Zimbabwe and the clinical impact of CYP2D6 polymorphism on safety in the use of psychotropics
No full textINTRODUCTION: Interindividual variability to drug response is a well known
phenomenon and dates back to the 1950s with isoniazid. When the same dose of the same
drug is given to different individuals, some may respond well, while others may respond but
with side effects, whilst others may not even respond at all. In a number of instances, this
variability has been shown to be due to genetic differences. The best documented are
pharmacokinetic differences due to polymorphism of drug metabolising enzymes, in
particular CYP2D6 which metabolises about 25% of clinically used drugs. The frequencies
of these mutations have been studied to a great extent in Caucasians and Orientals, and some
have shown to be variable among different ethnic groups. Africans have also been studied
but to a much lesser extent, yet they may be even more diverse. We sought to investigate the
frequencies of mutations of some drug metabolising enzymes in Zimbabwean ethnic groups
and the impact of CYP2D6 polymorphism in psychiatric patients on routine drug therapy in a
naturalistic setting.
MATERIALS AND METHODS: The study was approved by the Medical Research
Council of Zimbabwe and the volunteers gave written informed consent. Seventy-eight
Shona volunteers were recruited from the University of Zimbabwe Medical School whilst 63
San volunteers were recruited from the Plumtree district in Zimbabwe. Fifty psychiatric
patients were interviewed at the Parirenyatwa Hospital Psychiatric unit. Five mL blood
samples were drawn from all volunteers and stored at minus 20 °C until required for
genotyping. An additional 5 mL blood sample was drawn from each of the psychiatric
patients and the plasma was stored at minus 20 °C until required for analysis. PCR-RFLP
methods were used to genotype for CYP2C19*2, CYP2B6*6, CYP2D6*4, *17 and *29
mutations. LC-MS was used for the measurement of plasma concentrations of
chlorpromazine, thioridazine, fluphenazine, haloperidol, amitriptyline and nortriptyline.
Drug plasma levels were then correlated against CYP2D6 genotype.
RESULTS: Frequencies for CYP2C19*2, CYP2B6*6, CYP2D6*4, *17 and *29 in the Shona
were 0.16, 0.38, 0.05, 0.22, and 0.16, whilst in the San they were 0.12, 0.40, 0.10, 0.22 and
0.02 respectively. Differences between drug concentrations stratified by CYP2D6 genotype
were observed for thioridazine versus CYP2D6*29 and for fluphenazine versus CYP2D6*17
genotypes. No significant correlations were found for the other drugs.
DISCUSSION: Genetic polymorphism of the drug metabolising enzymes CYP2B6,
CYP2C19 and CYP2D6 was similar between the San and the Shona, except for the frequency
of, CYP2D6*29, an African-specific mutation, which was virtually absent in the San. The
most prevalent mutation in both populations was CYP2B6*6, which has implications for a
lower population-specific dose of the antiretroviral drug efavirenz to avoid central nervous
system side effects. Carriers of CYP2D6*29 and CYP2D6*17 mutations need lower doses of
thioridazine and fluphenazine respectively to avoid side effects related to high drug plasma
levels.
CONCLUSION: We investigated frequencies of mutations of the following drug
metabolizing enzyme genes; CP2D6, CYP2C19 and CYP2B6 in the Shona and the San.
Although clear relationships between CYP2D6 genotype and thioridazine and fluphenazine
concentrations were observed, these did not reach statistical significance due to the limited
sample.size
Investigation of the effect of STALANEV (stavudine, lamivudine and nevirapine) treatment on serum lactate levels in adults attending BRIDH and WIDH opportunistic infections clinics in Harare
No full textHuman Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) have become a significant public health problem in Zimbabwe, threatening the socio-economic fibre of the country and placing a tremendous strain on the capacity of the health sector to respond to the needs of the population. Antiretroviral therapy (ART) has reduced morbidity and mortality due to HIV and AIDS. Although it has also improved the quality of life of people living with HIV and AIDS, concern has risen due to its association with challenges such as impaired glucose metabolism, insulin resistance, lactic acidosis, osteopenia and dyslipidemia. Although World Health Organization (WHO) has recommended phasing out stavudine in all ART regimens due to its association with mitochondrial toxicity thereby leading to lactic acidosis, Zimbabwe has continued to use it due to the limited resources available. This study assessed the development of hyperlactatemia in patients on antiretroviral therapy containing stavudine, lamivudine and nevirapine(STALANEV) attending Wilkins Infectious Diseases Hospital (WIDH) and Beatrice Road Infectious Diseases Hospital (BRIDH) OI clinics in Harare.
Study design and methods
One hundred and eighty (180) adults aged 20-60 years who were HIV infected and were about to be initiated on STALANEV at WIDH and BRIDH OI clinics were recruited into this prospective cohort study. All the participants were antiretroviral naïve before entering the study and were commenced on first line regimen of STALANEV and then
iii
followed over a period of 4 months. The serum lactate levels of these participants were determined at enrolment (before commencing ART), after 2 months and 4 months on STALANEV treatment.
Results
Out of a total of 176 participants who completed the study, 95 (54.0%) developed hyperlactatemia over the 4-months follow-up period i.e. their serum lactate levels exceeded 2.5mmol/l. Eleven (6.8%) developed mild lactic acidosis i.e. their serum lactate levels exceeded 3.5mmol/l but were less than 4.0mmol/l. Serum lactate levels of 81 (46.0%) participants remained within the normal levels (0.5-2.5mmol/l) although there was an increase over the 4 months follow-up period. In all the participants, the mean difference between the serum lactate levels at baseline and 2 months after ART initiation was 20% whilst the one between 2 months and 4 months was 33%. A high increase of 59% was obtained between baseline serum lactate levels and the serum lactate levels after the 4 months follow-up period.
Conclusion
In this study population, STALANEV treatment led to an increase in serum lactate levels thereby, posing a danger for the development of lactic acidosis
Relationship between knowledge levels of high active antiretroviral therapy (HAART) and adherence levels of HAART among HIV positive pregnant women aged 15 to 49 years attending antenatal care at Marondera provincial hospital, Family Child Health department, Zimbabwe
No full textVertical transmission of HIV from mother to child remains a problem in Zimbabwe
and the world over. HAART adherence rate of at least 95% is essential and it is noted that it can reduce vertical transmission by less than 1%. However such high adherence rates could only be achieved when HIV positive pregnant women have optimum knowledge regarding HAART. The purpose of the study was to examine the relationship between knowledge of HAART and adherence levels among HIV positive pregnant women aged 15 to 49 years attending antenatal care Marondera Provincial Hospital Family Child Care Department. A descriptive correlation study design was used to guide the study. A sample of 80 participants was selected using systematic sampling. HIV positive pregnant women meeting the inclusion criteria participated in the study. Data was collected through interviews with the aid of a structured interview schedule. Pender’s Health Promotion Model was used to guide the study.
Frequency distribution, measures of central tendency and dispersion and inferential statistics were used to present findings in relation to the demographic variables, HAART adherence practices and knowledge regarding HAART. Pearson correlation coefficient test was (r = 0.197 p – value 0.081). The results showed that a weak positive non-significant correlation existed between adherence to HAART and knowledge regarding HAART. The findings of this study indicated that only 25% of the respondents had high levels of knowledge regarding HAART and only 17.5% had high levels of adherence hence one can safely infer that the moderate to low levels of knowledge in the majority of the respondents 75% could have a bearing on suboptimal adherence. The study recommends intensification of health education and counseling on HAART inorder to empower HIV+ pregnant women with relevant knowledge that could lead to attainment of optimum HAART adherence. Major challenges facing respondents on HAART were issues regarding disclosure for 33.3% and stigma and discrimination 23.1%. This points to need for midwives to address these important psychosocial barriers to optimum adherence by not only harnessing male participation in PMTCT issues but also through community involvement
The effect of a single low dose propofol at the end of the operation in reducing post operative nausea and vomiting ( PONV) in women undergoing laparoscopic gynaecological surgery at Parirenyatwa hospital.
No full textObjectives
To determine the effectiveness of single low dose propofol in reducing PONV in women
undergoing laparoscopic gynaecological surgery.
To describe factors associated with nausea and vomiting in women undergoing laparoscopic
gynaecological surgery.
Study design: Randomized single blinded controlled study
Setting: Parirenyatwa Hospital
Subjects: Eighty women aged between 19-55 years booked for laparoscopic surgery.
Statistical methods:Summary descriptive statistics, student’s t-test, and Chi-square test.
Results: Incidence of nausea within one hour was 7.5% in the propofol group and 2.5% in the
nonpropofol group (P = 0.6) and 10% and 15% nausea incidence after one hour in the respective
groups. There were no reported incidences of vomiting after one hour from both study groups.
Two participants from the propofol group (B) vomited within the first hour postoperatively and
none from the nonpropofol group. Four participants (10.5%) complained of either nausea or
vomiting from the propofol group compared to 9 (21.4%) from the non-propofol group (P =
0.23) which was not statistically significant.
Conclusion: Administration of single low dose propofol 0.5mg/kg at the end of laparoscopic
gynaecological surgery does not reduce the incidence of PONV after propofol (2mg/kg)
induction
Factors associated with 1st line ART failure among patients at Newlands Clinic, Harare
No full textFirst line ART treatment failure occurs when drugs being administered for the treatment of HIV are no longer able to kill the virus i.e. virus would have developed resistance to the drugs. This study sought to determine factors associated with 1st line treatment failure among patients taking ART at Newlands clinic, Harare.
Materials and methods:
An unmatched 1:1 case control study was conducted at Newlands Clinic. Patients who had been on ART for at least 6 months were eligible for study participation. Questionnaires were used to collect data and a review of patient records was done.
Results:
A total of 464 participants were enrolled into the study. Median age of cases was 33.5 (Q1= 17, Q3 =45) and 37 for controls (Q1=27.5, Q3=37). Females represented 58.1% of study population and 41.9% were males. Median duration on ART for cases was 3.1 years (Q1=2.01, Q3=4.7 years) and 2.9 years for controls (Q1=1.96, Q3= 4.64). Independent risk factors associated with treatment failure were: Not being married (AOR= 1.8: 95% CI 1.01- 3.21), ART commencement by private doctor (AOR =
11
4.86: 95% CI 2.11- 11.2), WHO stage 3 / 4 at ART commencement (AOR=2.08: 95% CI 1.21- 3.57), poor adherence to treatment (AOR=1.73: 95% CI 1.01-3.21) and CD
Use of antimalarial drugs in Zimbabwe
No full textMalaria is a world-wide problem which is estimated to contribute to 2.3% of global disease' and is an increasing problem, particularly in developing countries.2 In Zimbabwe, the development of widespread resistance to antimalarial drugs has been prevented through a comprehensive national malaria strategy including the development and enforcement of national guidelines tor the prophylaxis and treatment of malaria. However, in recent years numerous anecdotal accounts have circulated in the private sector of failure of malaria chemoprophylax is and treatment. This study set out to explore the use of antimalarial drug-products amongst doctors and pharmacists so as to identify potential problems requiring further investigation
Non-attendance of treatment review visits among epileptic patients in Gokwe South district: Midlands province, Zimbabwe
No full textEpilepsy is the most common condition reported through the psychiatric returns surveillance system in Gokwe South District. The condition is controllable with antiepileptic medication. Review visits attendance is key to the successful control of seizures among epilepsy patients. A high proportion of scheduled review visits are missed every month. This study sought to establish the attendance pattern of epileptic patients, prevalence of non-attendance and the associated factors.
Methods: The study was an analytic cross-sectional study. One hundred and ten (110) respondents were selected randomly from the district’ epilepsy register. Interviewer-administered pretested questionnaires were used to collect data. Epi info version 3.5.1 was used to create frequencies and proportions were calculated as well as Odds ratios to determine associations. Logistic regression analysis was done to identify independent risk factors and to control for confounding variables.
Results: One hundred and ten (110) epileptic patients were included in the study. The epileptic patients missed treatment review visits ranging from 1 to 11 of the expected 12 review visits between June 2011 and June 2012. 70.9% missed at least 2 visits in a period of 12 months while 46.4%missed 2 or more consecutive visits. Knowledge of treatment duration [POR 0.24(95% CI 0.08-0.74)] and high risk perception [POR 0.14 (95% CI: 0.06-0.33) were associated with a lower likeliness of missing review visits. Barriers such as shortage of drugs [POR 7.09 (95% CI: 3.00-16.72)] and long distances to health facilities [POR 6.63(95% CI: 2.63-16.76)] were associated with high likeliness of missing two or more review visits consecutively. Shortage of drugs [AOR 6.7336 (95% CI: 1.8538, 24.4581)]and higher risk perception [AOR 0.1948(95% CI: 0.0625, 0.6071)] remained significant on logistic regression analysis.
Conclusion and Recommendations
A high number of epileptic patients miss their review visits mainly owing to shortage of drugs, having no village health workers to assist patients in treatment process. The District Health Executive must ensure constant supply of Antiepileptic drugs