1358 research outputs found
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The prevention of maternal death: A continuing challenge
No full textPueiperal sepsis, haemorrhage, post abortal sepsis and hypertensive disease remain the main causes of maternal mortality at Harare Maternity Hospital. Lack of antenatal care was a factor in the majority of deaths. Preventative factors for the principal causes of death are discussed. The value of post mortem examination in cases of maternal deaths is stressed
Prevalence of Cutaneous Human Papillomavirus infections at Parirenyatwa hospital's Kaposi Sarcoma Clinic and the Opportunistic Infections Clinic: Association with Non- Melanoma Skin Cancers
No full textHuman papillomavirus (HPV) types from the Betapapillomaviruses (ß-HPVs) genus are
ubiquitous in non-melanoma skin cancers (NMSC), hyperkeratotic skin warts and in cancer free skin biopsies among fair skinned races. There is paucity of information
regarding the prevalence and distribution of ß-HPVs among black Africans. To determine the prevalence of ß-HPV genotypes in cutaneous infections among black Zimbabweans and their association with NMSC, a cross-sectional study was carried out in which skin biopsies were collected from patients attending a referral hospital. HPV typing was done by Primer mix polymerase chain reaction (PM-PCR) and the
subsequent reverse hybridization assay (RHA) which is known to identify 25 cutaneous ß-HPV types implicated in skin lesions. We included 144 Black participants with clinically apparent cutaneous warts (n=28), suspected NMSC (n=98) and Kaposi sarcoma (KS) (n=18). The skin biopsies were analyzed for HPV DNA presence and type. The frequency of ß-HPV DNA was 70.1% (101/144). HPV DNA positivity was significantly higher in the HIV infected group 79.2% (57/72) compared to the HIV uninfected 61.1% (44/72), [OR=2.42, 95%CI (1.09-5.47), P=0.018]. All warts patients were HPV DNA positive and 89% (16/18) of those with KS and 58% (57/98) of those with NMSC. Single HPV infections were observed in 33.7% (34/101) of the participants that were HPV DNA positive, 66.3% (67/101) had multiple HPV types and 20.8% (21/101) had greater than five HPV types. The frequency and distribution of different HPV types did not show associations with neither age, sex, biopsy type but showed association with immune status. ß-HPVs are not uncommon in the Zimbabwean black population with skin lesions. There is a difference in the types of HPV genotypes detected in the skin lesions in this population (ß species 1 predominance) when compared to European populations, where there is a ß species 2 predominance. The study provides baseline molecular-epidemiological information for cutaneous HPV infections in Zimbabwe. However, wider national surveys using less invasive techniques are warranted to establish the exact extent of HPV cutaneous infections for more effective public health interventions.The Letten Foundation of Norway and The ICOHRTA programm
Factors associated with delayed antiretroviral therapy initiation among Tuberculosis/ Human Immunodeficiency Virus co-infected patients in Lupane district, 2015
No full textBackground: Antiretroviral therapy (ART) should be given to all Human Immunodeficiency Virus (HIV)-positive Tuberculosis (TB) patients within the first eight weeks of commencing anti-tuberculosis treatment (ATT), to reduce risk of mortality. In 2012 and 2013, Lupane district initiated 62% and 37% respectively of TB/ HIV co-infected patients on ART against a target of 100%. The study was conducted to determine the prevalence of delayed ART initiation in 2015 and to identify factors associated with the delays.
Methods: An analytic cross sectional study was conducted at seven health facilities in
Lupane district. Two hundred and ten study participants were recruited into the study. A
checklist was used to assess for quality of care at the health facilities. Key informant
interviews were held with program Managers and health workers.
Results: Among the 210 patients studied, 19 % (n= 39) delayed ART initiation. The median delay between starting ATT and ART was 23 days (Q1= 18 days, Q3= 30 days). Independent factors associated with ART initiation were marital status; separated (AOR 6.21, 95% CI 1.63-23.71), single (AOR 9.58 95% CI 2.39 – 38.36) and widowed (AOR 14.23 95% CI 1.72 – 117.76), first HIV treatment at health centre (AOR 0.35 95% CI 0.13-0.94), transport cost more than US$1 (AOR 5.69, 95% CI 1.87-17.34), fear of medicine toxicity (AOR 7.68, 95% CI 2.63-22.41), and having a family member on TB treatment (AOR 0.22, 95% CI 0.07-0.67). ART follow up and outreach was not being one at all the facilities. Communication on referred TB/ART patients was not complete between facilities.
Conclusion: Intensifying ART preparation, streamlining clinic visit schedule protocols,
follow up on defaulting patients and outreach clinics are vital in averting delays. Health
workers should communicate on referred ART patients to expedite linkage in care
Loss to follow up in HIV exposed infants in the PMTCT programme in Hurungwe District, Zimbabwe
No full textHigh rates of loss to follow-up (LFU) of HIV exposed infants after birth have been described to be a challenge in the PMTCT programme. In Hurungwe District out of the 148 exposed infants in the exposed infants register 73,6% (109)at Karoi Hospital were lost to follow up as of October 2011. A better understanding of the characteristics of women-infant pairs lost to follow and those still coming for PMTCT reviews is needed so as to come up with factors associated with loss to follow up.
Methods: A 1:1 unmatched Case-Control study was conducted in 3 health centers purposively selected with the top 3 PMTCT coverage’s in Hurungwe District Mashonaland West Province. A case was any infant who was HIV exposed who defaulted regular reviews for 3 months or more and during the course of the study was still lost to follow up. A control was any infant who was HIV exposed who was still coming for their regular review visits for the period (less than 3 months).The sample size was calculated at 95% confidence, 80% power and assuming 50% exposure in control group with odds ratio of 0,30 the sample size was set at 56 cases: 56 controls total sample size at 112. The study instruments were constructed according to the educational diagnosis phase of the PRECEDE-PROCEED Model borrowing constructs from the Theory of Planned Behavior. Focus group discussion guide and an interviewer administered questionnaire were used for data collection.
Results: Mothers who took ARVs during labor were less likely to be lost to follow up (0.0303). This protective association was statistically significant at 95% CI. Infants who were alive and well were significantly more likely to be lost to follow up (9.75). 5.4% (3) infants had deceased. Infants who were receiving extended Nevirapine and Cotrimoxazole were less likely to be lost to follow up with odd’s ratio of 0.0171 and 0.2391 which were statistically significant. Infants with good nutrition (OR0.76) less likely to be lost to follow up however this was not statistically significant. The log odds of mothers that said they were likely to take their child for review and drug resupply were protective (OR: 0.2732) with cases less likely to intended to take their child for such visits, this was statistically significant at 95%CI (0.1215;0.6141).
Conclusion: The District Health Executive for Hurungwe district should formulate interventions to increase the behavioural intention of mother of exposed infants to access care. Mothers should be given health education on the importance of early infant diagnosis and the need to prevent opportunistic infections through the use of extended nevirapine and cotrimoxazole prophylaxis
Current treatment and future prospects for the management of acute coronary syndromes
No full textThe impact of ischaemic heart disease on the burden of cardiovascular disease continues to escalate worldwide. • although international statistics suggest a levelling off in Western world, in the less industrialised parts of the world the effects of this diases are only beginning to be documented, nonetheless, rapid advances have been made in the diagnosis and management of the acute coronary sydromes (the term which encompasses the protean clinical manifestations of the ischaemic process). The therapeutic strategies discussed in this article cover two broad subjects that have been found to be critical in the evolution of the disease:- i. interfering with the haemostatic balance by retarding the thrombotic process; ii. modifying local and systemic vasoconstricting stimuli
Unusual complications of typhoid fever
No full textTyphoid fever is endemic in most of tropical Africa. The common complications encountered include perforation, hemorrhage, acute renal failure, cholecystitis, pyelonephritis and pneumonia. Typhoid meningitis and endocarditis are quite rare. We report here a case of proven meningitis and a case of endocarditis
Health workers’ participation in voluntary counselling and testing in three districts of Mashonaland East Province, Zimbabwe
No full textObjectives: To determine the proportion of health workers who had undergone VC'T for HIV' in three districts of Mashonaland East Province and to further explore reasons for non-participation in those who had not been tested.
Settings: The study was conducted in the rural Districts of Murewa. Mutoko and Mudzi in Mashonaland East province.
Design: The study was a descriptive cross sectional survey.
Subjects: All categories of health workers in Murewa. Mutoko and Mudzi.
Main Outcome Measures: Participation in VCT, and reason for non-participation.
Results: Out of 200 questionnaires sent out 183 (91.5%) were completed and returned. The majority of the respondents were nurses 142(77.6% ), female 113 (61.7%), married 135 (73.8% )The median age was 33 (Q1: 28: Q3: 38) and they had attained a high school education 137 (74.9%). Of the respondents 160 (87.4% ) had not gone for VCT; 141 (77%) did not want to have an HIV test. The reasons for not being willing to have an HIV test included not being ready to go for VCT 154 (84.2%); could not cope with the results, 143 (78.1%), do not have the courage to go 133 (72.7%): no need for testing as there is no cure for HIV/AIDS J 06 (57.9%). One hundred and twenty six (69%) indicated that they needed counseling for them to be able to go for VCT. Conclusion:
HIV/AIDS programmes have been directed at the community at large neglecting the health
worker. This study, therefore, recommends programmes specifically tailor-made for health workers. These
programmes should have a strong counselling component and should focus on self-efficacy so that health
workers can finally be ready, be able to cope with HIV results and have the courage to participate in VCT
Hypertension awareness, treatment and control at Vubachikwe Mine, Gwanda, Zimbabwe, 2013
No full textBackground: In July 2012, according to the chronic disease register Vubachikwe mine had at least 1 in every 10 workers suffering from hypertension. However about 30 workers had defaulted hypertensive treatment that is offered free at the mine clinic. The management was concerned about lost to shift hours and high costs of medical care due to hypertension related illness among employees. Therefore we set out to evaluate the prevalence of hypertension and the reasons why employees defaulted treatment. Methods: An analytic cross sectional study was done at Vubachikwe mine. Systematic sampling was used. An interviewer administered questionnaire adopted and modified from the WHO STEPwise survey was used to capture; demographic data, risk factors and awareness of hypertension. Biophysical measurements; weight, height, random blood sugar and blood pressure were measured. Results: Ninety three percent of employees were aware of their blood pressure. The prevalence of hypertension was 27.2% while males were 6 times more likely to develop hypertension compared to females. Awareness of hypertension increased with age, (p<0.05). Thirty five percent of hypertensives were non-compliant to treatment and 70% of hypertensives had well controlled blood pressure. Earning more than US300 (POR 1.5; 95% CI, 0.46-0.93). ). However, heavy manual workers were less likely to be diagnosed of hypertension [POR 0.19 (0.042-0.852) 95% CI] and they also earned less than US600 which is associated with a sedentary lifestyle. Heavy manual workers who earned less than US$300 were less likely to be diagnosed of hypertension. Based on the study findings, the mine management has instituted interventions targeted at health educating workers on hypertension and defaulters will be traced, given psychosocial support and encouraged to comply with medication
Knowledge of women of child bearing age on the utilisation of intermittent preventive treatment of malaria in pregnancy at Dangamvura and Sakubva health centers, Mutare, Zimbabwe .
No full textEven though it appears as if countries in sub-Saharan Africa have made important
progress in IPTp implementation, coverage levels remain low. Various studies done have
come out with various findings ranging from lack of knowledge to negative attitudes of
woman towards the program. The purpose of this study was to determine the association
between knowledge and utilization of IPTp by pregnant women attending ANC services at
Dangamvura and Sakubva Mutare city clinics. Pender’s health promotion model was used to
guide and direct the study. A descriptive correlation design was used for the study. The author
examined the strength of the relationship between knowledge and utilisation of IPTp by
pregnant women attending ANC at Dangamvura and Sakubva Mutare Clinics. A sample of 80
women who were attending ANC visits was selected by systematic random sampling. Data
were collected through face to face interviews using a structured questionnaire. Interview
guide consisted of questions on knowledge and utilization of IPTp and the association between
knowledge and utilization were asked. Additionally Focus Group Discussions were used. Data
were analysed using descriptive and inferential statistics. Pearson’s correlation showed an
insignificant correlation (r=0.097) women’s knowledge to utilisation of IPTp. The findings did
not support that knowledge on IPTp improves utilisation of the program. It is important
therefore for Midwives to intensify tailor made health education and motivate women to
utilise IPTp services