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How are condoms used in a family planning setting: Evidence from Zimbabwe
No full textObjectives: (To determine the level and consistency of condom use among family planning clients at three family planning clinics in Zimbabwe.)
Design: A prospective cross sectional study.
Setting: The study was carried out at three Zimbabwe National Family Planning Council clinics.
Subjects: We interviewed 899 consecutive women seeking family planning services at these three clinics using a structured questionnaire.
Main Outcome Measures: The prevalence of condom use among this population of family planning clients and the factors predicting condom use were the main outcome measures. We define dual method use (DMU) as the use of condoms in conjunction with another highly effective contraceptive and dual purpose use (DPU) as the use of condoms for both pregnancy and STI/FIIV prevention. We measured selt-reported condom use during the last 30 days prior to each interview.
Results: The prevalence of condom use among this population of family planning clients was 38%. Of all the study participants, 32% were DMU clients while 5% were DPU clients. Fifty eight percent of the DMU clients and 89% of the DPU clients clients reported consistent condom use respectively. Logistic regression analysis showed that young age and reporting high risk sexual behaviour were predictors of condom use.
Conclusions: The level of condom use among this population of family plannig clients is too low for a country with such a high HIV prevalence. Condom users were more likely to report DMU than DPU. Those reporting DPU were more likely to report consistent condom use
Malaria and HIV co-infection: Available evidence, gaps and possible interventions
No full textObjectives: To review the evidence of association between malaria and HI V/AIDS co-infection for purposes of developing strategies for malaria control. Design: Desktop review of literature. Setting: Harare, Zimbabwe. Main Outcome Measures: Response to treatment, development of severe malaria, malarial immunological response in HIV/AIDS positive people and incidence of malaria in HIV,'AIDS positive individuals. Results: HIV-1 infection increases the incidence q{ Plasmodium falciparum parasitaemia and is associated with the development of severe malaria, commonly anaemia, cerebral malaria and high parasite density (OR=2.56; 95% CI= 1.53 to 4.29; pcO.OOl). The efficacy of chloroquine and sulphadoxine-pyrimethamine in reducing placental malaria in HIV-1 positive pregnant women was impaired compared to HIV-I negative pregnant women. However, the situation in non-gravid HIV-1 positive people as regards efficacy of chloroquine and sulphadoxine-pyrimethamine prophylaxis is not known. Also not known is the relationship between malaria parasitaemia without symptoms and HIV-1 infection, the results of which may provide useful information regarding malaria control and prevention in HIV-1 positive people. Con elusions: HIV-1 positive people staying in malaria endemic areas are at risk of developing severe malaria. Malaria prevention using insecticide-treated bed nets and indoor residual house spraying may be the best available options for these people. Chloroquine and sulphadoxine-pyrimethamine prophylaxis require further studies to verify their efficacy, in the presence of H1V-1/A1DS infection
Logistic regression and linear discriminant analysis in the evaluation of factors associated with stunting in children: Divergence and similarity of the statistical methods
No full textBackground: Stunting is a well-established child health indicator of chronic malnutrition
which is associated with biological, environmental and socioeconomic factors. Logistic
regression and linear discriminant analysis are two statistical methods that can be used to predict or classify subjects as either stunted or not stunted based on all or a subset of measured predictor variables. The predictive accuracy of the two methods were compared with respect to several attributes of each of the methods.
Methods: Data used for the study was extracted from the Zvitambo trial data set. The
multivariable logistic regression and linear discriminant models were fitted using 20
bootstrap samples for cross validation of the coefficients. The two models were compared with respect to the variables selected, the sign and magnitude of the coefficients, sensitivity, specificity, overall classification rate and areas under ROC curves. The two methods were applied in combination to check if predictive accuracy would improve.
Results: Logistic regression and linear discriminant analysis had the same predictive
accuracy with classification rates of 78.76% and 78.86% respectively. Both methods
identified two common factors, sex and birth weight, and the coefficients of the two factors had the same negative sign but the magnitude differed significantly, both had low sensitivity (13.19% and 8.68%) and high specificity (97.44% and 98.24%). Combining the two methods did not improve predictive accuracy (71.5% before and 70.24% after).
Conclusion: The two multivariable techniques tend to converge in classification accuracy mainly when the sample size is large (>50) but when faced with making a choice between the two, it is recommended to use the method whose assumptions for application are fulfilled
Cryptococcal infection in the era of anti-retroviral therapy (ART) amomg HIV infected patients with meningitis at a tertiary hospital in a low - resource setting.
No full textBackground: Despite improved access to anti-retroviral therapy (ART) in Africa, HIV-associated cryptococcal meningitis (CM) appears to remain a cause of substantial morbidity and mortality in sub-Saharan African. This study determined the prevalence, associated factors and outcomes of CM among HIV positive meningitis patients at a tertiary hospital in Zimbabwe.
Methods: Eligible HIV positive patients admitted with clinical features of meningitis
were recruited into the study. CM was diagnosed on the basis of a positive cerebrospinal fluid (CSF) culture for cryptococcus species, a positive CSF cryptococcal antigen test (CRAG) or a positive CSF India ink test. Patients’ demographic information, clinical features and laboratory test values were recorded.
Results: One hundred and forty-four participants were enrolled into the study. CM was diagnosed in 41% (59/144). Of the patients with CM, slightly more than half [54.2% (32/59)] were on ART and 53% (17/32) had initiated ART within one year prior to the diagnosis of CM. Median current CD4 counts were significantly lower among CM patients [32 .0(IQR 10.5 – 64.0)] compared to non-CM patients [158.0(IQR: 47.0–324.0)] (p<0.001). In-hospital mortality associated with CM was 45%.
Conclusions: The proportion of cryptococcal meningitis cases and the associated in-hospital mortality were very high in the study. This suggests that cryptococcal disease burden is still significantly high despite improved access to ART. Expansion of prevention strategies, such as screening for asymptomatic cryptococcal infection among patients with low CD4 count (less than 200), has the potential to improve the morbidity and mortality associated with cryptococcal meningitis
Role of the sympathetic nervous system in the development of hypertension and metabolic syndrome in low birth weight offspring
No full textThe sympathetic nervous system plays a pivotal role in the development of the metabolic syndrome particularly hypertension in low birth weight offspring. The Barker hypothesis reported that individuals born with low birth weight were at risk of developing chronic diseases later in life. Animal and human studies have since confirmed this relationship, however the mechanisms involved remain unknown. Therefore, this study investigated the role of the sympathetic nervous system in protein restricted rats and pre-clinical University of Zimbabwe students whose birth weights were less than 2.5kg. According to the Barker hypothesis adverse influences early in foetal development can result in permanent changes in the metabolism and physiology with such changes resulting in increased disease risk of the metabolic syndrome in adulthood. It was hypothesized that the sympathetic nervous system was the mechanism by which themetabolic syndrome particularly hypertension occurred in low birth weight and intrauterine growth restricted offspring.
An intrauterine growth restricted (IUGR) rat model was developed using local Zimbabweans diets. Using this model, mean blood pressure (mmHg) measured using the tail cuff method was significantly higher within 10 weeks in IUGR rats than in normal rats (122.46±2.73 vs 106.50±5.81 p=0.0001). The blood pressure significantly decreased in IUGR rats whose renal nerve (sympathetic influence) had been denervated (103.44±8.17mmHg vs 98.49±7.85mmHg p=0.013).
A series of human experiments were then conducted in young adults from the University of Zimbabwe. The students were put through exercise paces to allow the expression of the autonomic nervous system. Heart Rate Variability (HRV) ratio, and Pulse Wave Amplitude (PWA) responses to activation of the muscle metaboreflex were exaggerated in low birth weight (LBW) compared to normal birth weight (NBW) offspring (HRV: 1.015±1.034 vs 0.119±0.789 p<0.05) PWA: -1.320±1.064 vs -0.735±0.63 mV p=0.28. This suggested that the exercise pressor reflex, which is involved in tight regulation of the cardiovascular response to exercise, is persistently dysregulated into early adulthood for LBW individuals.
The study showed a significant difference in decrease in diastolic function (E/A ratio) in LBW than NBW groups ( 0.48±0.27 vs 0.19±0.18 p=0.031) and a significant association between LBW and exercise induced cardiac fatigue with diastolic dysfunction (p<0.001 odds risk ratio 7.5[95% CI 2.7-20.7]). Furthermore, the mechanisms of exercise induced cardiac fatigue involved transient myocardial stunning and a decrease in sensitivity of myocardium to catecholamines reducing the effect of adrenaline in improving both systolic and diastolic function during exercise.
LBW was associated with exercise induced hypertension (EIH) (62% vs 32% p<0.05) and post exercise hypotension (PEH) in young adults, a phenomenon hypothesised to be mediated by two processes; physiological down regulation of the cholinergic sympathetic vasodilator receptors in peripheral tissues due to chronic sympathetic stimulation; and increased wall thickening (EIH) and derangements in sympathetic tone (PEH). In the glucose tolerance study in LBW young adults had elevated sympathetic activity and were glucose intolerant (after 60mins 8.4±.56 mmol/l vs 7.57±0.36mmol/l p=0.035).
It is concluded that the sympathetic nervous system possibly has a role in the development of the metabolic syndrome in low birth weight humans and intrauterine growth restricted rats.National Institute of Neurological Disorders and Stroke (NINDS).
Office of the Director -National Institutes of Health (OD) and National Heart,
Lung, And Blood Institute (NHLBI) through a Medical Education Partnership Initiative
(MEPI) Grant to the University of Zimbabwe College of Health Sciences and Southern
Africa Consortium for Research Excellence (SACORE) and the University of
Zimbabwe College of Health Sciences Physiology Department
Result of the Emergency Nutrition Assessment in 11 Selected District Zimbabwe
No full textSurvey ReportUNICE
Evaluation of the prevalence of retinopathy of prematurity at Parirenyatwa group of hospitals and Harare central hospital
No full textBackground: Retinopathy of prematurity is notably one of the causes of avoidable
blindness. The risk factors for the development of ROP are very low birth weight(<1500g), low gestational age (GA) (<32 weeks) and duration of oxygen
supplementation. The prevalence varies world over, with high income countries having higher figures than their low income counterparts. Zimbabwe is a low income economy, however Harare is urbanised and a significant number of preterm infants at risk of developing ROP do survive.
Objectives:
1. To establish the prevalence of ROP at PGH NICU and HCH NNU at 4-6 weeks chronological age.
2. To assess the prevalence of ROP requiring treatment and ROP not requiring treatment a 4-6 weeks chronological age.
3. To establish the risk factors associated with ROP as well as the ocular features of ROP in our neonatal units.
4. To assess the current oxygen delivery protocols for VLBW preterm babies in our neonatal units.
Study Design: Hospital based cross sectional analytical study.
Methodology: All neonates admitted in the neonatal units were screened weekly to
identify patients that met the study inclusion criteria. These infants were enrolled
into the study and examined at either the 4th, 5th or 6th week after birth. Ocular
examination findings were noted as well as the risk factors for ROP that each neonate may have been exposed to. Details of supplementary oxygen for each neonate were documented, that is duration of oxygen delivery, mode and flow rate.
A self-administered questionnaire was completed by medical personnel working in the units, to assess their current knowledge concerning oxygen delivery in VLBW preterm infants.
Results: A total of 141 premature babies were enrolled into the study. Twenty infants died and 121 were examined. Six infants were diagnosed with ROP, therefore the prevalence of ROP at 4-6 weeks chronological age was 5.0%. All the infants diagnosed with ROP
had spontaneous resolution making the prevalence of children with ROP requiring treatment 0.0%. Three out of 6 (50.0%) had stage 1 disease and 3(50.0%) had stage 2 disease. Location of the disease was as follows; Five out of 6 (83.3%) neonates had
disease in zone 3 and 1 (16.7%) had disease in zone 2.
The risk factors associated with ROP in this study were, prolonged duration of oxygen
supplementation >2 weeks, very low birth weight <1100g and EGA<30 weeks.
Seventy per cent of the medical personnel stated that they were aware of an oxygen
delivery protocol. However the SaO2 levels that they aim to maintain vary, with most
personnel aiming to maintain in the 90-95% and 95-100% ranges.
Conclusions: There are VLBW preterm infants who survive and develop ROP in our
neonatal units. It follows that the screening of all neonates at risk is essential.
Current oxygen delivery protocols must be revisited & revised by medical personnel.
Monitoring SaO2 in VLBW preterm neonates would improve with more equipment for monitoring SaO2 as well as more nursing staff
Rhabdomyosarcoma of the orbit in a four months old infant in Zimbabwe: A case report
No full textInfants younger than one year of age with RhabdomyosarcTJmrr'appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome.. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Cal 1 is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma
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
Mortality within 24 hours of admission to the Paediatric Unit, Harare Central Hospital, Zimbabwe
No full textObjective: To determine the proportion of deaths, characteristics of children and risk factors for mortality within 24hours of admission to a Paediatric hospital in Harare.
Study Design'. Prospective cohort study.
Settings: Paediatric Unit, Harare Central Hospital.
Subjects: All patients admitted to the medical wards who consented to participate were enrolled. Preadmission factors including duration of illness and health seeking behaviour prior to presentation, delays in A&E department assessed by lag time to assessment, administration of initial medications and admission to the ward were documented. The presenting clinical signs and admission diagnoses were also recorded.
Main Outcome Measure: Death within 24hours of admission.
Results: Of the 737 pediatric admissions during the study period, 54 children died within 24 hours giving a case fatality rate of 7.3%. These constituted 34.6% of total deaths in the study population (54/155).The median age of the children in this study was 16 months (Q,= 4, Qy= 36) and 53.2% were male. Having subcostal recessions on admission was significantly associated with mortality (within 24hours of admission) with a RR 2.99 (95% Cl 1.56-5.74) while socio-demographic factors, duration of illness, fever, diagnosis on admission and delays in A&E department were not.
Conclusion: The contribution of deaths within 24hours of admission to the overall mortality in children remains unacceptably high. Sub-costal recessions on admission (a proxy for severe pneumonia) had the highest risk of mortality within 24hours of admission. There is need for early identification and aggressive management of children with pneumoni