1358 research outputs found
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Management and outcomes of antepartum hemorrhage at Harare maternity hospital
No full textBackground: Antepartum haemorrhage and its complications are responsible for a
significant proportion of maternal and neonatal morbidity and mortality worldwide. At Harare Maternity Hospital, the incidence, major causes, burden to the health system, overall contribution to complications is largely unknown.
Objectives: To assess the incidence, maternal and perinatal morbidity and mortality as well as to evaluate the management rendered to women presenting with antepartum hemorrhage
Study Design: Prospective cross sectional (observational) study carried out on 125 women recruited between August and December 2014.
Setting: Harare Maternity Hospital, Zimbabwe.
Main Outcome Measures: The study evaluated demographic data, incidence, causes,
maternal and neonatal complications and management of antepartum haemorrhage cases.
Results: A total of 6033 deliveries were recorded with an incidence of 2.1% for antepartum hemorrhage. The causes included placenta abruption 49(39.2%), placenta previa 44(35.2%), indeterminate 18(14.4%), heavy show 12(9.6%) and ruptured uterus 2(1.6%). Mean age was 29 years (range 17-43) and overall mean parity was 1.6±1.2. Evaluation of management of cases revealed that insertion of large bore cannula, cross matching of blood, catheterisation were achieved in between 70-80% of cases. Maternal complications included postpartum hemorrhage 50(40%), need for transfusion 41(32.8%) and caesarean hysterectomy 4(3.2%). Maternal deaths, 5(4%) were all due to placenta abruption. 44.8% of deliveries were preterm births and 53.6% were admitted to neonatal unit. Stillbirths occurred in 3(6.8%) of placenta previa and 35 (71.4%) of placenta abruption and 3 (9.4%) were due to other causes.
Conclusion: The study showed an incidence of anterpartum haemorrhage of 2.1% and a considerable maternal and perinatal morbidity and mortality attributable to antepartum
haemorrhage. There were gaps in adhering to the management protocol
Determinants of acute malnutrition in children under five years in Harare City Zimbabwe 2011
No full textBackground: Malnutrition is associated with 35% of the top five causes of childhood mortality in Zimbabwe. The aim of the study was to identify factors associated with acute malnutrition in Harare City.
Methods: A 1:1 age group matched case-control study using a structured interviewer administered questionnaire was done. A case was a child with low weight for height or a mid-upper arm circumference less than 125mm. A control was a child with no signs of malnutrition.
Results: We interviewed 116 cases and 115 controls in the six to 24 month age group and 57 cases and 60 controls in the 25 to 59 month age group. The median age was 18 months (Q1=11, Q3=27) for cases and (Q1=10, Q3=29) for controls. Significant determinants of malnutrition were: breastfeeding less than eight times a day [OR=1.83(1.05-3.20)]; eating less than three meals a day [OR=2.16 (1.22-3.81)]; drinking less during fever or cough [OR=2.12 (1.08-4.16)] and birth weight less than 2300g [OR=2.67 (1.01-7.06). Cases used more coping strategies, 110 (Q1=92, Q3=122) for finding food than controls, 91 (Q1=78, Q3=112), p-value 0.01. After further analysis, acute malnutrition remained independently associated with breastfeeding less than eight times the previous day [OR=1.86 (1.02-3.39)] and eating less than three meals a day [OR 2.16 (1.20-3.88)].
Conclusion: Determinants of acute malnutrition are breastfeeding less than eight times a day and children not feeding more than three times a day. To reduce childhood malnutrition, emphasis should be given to increasing the knowledge of caregivers on infant and young child feeding practices
Survival patterns of patients enrolled into Island Hospice Service palliative care programme
No full textIntroduction and Background: Palliative care services aim to attain the best quality of life of
patients. However, the lack of information on the survival of patients under palliative care has
resulted in the implementation and assessment of care models being focused on reach without
much consideration of the quality of care and the quality of life of patients in the context of
survival. Amongst the few studies undertaken elsewhere, the target groups and settings to which
the findings are inferable to are distinct to the Zimbabwean scenario. This study’s main aim was,
therefore, to determine the survival of patients after enrolment into Island Hospice Service (IHS),
a Zimbabwean palliative care programme established as the first hospice in Africa.
Methodology: The study took the form of a Retrospective Cohort Design with data obtained
from a computerized database at IHS. A total of 597 patients enrolled in the programme between
01/01/06 and 31/12/07 were included in the study and were retrospectively followed up with
respect to mortality from their respective dates of enrolment to the study end-date of 31/12/08.
Observations were censored on the study end-date and date of transfer or relocation.
Results: This study found that the overall median survival of patients referred to the IHS
palliative care programme is 419 days. This estimate is considerably higher than that found from
other previous studies which range from 11 to 54 days. Patients diagnosed with HIV only were
noted to have longer survival compared to those with Cancer only as well as those with both HIV
and Cancer. The median survival estimates for patients with Cancer only and those with both
Cancer and HIV were observed to be 84 days and 113 days respectively whilst that for those
with HIV only was indeterminate. Some statistically significant differences in survival were also
observed for study factors such as gender, age, source of referral and functional status but with
variations under the specific disease groups.
Conclusion: Patients enrolled in the IHS programme generally live longer relative to other
palliative care programmes. The survival patterns of these patients are influenced by several
factors, key among them being the disease status and functional status on enrolment. The study
identified the need to incorporate survival data in care planning and modelling. Providing some
awareness of the IHS Palliative Care programme to health professionals is also recommended as
a possible strategy to improve the timing of referrals. This study also presents an opportunity for
further epidemiological inquiry that may contribute to the organisation’s cancer prevention
efforts
Occupational therapy needs of adolescents and young adults with cerebral palsy in Zimbabwe: Caregivers’ perspectives
No full textObjectives: To determine occupational therapy needs of adolescents and young adults with cerebral palsy living in an urban setting, to identify participation levels in activities of daily living and social activities, to identify factors influencing participation and to determine the contribution of occupational therapy in participating in these activities. Design: Descriptive cross-sectional Setting: Community rehabilitation outreach points in Epworth, Mufakose, Glenview, Dzivarasekwa, Mabvuku and Norton. Participants: Thirty-five randomly selected primary caregivers of adolescents and young adults with cerebral palsy. Data analysis: Data collected on the questionnaires was analysed using SPSS/16.0 for frequencies and means. Results: Fourteen (41%) of the adolescents and young adults were independent in self-care activities such as toileting, grooming, dressing, mobility and bathing. Twenty-one (59%) were totally dependent or needed some assistance in performing activities of daily living. Factors reported to influence participation included upper and lower limb contractures, lack of transport, financial constraints and a difficult home environment. Occupational therapy needs of adolescents and young adults as reported by their caregivers included further training in activities of daily living (74%), home adaptations (66%), vocational skills training (20%) and provision of appropriate assistive devices (6%). Conclusion: In light of these findings performance areas that still needed occupational therapy interventions included activities of daily living, vocational skills training, use of assistive devices and home adaptations. Therefore adolescents and young adults with cerebral palsy living in Zimbabwe still have functional performance deficits that can be addressed by provision of follow-up community occupational therapy interventions
Development toxicity effects of atorvastatin and rosuvastatin in mice
No full textBackground: Statins reduce the risk, morbidity and mortality associated with cardiovascular events, and generally considered safe to use but their safety in pregnancy is not known. Statins are considered potentially teratogenic and are contraindicated in pregnancy on the basis of lack of evidence.
Objectives: The objectives of the study were to determine and compare the developmental toxicity effects including teratogenic and offspring weight effect of rosuvastatin and atorvastatin in time mated mice.
Methods: Fifty six Balb c mice were divided into seven experimental groups of eight mice
each. Atorvastatin and rosuvastatin were administered at doses of 10, 40, 100mg/kg/day via oral gavage route once every day for 7 days prior to the mating and continued during the mating and pregnancy period up to delivery. Maternal weight changes and miscarriages were monitored during the pregnancy period. The mice were allowed a vaginal delivery and the offspring were weighed and assessed for gross morphological defects.
Results: There was no dose related changes in litter size or suppressed maternal weight gain in the study groups. No significant differences when the control group was compared to the individual atorvastatin groups, rosuvastatin 10 and 100mg /kg (p > 0.05). The rosuvastatin 40 mg/kg had significantly lower birth weight compared with control (p =0.022) in post hoc analysis. No gross morphological defects were observed in all the offspring.
Conclusions: No developmental toxicity including teratogenic effects were observed on
atorvastatin and rosuvastatin at 10, 40 and 100mg/kg in a mice model
Factors associated with the nutritional status of children from primary schools in Chitungwiza: Secondary data analysis
No full textBackground: Studies have shown high morbidity and mortality in primary school going children due to malnutrition. Few studies have looked at nutritional status of primary school going children in Chitungwiza and factors associated to this are poorly described. The aim of the present study was to assess common ailments and identify predictors of malnutrition in primary school children in Chitungwiza in order to enforce corrective and preventive measures.
Methods: A secondary analysis of data obtained from the child health survey done at four selected primary schools in Chitungwiza in 2006 was used to assess the nutritional status of 241primary school going children in the area. Nutritional status was assessed using anthropometric measurements. The predictors of nutritional status were determined using logistic regression models.
Results: 241primary school going children aged between 8 and 11 years took part in the study. Tooth decay was the most common health problem with prevalence of 32% followed by skin disease with prevalence of 19.9% and then vision with prevalence of 10.4% and 9.5% for right and left eyes respectively. Overall 54% were stunted, 62.4% were wasted and 38.1% were underweight. In the multivariate analysis, age of a child, education of mother, body mass index of a child and education of father (p<0.05) were found to be independently associated with nutritional status of primary school going children in Chitungwiza.
Conclusion: Dental caries, skin diseases and vision were the most common health problems among primary school going children in Chitungwiza. Wasting was identified as the most common condition of malnutrition among these children. The study identified age of a child, education of mother, body mass index of a child and
education of a father as predictors of malnutrition among primary school going children in Chitungwiza
Evaluation of Factors Associated with HIV Prevalence among 15- to 49-Year-Olds in Chimanimani District of Zimbabwe: Divergence and Similarity of the Two Statistical Methods
No full textIntroduction
AIDS surveillance has been the cornerstone of national efforts to monitor the spread of HIV infection in the world and to target HIV-prevention programs and health-care services. HIV case surveillance provides data to better characterize populations in which HIV infection has been newly diagnosed, including persons with evidence of recent HIV infection such as adolescents and young adults. The aim of this work after summarizing the properties of the two discriminating methods is to explore the convergence (give same results) and divergence (give different results) of the two analytical methods when they are used to classify participants as “HIV positive” or “HIV negative” using the symptoms of HIV.
Methods
The study was conducted in Chimanimani district, Manicaland Province of Zimbabwe in 2005.This was secondary data analysis of data from baseline study that utilised the Household survey of HIV-prevalence and behaviour in Chimanimani District, Zimbabwe which sort to quantify the magnitude of HIV and AIDS problem among children and adults; determine the knowledge ,attitudes, behaviour and practice of the general population; identify prevention and care programmes and human rights issues concerning HIV and AIDS among the general public and provide evidence-based information to policy makers on HIV and AIDS preventive mitigatory needs.
Results
The data was analysed using discriminant analysis (DA) and logistic regression (LR). The results of the DA showed that 87.4% of the cases were correctly classified as either HIV-
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positive or HIV-negative whilst LR managed to classify 89.1% of the same cases. LR identified 11 variables that include swollen lymph nodes, burning urine, clothes too large which were not picked by DA as significant. Comparing the results obtained from logistic regression and discriminant analysis indicate that the two techniques gave almost the same percentage of correct classification, different error rates and kappa coefficients but have a very high overall kappa coefficient of 0.98. The Logistic Regression model had positive coefficients whilst the Discriminant Analysis model had negative coefficients but the two can correctly identify the almost the same number of patients who are HIV-positive or HIV- negative. This means that the clinician can apply any model to classify a patient.
Overall HIV prevalence among the 15-49 year age group was 15.1%, 95% CI = [13.1-16.9].
Conclusions
The logistic model has proved to be an efficient tool for classifying patients as HIV-positive or negative. It has shown that it can correctly classify 89.1% of the patients who come presenting with HIV symptoms whilst the discriminant mode can correctly classify 87.4% of the patients. LR has a lower error rate (10.9) and a higher Predictive Value Positive (79.6) compared to DA’s 12.6 error rate and 30.5 Predictive Value Positive. The results of Logistic regression model were closer to those of discriminant analysis model and any model can be used.Forgarty International Centre, National Institute of Health (NIH-USA) through the International Clinical, Operational and Health Services and Training Award (ICOHRTA) Programm
RELATIONSHIP BETWEEN FEMALE CAREGIVERS SELF-CARE KNOWLEDGE ON PREVENTION OF MALARIA AND EPISODES OF MALARIA AMONG UNDER FIVES AT HAUNA HOSPITAL.
No full textAccording to the Zimbabwe National Health Strategy (2009) malaria ranked the highest cause of outpatient attendances accounting for all 11.5% of all attendances. Malaria was also the second cause of mortality in all age groups. The problem was the increasing number of malaria episodes in the under fives as seen from the Hospital records. In Hauna there were many children coming with repeated attacks of malaria within the same season, despite the National Malaria Control Programme in place particularly in Mutasa District. Thirty countries in Sub-Saharan Africa and Asia account for 98% of global malaria episodes and deaths (WHO, 2004). The purpose of the study was to examine the relationship between female care-givers self-care knowledge on prevention of malaria and episodes of malaria among the under fives. Orem’s Conceptual framework was used to guide this study. A descriptive correlational study design was used. Face to face structured interviews were used to collect demographic data, data on self-care knowledge and episodes of malaria, from 80 subjects who met the inclusion criteria. Data were analysed using the descriptive and inferential statistics. Pearson Correlation test was used to analyse the relationship between malaria prevention self-care knowledge and episodes of malaria and r was (r=.016; p>.01) results showed a non-significant relationship between self-care knowledge on malaria prevention and episodes of malaria. The results, therefore, did not support the premise that when self-care knowledge on malaria prevention increases, the number of malaria episodes decreases as proposed in the study. Further research is needed to establish more factors that could be impacting on malaria episodes in children and explore relationship between self-care practices and episodes. Nursing practice should strengthen information dissemination to all communities on malaria