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Clinical falciparum malaria: Its severity, types, splenomegaly, association with malnutrition and criteria for diagnosis
No full textA clinical study of 78 consecutive cases - almost all by P. falciparum - was carried out.
The population is semi-immune.
1. Most of the patients appeared to have contracted the disease when visiting the
rural areas. Relapse malaria appears to be very uncommon.
2. The disease is very common in infants and children.
3. The spleen was palpable in about a third of all the cases, but the number of children
who showed a splenomegaly was significantly greater than in the adults. The
possibility that malaria is a cause of sequestration of the spleen is made.
4. A confident diagnosis of acute malaria is seldom made in the absence of positive
blood smears.
5. Not uncommonly the main presenting symptoms were those of cough, diarrhoea
or severe headache.
6. The main clinical types are described, the most common found being the anaemic
type. There was one case which corresponded to the psychiatric type. Other types encountered included those of cerebral, renal, hepatic, gastrointestinal and algid.
7. Severe malaria may not uncommonly be seen in the malnourished infant or child.
8. A positive blood culture occurred in some of the cases with acute malaria but the
importance of this finding was difficult to assess.
9. The criteria for considering a diagnosis of acute malaria in the absence of positive
blood smears are made.
10. Often when chloroquine was given to a patient the fever dropped steeply
Anaesthesia associated mortality in a district hospital in Zimbabwe: 1994 to 2001
No full textObjective: To describe anaesthetic associated mortality in a district hospital in Zimbabwe. Design: A retrospective descriptive study of anaesthesia associated mortality over an eight year period. Setting: Murambinda Mission Hospital: a 120 bed rural district hospital in Zimbabwe. Subjects: All patients who died within 24 hours of receiving an anaesthetic. Main Outcome Measures: The overall mortality rate (OMR), being all deaths up to 24 hours after an anaesthetic. Avoidable anaesthetic mortality rate (AMR), are deaths in which correctable anaesthetic factors played a major role. Results: An overall mortality rate (OMR) of 1:344 (2.9 deaths/1 000 anaesthetics) and avoidable mortality rate (AMR) for anaesthesia of 1:482 (2.1 deaths/1 000 anaesthetics) are reported. Factors under the control of the anaesthetist accounted for 72% of mortalities (AMR:OM R). Ail were emergency obstetric patients and had emergency surgery. The hospital maternal mortality rate of 360 per 100 000 and an operative obstetric mortality of 1:293 (3.4 deaths/1 000) are reported. Conclusions: Most of the anaesthetic factors are preventable. These results, although very poor, are consistent with reports from hospitals in the region. By comparison, developed countries are at least 10 times better. Improving the provision, skills, support and profile of anaesthesia providers in the care of peri operative patients, would reduce anaesthesia-associated factors in peri operative mortality. A system of national audit data collection comparable to the CEPOD or Confidential Enquiry into Maternal Deaths is overdue in Zimbabwe
Serum IgG subclasses levels in paediatric patients with pneumonia
No full textObjectives: To determine the IgG subclass levels of patients admitted to Harare Central Hospital paediatric wards with pneumonia. Design: A cross sectional study. Setting: Harare Central Hospital. Departments of Immunology and Paediatrics. University of Zimbabwe: Department of Paediatric Immunology, University of Utrecht. The Netherlands. Subjects: 56 paediatric patients. Main Outcome Measures: IgG subclass profiles of children with pneumonia. Results: Of the 56 children tested, 40 (71%) had antibodies to human immunodeficiency virus (HIV). The levels of IgGl and IgG3 subclasses were significantly higher in HIV antibody positive children (p<0.001, p<0.01 respectively) than in those without detectable HIV antibodies in their sera. There was no significant relationship between IgG subclass levels and the presence of HIV p24 antigen. Furthermore, age and gender also had no significant influence on the levels of IgG subclasses in this population. Conclusion: High levels of IgGl and IgG3, but not IgG2 and IgG4. occur frequently in children with pneumonia and are associated with the presence of HIV antibodies
Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross sectional study
No full textLetten FoundationObjective'. To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were born in a national HIV prevention programme. Design'. This was a community based cross-sectional study. Setting: A resource poor peri-urban setting with high prevalence of HIV infection. Subjects: School aged children six to 10 years old who were bom in a national mother-to-child HIV prevention programme. Main Outcome Measures: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels. Results: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb 8.3pg/L) were 15%, 4% and 2% respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children. Conclusion: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia. HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential
The relationship between knowledge of breast self-examination and practices regarding breast self-examination among women aged 25 – 49 years at Mbare family services clinic in Harare, Zimbabwe
No full textWorldwide, breast cancer is the most frequently diagnosed cancer in women and it is the leading cause of cancer deaths among women (Jemal, Ward, Center, Siegel and Thun). In Zimbabwe, the proportion of women dying from breast cancer is 1 in 28. The breast cancer rates are higher than those for any other cancers besides lung cancer (Chokunonga, Borok, Chirenje, Nyakabau and Rukainga, 2009). The purpose of the study was to examine the relationship between knowledge of breast self-examination and practices regarding breast self-examination among women aged 25 to 49 years at Mbare Family Services Clinic in Harare, Zimbabwe. The Health Promotion Model was used to guide the study. A non-experimental descriptive correlational study design was used. A simple random sample of 85 women who visited Mbare Family Services Clinic in Harare, Zimbabwe was used. A structured interview questionnaire comprised of demographic data, knowledge of breast self-examination and practices of breast self-examination. A pilot study was conducted. Data was analysed using the statistical package for social sciences (SPSS/CP). Data was analysed using descriptive statistics, inferential statistics and the Pearson’s Correlation Coefficient. The study findings showed a strongly positive linear relationship between knowledge of breast self-examination and practice of breast self-examination. The r = 0.668 indicating that as knowledge improves the practice of breast self-examination improves. The regression analysis was done R2 = .446 which implies that the effect of knowledge accounts for 44.6% of the variation on the practice of breast self-examination
Factors associated with late presentation to HIV/AIDS care in Harare City , 2015
No full textIntroduction: Despite widespread awareness and publicity concerning HIV care and advances in treatment, many patients still present late in their HIV disease. Preliminary review of the ART registers at Wilkins and Beatrice Road Hospitals indicated that 67% and 71% of patients enrolled into HIV/AIDS care presented late with baseline CD4 of <200 cells/uL and/or WHO stage 3 and 4 respectively. We therefore sought to explore factors associated with late presentation, with a view to encourage early health seeking behaviour.
Methods: We conducted a 1:1 unmatched case control study in Harare City where a case was an HIV positive individual (>18 years) with a baseline CD4 of 18 years) who had a baseline CD4 of >200/uL or WHO clinical stage 1 or 2 at first presentation in 2014.
Results: A total of 268 participants were recruited (134 cases and 134 controls). Independent risk factors for late presentation for HIV/AIDS care were illness being reason for test (AOR=7.68, 95% CI=4.08-14.75); Being male (AOR=2.84, 95% CI=1.50-5.40) and; experienced HIV stigma (AOR=2.99, 95% CI=1.54-5.79). Independent protective factors were receiving information on HIV (AOR=0.37, 95% CI=0.18-0.78) and earning more than US250). Based on this evidence, we recommended targeted interventions to optimize early access to testing and enrolment into care
Determination of omega-3 long chain polyunsaturated fatty acid levels using dried blood spots in Zimbabwean children aged 7 to 9 years
No full textBackground: Blood omega-3 long chain-polyunsaturated fatty acids (LC-PUFAs) have been widely studied in children because of the benefits from optimum physical and mental development. Despite these recognized benefits, the levels of blood omega-3 LC-PUFAs are unknown in Zimbabwean children. Omega-3 LC-PUFA levels were determined and reference intervals were established for the 7-9 year old Zimbabwean children. The association between omega LC-PUFAs and cognitive outcomes was also determined.
Methods: A cross sectional study was conducted from September 2011 to August 2012 on a cohort of peri-urban Zimbabwean children aged 7-9 years born to mothers enrolled at late pregnancy into an HIV prevention program between 2002 and 2004. Whole dried blood spots were sampled and LC-PUFAs were quantified using gas liquid chromatography. Differences in LC-PUFAs between groups were compared using the Kruskal Wallis test. Spearman correlation coefficient was used for the relationship between LC-PUFA levels and cognitive development.
Results: LC-PUFAs levels were determined in 297 Zimbabwean children of whom 170 (52%) were girls. The LC-PUFAs (wt/wt) ranges were; EPA 0.06–0.55%, DPA 0.38–1.98%, DHA 1.13–3.52%, ARA 5.58–14.64% and ARA: EPA ratio 15.47–1633.33. There were no gender differences in omega-3 LC-PUFAs levels (all p>0.05). EPA was statistically significantly elevated in the 8 years age group compared to those aged 7 and 9 years (0.20 vs 0.17 vs 0.18, respectively, p=0.049). ARA:EPA ratio was statistically significantly elevated in the 7 years age group compared to those aged 8 and 9 years (64.38 vs 56.43 vs 55.87 respectively, p=0.014).
Conclusions: In this cohort of children, lower EPA levels and higher ARA:EPA ratios were observed compared to those reported in apparently healthy children elsewhere. The high ARA:EPA ratios make the children vulnerable to inflammatory pathologies. Identification and incorporation into diet of locally available foodstuffs rich in omega-3 LC-PUFAs is recommended as is as omega-3 supplementation
The relationship between prenatal self- care practices during pregnancy and birth outcomes among young mothers aged 16 to 24 years delivering at Gweru Maternity Hospital
No full textYouth pregnancy is an important public health problem since it occurs in the context of poor social support and maternal wellbeing. Age at which child bearing begins has an impact on the health and welfare of the mother and her children, with young mothers being more likely to experience adverse birth outcomes. Highest pregnancy rates in the world are in sub – Saharan Africa where maternal deaths in the 16 – 24 years age group is twice as high as their older counterparts. In Zimbabwe 21% of women aged 16 – 24 years have begun child bearing with rural youths and those with less education tending to start earlier (Ministry of Health and Child Welfare, 2009).
The purpose of the study was to examine the relationship between Prenatal Self-Care Practices during pregnancy and Birth Outcomes among young mothers aged 16 – 24 years delivering at Gweru Maternity Hospital. Orem’s Self-Care model was used to guide the study focusing on the Self-Care, Self-Care Deficit and Supportive Educative Nursing System concepts. A descriptive correlation research design was used. A sample of 80 participants was selected through systematic random sampling, a probability sampling procedure. An interview schedule was used to collect data on self-care practices and birth outcomes. Data was analysed using the Statistical Package for Social Sciences (SPSS). Descriptive and inferential statistics was used to analyse data. Pearson coefficient correlation test was used to analyse the relationship between the two variables, which revealed a significant moderate positive relationship of (r.340 p<0.01) this explained that as self-care practices during pregnancy increases, birth outcomes improved. Midwifery practice should adapt protocols to support individualised self-care practices to maximise improvement in birth outcomes. Further research and inquiry is needed to explore other factors and variables that could have attributed to the high rates of adverse birth outcomes in young women
Comparison of retention in care rates among HIV-infected older persons and young adults on higly active antiretroviral therapy at a tertiary hospital in Harare, Zimbabwe
No full textObjective: To evaluate differences in retention in care rates between older individuals and young adults initiated on HAART and to determine the baseline characteristics that are associated with retention in care.
Design: Retrospective cohort study using routinely collected clinic data
Setting: A public sector HIV adult facility at the Parirenyatwa Hospital Family Care
Centre, Harare, Zimbabwe.
Participants: 444 HIV infected elderly patients (age 50 years and above) and young
adults (age 25 to <50 years) who initiated HAART between 1 January 2009 and 31
December 2011.
Main outcome measures: Primary outcome: Retention rate among older individuals
(=50 years) compared to younger individuals(25-49 years).
Secondary outcomes: Factors associated with attrition.
Methods: Analysis of patient records was done. Survival analyses were performed
using Kaplan-Meier method. Univariate analyses were done to determine factors
associated with retention in care.
Results: Older individuals had a significantly lower retention in care rate than young
adults(67.0% versus 81.8%) after 24 months on HAART in the final survival analysis(p<0.0001). Baseline CD4+ T-cell counts were significantly lower in the older
age group(p=0.042) who also presented with more advanced WHO clinical stages 3
and 4(p<0.0001). Time from HIV diagnosis to HAART initiation was significantly shorter in older persons compared to younger individuals(31days versus 47.5days). In the older age group, baseline characteristics associated with attrition were WHO clinical stage 3and 4 OR 3.11 p=0.048[95%CI:1.96-4.05, CD4+ T-cell counts=100cells/mm³ OR 2.27 p=0.041 [95% CI: 1.82-3.22 ]and presence of at least one co-morbidity OR 2.07 p=0.028 [CI:1.71-6.02].
Conclusion: Retention in care was lower in older persons as compared to younger
individuals. Older patients need to be tested for HIV and commenced on HAART early in order to maintain their continuity in care and prevent death