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Effectiveness of short message services reminder on childhood immunization programme in Kadoma- a randomized control trial, 2013
No full textIntroduction: Globally, non-attendance for immunization appointments remains a challenge to healthcare providers. Adoption of short message services has been shown to enhance attendance in medical setting. A review of the 2011 consolidated monthly return form (T5) for Kadoma City reveals that the annual OPV1, Pneumococcal 1, and Pentavalent 1 coverage at 6weeks was 74% and for OPV2, Pneumococcal 2, and Pentavalent 2 was 84% at 10weeks. The coverage for OPV3, Pentavalent3 and Pnemococcal3 was 74% at 14weeks. The immunization coverage was less than the district target of 90% for all the antigens at 6, 10 and 14 weeks. The study was conducted to determine the effectiveness of short message services reminders on immunization programme for Kadoma City.
Methods: A Randomized Control Trial was conducted at Kadoma City Clinics. Woman who delivered in Kadoma and are residence of Kadoma City were recruited into the study within 72hours after delivery. In the intervention group Short Message Service reminders were sent at 6, 10 and 14 weeks. In the non-intervention no message reminders were used. Data were collected using a standardized interviewer administered pretested questionnaire. Data were collected in phases that are; soon after delivering, at 6, 10 and 14 weeks. Data were entered and analysed using Epi Info 7TM (CDC August 2012). The data were displayed on frequency tables, the means of continuous data were calculated and also contingency tables were used to analyze categorical data.
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Results: A total of 305 participants were recruited into the study. A total of 152 participants received the short message services as immunization reminders while 153 did not receive the short message reminders. The immunization coverage in the intervention group was 97% and in the non-intervention group was 82% at 6 weeks (p<0.001). At 10 weeks the immunization coverage was 96% and 80% in the intervention and non-intervention group respectively (p<001). Immunization coverage at 14 weeks for OPV3, Penta3 and PCV3 was 95% in the intervention group and 75% in the non-intervention group (p<0.001). The proportion of those who did not delay in receiving OPV1, Penta1 and PCV1 was 82% in the intervention group and 18% in the non-intervention group. The proportion of those who did not delay in receiving OPV3, Penta3 and PCV3 was 81% in the intervention group and only 8% in the non-intervention group. The median delay in the intervention group was 0 days (Q1=0; Q3=0) whilst the median delay in the non-intervention group was 10 days (Q1=6; Q3=17).
Conclusion: The immunization coverage in the intervention group was significantly higher than in the non-intervention group. There is a difference on the immunisation coverage among those receiving short message service reminders and routine immunisation health education and those receiving routine immunisation health education only. The overall increase in the immunization coverage can be attributed to the use of short message reminders in this study
Hepatitis BeAg in chronic asympomatic Hepatitis B surface antigen carriers and in primary hepatocellular carcinoma patients
No full textA total of 246 HR, Ag - positive subjects were iSted for the presence of Hepatitis Bt, antigen,
ad total anti-delta IgG. Of the 246, 174 were
BsAg- positive asymptomatic chronic carriers
nd 72 were primary hepatocellular carcinoma
atients attending the two teaching hospitals, i.e.
arirenyatwa and Harare Central Hospital.
All sera were examined by the enzyme-linked
nmunosorbent assay (ELISA), and results were
:ad spectrophotomctrically at a wavelength of
92nnr 82 (33,3%) were HBcAg - positive. Of
le 246,56 (39,4%) males and 26 (25%) females
ad HBeAg present in the serum. However, the
revalence of HBeAg from only the chronic
symptomatic HB.Ag -positive carriers in males
ad females was 17 out of 103 (16,5%) and 12
at of 71 (16.9%)). respectively—thus with an
rerall prevalence of 31 (17,8%) from the
symptomatic group. Consequently. the prevalence
: HBcAg from the primary hepatocellular
ireinoma (PHC) group was 32 of 72 (44,4%).
he rate of positives from the males and females
’the PHC group was 46,2% and 42,4% respec-
rely. Total anti-delta IgG was not detected in
e 246 examined sera
The effects of weighting in the regression analysis of survey data collected using non-probabilistic sampling methods: A secondary data analysis
No full textIntroduction
When surveys are conducted especially for hidden populations, data is rarely collected using random sampling which is the ideal way to collect representative data. However, it is common practice to analyse this data as if it was collected through random sampling
ignoring the sampling design. We sought to determine the effects of including weights in the analysis of survey data collected through non-probabilistic sampling methods.
Broad objective
To assess the effects of weighting on risk taking behaviours associated with STIs
among female sex workers (FSW) and long distance truck drivers (LDTD) in Beitbridge using weighted and unweighted logistic regression models.
Methods
Both inverse probability weighted and unweighted forward selection multivariate logistic modelling techniques were used to determine significant risk taking behaviours
associated with STIs in FSW and LDTD. Final models compared magnitude of the difference between odds ratios, the selection of final variables, standard errors,statistical significance of selected variables and the overall fit of the models to determine whether or not we believed weighted models were more appropriate for the analysis of the survey data for FSW and LDTD.
Results
For risk taking behaviours associated with STIs, inclusion of weights resulted in an
increase in the odds ratios, a decrease in the standard errors and narrowing of theconfidence intervals for the parameters in the weighted model for FSW. In the
weighted model for LDTD, the odds ratios were higher than in the unweighted model
and the confidence intervals were slightly narrow. However, the standard errors were
higher in the weighted models.
Conclusion
Based on the results, we concluded that weighting in the regression analysis of survey data collected using non probabilistic sampling methods helps to improve the precision of the regression estimates; hence weighted models should be used
Delays in performing emergency caesarean sections at Harare maternity hospital and Mbuya Nehanda hospital: Causes and outcomes
No full textIntroduction
The ideal decision-to-delivery interval (DDI) for emergency Caesarean sections (ECS) quoted in international guidelines is 30minutes. Achieving this DDI is anticipated to improve perinatal outcomes. It has however been found in several institutions that it is not achievable in routine practice. There had not been a study in Zimbabwean institutions to determine our achieved DDI for ECS. In the event that we fail to achieve a 30minute DDI, there was no data on what were the influences or causes of delay in performance of ECS, and the maternal and perinatal outcomes thereof.
Objective
What is the achievable DDI for ECS performed at Harare Maternity Hospital (HMH) and Mbuya Nehanda Maternity Hospital (MNMH). What are the causes of delay in performing ECS and what are the perinatal and maternal outcomes.
Design
Hospital based prospective descriptive study.
Setting
Harare Maternity Hospital and Mbuya Nehanda Maternity Hospital
Study population
Consenting women that had undergone emergency Caesarean section.
Methods
Convenience sampling of women who had had ECS and were able to give consent to participate in the study was done.
Data was collected by the researcher using a questionnaire on the day after they had ECS. On day 7 after the operation, a follow-up interview was conducted to check on the condition of both mother and baby. Data analysis was done using EPI INFO version 3.22 statistical software. Ethical approval was obtained from the ethics boards of each institution.
Main outcomes of measure
The indication of the ECS and the achieved DDI were explored. We also looked at the demographics and obstetric history of the participants, the stated causes of delayed DDI, the maternal morbidity and perinatal morbidity and mortality associated with delayed DDI.
Results
The total number of deliveries performed at both hospitals during the study period was 3 724 of which 1 050 (28.2%) were performed as Caesarean sections. Of all Caesarean sections, 866 were ECS (82.5%). The calculated sample size was 183. The study included 200 participants. The median age of participants was 25.5years. The majority of participants were married (94.5%), educated to secondary level or better (74%), Christian (68.5%), housewives (67.5%). 81 participants were primiparous. 13 participants delivered twins, therefore the total number of delivered infants was 213. Of these, 38 (17.8%) were delivered prematurely and 130 (16.9%) were term. 177 participants (88.5%) had booked their pregnancies. On admission, 147 (73.5%) were referred from within the Greater Harare Maternity Unit (GHMU), 26 (13%) were self-referrals and 27 (13.5%) were from outside the GHMU. The majority of participants had not had previous uterine surgery (75.5%). Most had successful regional anaesthesia (68%). In the study group, 92 participants (46%) had category 1 ECS and 108 (54%) had category 2 ECS. The median DDI for the whole group was 201.5minnutes (3hours 21minutes). Notably MNMH achieved a median DDI which was 1hour less than that at HMH. The top five causes of delay were delays in pre-operative preparation of the patient, theater being otherwise occupied, laboratory delays, delays in accessing blood products and delays in obtaining consent for theater. Of the 200 participants, only 14 (7%) had postpartum haemorrhage, and only 3 (1.5%) of these were still admitted 7days after the ECS while awaiting blood transfusion, the rest were home and in satisfactory condition. Of the 213 infants born, 186 (87.4%) had a 5minute Apgar of >7, 89 (41.8%) were admitted to neonatal unit and 27 (12.7%) suffered perinatal death.
Conclusion
A 30 minute DDI is not achievable in our institutions but with minimal adverse effects on the parturient or her infant
Use of packed red cells in a major hospital in Harare, Zimbabwe
No full textObjectives: To document the current pattern of packed red cell (PC) usage and the crossmatch to transfusion ratio (C/T ratio) in a major city teaching hospital in Harare, Zimbabwe. Design: Restropective, (audit). Setting: Harare Central Hospital, a 1 200 bed multidisciplinary hospital located in Harare, Zimbabwe. Main Outcome M easures: Amount of PC ordered and proportion collected for the year 1995. Quantity of PC used by different medical specialities. Results: In 1995 a total of 8 292 PC were collected from Harare Hospital blood bank. This translates to an average PC usage for a 1 200 bed hospital of seven units per hospital bed per year. Only 48.5% of PC crossmatched was collected with a C/T ratio of 2.1:1. Revenue loss of Z$478 434 is estimated to have occurred due to expired units and resource wastage from uncollected crossmatched units. The largest consumer of PC was the Department of Gynaecology, followed by Surgery and Paediatrics. Conclusion: Regular auditing of blood usage is recommended to promote the efficient use of PC in accordance with accepted international standards and local guidelines and practice
The Prevalence and Factors Associated with Gender Based Violence among Zimbabweans Deported through Beitbridge District, Matabeleland South Province, Zimbabwe, 2013.
No full textBackground: Gender Based Violence (GBV) is gaining recognition in Zimbabwe due to rising prevalence and long term health consequences of the survivors. Beitbridge district handles an influx of deported migrants over any given period. Preliminary information obtained from the International Organization for Migration (IOM) suggested a high burden of GBV amongst deported migrants. We investigated the prevalence and factors associated with GBV amongst Zimbabwean women deported through Beitbridge District.
Methods: An analytical cross sectional study was conducted among Zimbabwean women aged 18 years and above deported from South Africa through IOM Centre in Beitbridge District in 2013.Data was summarized using proportions and means.Bivariate and Step wise logistic regression was done to identify factors associated with GBV.
Results: Results from 291 participants were analysed. The prevalence of ever experiencing GBV was 44.7% (CI:38.9; 50.6).The distribution of GBV by typology was emotional/psychological 38.8(CI:32.7;45.4), Physical 36.4%(CI:30.6;42.9),Sexual abuse 34%(CI:28.5;40.2) and economic abuse 14%(CI:10.1;19.6). Independent risk factors were Age<18yrs at marriage or when started living with partner POR 3.8(CI: 1.12; 11.78), Using private transport while migrating POR 4.1(CI: 2.07; 8.26),having a partner/husband with other sexual partners POR 5.9(CI: 2.35; 14.85) and partner/husband alcohol consumption POR 3.0(CI: 1.58; 5.99)
Conclusion: The crude prevalence of GBV of was 44.7%. Risk factors identified in this study were, age<18yrs at marriage, use of private transport, partner/husband with other sexual partners and husband/partner alcohol consumption. Majority of GBV survivors did not report or seek help because they feared arrest and deportation.
Recommendations:There is need to put in place a program and resources to screen all female deportees for GBV and give them appropriate treatment as they pass through the IOM support centre.Humanitarian space should also be opened up to partners working in health services provision for treatment and management of GBV survivors
A relationship between self-care knowledge and self-care practices on pregnancy induced hypertension (PIH) among women aged 15-49 years with PIH attending antenatal clinic at Harare hospital
No full textPregnancy induced hypertension (PIH) is a gestational hypertensive disorder. It is
the commonest unavoidable medical condition encountered in pregnancy, complicating
approximately 10% of all pregnancies. The purpose of this study was to examine the
relationship between PIH self-care knowledge and PIH self-care practices in women aged 15 to 49 years with PIH. Orem’s Self-care Model was used to provide a theoretical
framework to guide this study. A descriptive correlational study research design was
adopted to guide the study. A sample of 78 participants was selected using the convenience sampling technique. The investigator wished to examine the relationship between the PIH self-care knowledge levels the women possessed and their PIH self-care practices. Data was collected through a face to face interview interaction using a structured interview schedule. Descriptive statistics, frequencies, percentage, mean and range were used to analyze the data on the level of PIH self-care knowledge they possessed and the PIH self- care practices done by the women. Inferential statistics, the Pearson’s product-moment correlation co-efficient was used to analyze the relationship between PIH self-care knowledge levels and PIH self-care practices. The major findings of the study showed that the extent of PIH self-care practices was above average for all (78) (100%) participants. Fifty-seven (73.08%) participants demonstrated an above average level of PIH self-care knowledge, whilst only 11 (14.1%) had a level below average. Scores varied, and ranged from 4 to 14.Pearson correlation coefficient showed a non-significant, positive weak association (r= .203, p >0.01) of PIH self-care knowledge and PIH self-care practices. Midwifery practice should therefore reinforce on areas with weak scores of PIH self-care knowledge such as recognition of oliguria and severe headache as danger signs, and the importance of taking correct action when they manifest
Oestrogen transdermal patches for post partum depression in lactating mothers: A case report
No full textOestrogen transdermal patches are now being used in the prophylaxis and treatment of post partum depression. Oestrogens are known to have potential adverse effects on breastfed infants. This case describes jaundice and poor weight gain in the child of a lactating mother prescribed oestrogen transdermal patches. There is a need for caution in the use of this therapy in breast feeding mothers and health professionals should be alert for problems
Haematemesis in an African medical ward
No full textBetween 1957 and 1963, 63 male patients were admitted under my care to Harare African hospital. They were suffering from acute haematemesis from the upper gastrointestinal tract. The bleeding in each case was sufficient to necessitate the patient’s early admission to hospital. In some cases it stopped quickly, but in others it was so severe that the patient succumbed rapidly or. in the case of those with liver disease, some passed into coma and died
Clinical laboratory test prices in Zimbabwe: A case of profiteering?
No full textObjective: To compare the prices charged for clinical laboratory tests in Zimbabwean institutions with those o f similar institutions abroad. Design: An online analytical cross sectional study was conducted Setting: An online survey Subjects: We did an online survey of clinical laboratories that published prices of the tests offered on their websites. We also extracted price information from documents published by fees regulatory authorities. Main Outcome Measures: Laboratory test prices for independent institutions, Laboratory test prices for State institutions. Results: Overally for all countries, laboratory test prices were lower in state laboratories compared to the independent laboratories. In Zimbabwe, state laboratories generally charged about 50% of the independent laboratory tariff for most tests. However prices from both Zimbabwean institutions were generally much higher than those of the comparison countries (United Kingdom, South Africa, India, United States of America and New Zealand). Conclusion: Prices of laboratory tests are indeed higher in Zimbabwean institutions compared to other centres abroad. These higher prices could be attributed to challenges in consumable procurement logistics. We also present measures that could be put in place to reduce the costs and therefore prices