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Factors associated with respiratory distress in the newborn, Harare maternity hospital, 2013
No full textIntroduction: Globally, 4 million babies die each year in the first four weeks of life, the
neonatal period. Neonatal deaths account for nearly 40% of deaths worldwide in children less than five years old. Neonatal Respiratory Distress is among the leading causes of neonatal morbidity and mortality. Previous studies at Harare Maternity Hospital have shown that a ratio of one to three newborns admitted to the neonatal unit was diagnosed with respiratory distress.
The objective of this study was to assess factors associated with contracting respiratory distress in the newborn at Harare Maternity Hospital.
Methods: An unmatched 2: 1 case-control study (70 cases and 140 controls) was conducted at Harare Maternity Hospital, where all single deliveries occurring during the period under study constituted our study population. A case was defined as any live birth diagnosed with respiratory distress at birth. A control was defined as any live birth with no diagnosis of respiratory distress at birth. All cases on a day were recruited; controls were randomly selected using lottery method. A semi-structured questionnaire was administered to collect data from mothers. Data was extracted from delivery registers and maternity patient record.
Results
A total of 210 mothers were interviewed. The median age was 28 years for mothers of cases (Q1 22; Q 2 30), 26 years for those of controls(Q 121; Q 3 30). Factors associated with respiratory distress in the newborn were: Prolonged rupture of the membranes for more than 24 hours before onset of labour (OR 6.9; 95% CI 2.57-18.67; p <0.0001 ); Gestational age below 37 weeks (OR 5.74; 95% CI 2.60-12.68; p 0.0001); Low birth weight (less than 2500 grams) (OR 9.75; 95% CI 4.11-23.10; p <0.0001 ).
Conclusion
Prolonged rupture of the fetal membranes for more than 24 hours before onset of labour was found to be an independent risk factor for respiratory distress in the newborn at Harare Maternity Hospital. Meanwhile, further studies are needed in order to investigate on the causes of premature rupture of the membranes
Urinary iodine excretion in pregnant women as an index of the impact of a national iodization programme
No full textObjective: To evaluate the extent to which increase in iodine requirement was achieved in pregnant women who attended the antenatal clinic at Harare Central Hospital. Design: Cross sectional. Setting: Samples were collected from pregnant women attending antenatal clinic at Harare Central Hospital, and from lactating mothers and their infants. Subjects: 100 pregnant women attending the antenatal clinic at Harare Central hospital, 80 infants, 80 lactating women and 18 non-pregnant women. Main Outcome Measures: Comparison of urinary iodine excretion levels among pregnant women, lactating mothers and their infants. Result: The results indicated lower urinary iodine excretion levels for the pregnant women and lactating mothers compared to the urinary iodine excretion of the infants and the breast milk iodine content. The urinary iodine excretion level of the non-pregnant control women was median (first and third quartiles): 18.5pg/dl (30.0, 30.2pg/dl). The urinary iodine excretion level of the lactating mothers was median (first and third quartiles): 12.0 mg/dl (7.6, 19.5 mg/dl) compared to the level of the infants, median (first and third quartiles): 26.5 mg/dl (18.8, 11.5 mg/dl). A significant difference was noted between the median urinary iodine excretion levels of the mothers, and the median levels of the infants, p = 0.001. The mean milk iodine content was 21.2 ± 6.8 mg/dl. There was no correlation between breast milk iodine levels and the urinary iodine excretion levels of the infants, (p = 0.96, r = 0.006). Positive correlation was found between maternal urinary iodine excretion levels and the urinary iodine excretion levels of the infants, p = 0.016 r = 0.285. Serum FT4, and TSH levels were found to be higher for infants at six weeks after birth, (FT4 =20.91± 65pmol,L) and median TSH= 2.28 mJU/ml (1.36, 0.86)mlU/rnl, compared to levels at 12 weeks postpartum: (FT4=17.53 -*6.4pmol/L) and median TSH=2.02 mlU/ml. (0.84. 1.55)mlU/ml. The differences were not significant. Conclusion: The results indicated a significant reduction in the urinary iodine content of pregnant women, and lactating mothers which did not appear to have any relationship to the urinary iodine excretion levels of infants and iodine content of breast milk. Iodine intake needed to be raised to reflect the recent proposed recommendation.Medical and Actuarial Research Foundatio
Cancer of the cervix: knowledge, beliefs and screening behaviours of health workers in Mudzi District in Mashonaland East Province, Zimbabwe
No full textObjective: To assess the knowledge, beliefs and screening behaviours on cervical cancer among health workers in Mudzi District, Design: Cross sectional survey. Settings: Mudzi District Hospital and all the 20 rural health centres in Mudzi District ot Mashonaland East. Subjects: Sixty health workers in Mudzi District. Main outcome measures: Knowledge of cervical cancer risk factors, screening methods and treatment options. Beliefs and screening behavioursResults: The knowledge levels were lower for many of the predisposing factors of cervical cancer except for the use of vaginal herbs or chemicals, which 85 % of the health workers knew. Though 50 % of the respondents knew of the Pap smear as a screening method for cervical cancer, 86.6% d:d not know the human papiloma virus screening and 90% did not know of the visual inspection of the cervix using acetic acid. There were also very low knowledge levels for most of the treatment options for pre-cancer with all health workers not knowing the leepand the Laser options. The majority 73.3 % believed that the v where not at risk of developing cervical cancer. Most of the respondents, 81.7% , had not undergone any form of cervical cancer screening. However, the main reason for non screening was that there were no cervical cancer screening facilities in Mudzi District. Conclusion: The study revealed low knowledge levels, negative beliefs about the risk of developing cervical cancer and poor screening behaviours among health workers in Mudzi District. Training in cervical cancer is, therefore, recommended for the health workers. However, the training should be combined with setting up facilities for cervical cancer screening
Pictorial labels as an aid to increased patient compliance
No full textA study was conducted at Pumula Clinic in Bulawayo to assess the usefulness of pictorial labeling in increased patient understanding. The results of the study indicate that compliance was significantly improved by the use of pictograms as opposed to written instructions. Such a scheme, if implemented on a national scale, should improve health care in Zimbabwe
Accuracy of the kato-katz method in diagnosis of s.mansoni and soil transmitted helminths infection in Zimbabwe.
No full textIntroduction: Mapping of schistosomiasis and soil transmitted helminths infection in Zimbabwe was prioritized for evidence based treatment control strategy in year 2010. Two diagnostics tests: Kato-Katz (KK) and fomol ether concentration (FEC) were used during the mapping process.
Objective: This study aimed to determine the sensitivity and specificity of Kato-Katz technique in the absence of a gold standard using Bayesian modelling for the determination of S. mansoni and soil transmitted helminths infection (STHs) in Zimbabwe.
Methods: This is a secondary data analysis based on primary school children (n=15 818) aged 10-15 years who were enrolled in the national mapping of S. mansoni and STHs study, since they were reported to be the most exposed age group. Both parasitic infection by S. mansoni and STHs were diagnosed using a combination of two diagnostic techniques: the Kato Katz technique and the formol-ether concentration technique. A Bayesian approach was used to evaluate the diagnostic performance of the evaluation tool.
Results: The formol ether diagnostic technique was generally more sensitive with S. mansoni detection operational characteristics as follows (Sensitivity: 0.995; 95% Bayesian Credible Interval (BCI): 0.989 - 0.999), STHs- Hookworm detection (Sensitivity: 0.991; 95% BCI;0.988 - 0.993 ) , STHs– A. lumbricoides detection (Sensitivity:0.992; 95% BCI;0.989 - 0.995) and STHs– T. trichiuria (Sensitivity:0.988 95% BCI: 0.926 - 1.00); than the Kato- Katz diagnostic technique (for S. mansoni detection (Sensitivity: 0.981; 95% BCI:0.971 - 0.994), STHs - Hookworm detection (Sensitivity:0.966; 95% BCI;0.963 - 0.970) , STHs – A. lumbricoides detection (Sensitivity: 0.967; 95% BCI;0.974-0.981) and STHs – T. trichiuria (Sensitivity:0.988; 95% BCI;0.974 - 0.981). However, specificity is higher for the Kato- Katz technique compared to the formol ether concentration technique.
Conclusion: The formol ether concentration technique has better sensitivity compared to the Kato-Katz technique, but however it has less specificity compared to the formol ether concentration technique. been shown for the Kato – Katz technique for all the infections respectively
Not everything acid-fast is Mycobacterium tuberculosis: A case of Nocardia
No full textWe report a case of a 47 year old woman who presented with a history of motor convulsions and a three month history of an increasingly painful and progressively enlarging mass on the right side of her back. Neurological examination revealed generalised wasting and a right sided hemiplegia. A biopsy of the mass was taken for microbiology which reported growing branching gram positive rods after three days of incubation. A mycological diagnosis of Nocardia asteroides was made. An MRI scan revealed extensive infiltration of the fungal mass into extending from the base of the skull to fifth cervical vertebra
Factors Associated with Uptake of HIV Testing Among HIV Exposed Infants in Goromonzi District, 2012
No full textBackground: One of the national ART goals is elimination of pediatric AIDS through Early Infant Diagnosis (EID) and antiretroviral therapy where appropriate. National achievement for HIV test among HIV exposed infants between six and eight weeks of age (Dried blood spot) was 67% against a target of 60% for the year 2012. However, Goromonzi district achieved 12%. Two thirds of childhood deaths in Zimbabwe occur in infancy and Goromonzi district recorded 859 deaths in children under five years of age in 2012. The proportion of HIV exposed infants missing EID means pediatric ART cannot be scaled up. Factors associated with uptake of EID have to be established so as to increase pediatric ART and reduce childhood deaths.
Methods: A 1:2 case control study was conducted. A case was defined as an infant resident and born in Goromonzi district from the 5th of November 2011 up to the 4th of November 2012 (attained eight weeks of age in 2012) to HIV infected mother and did not have HIV test at six to eight weeks of age in 2012. A control was defined as an infant resident and born in Goromonzi district from the 5th of November 2011 up to the 4th of November 2012 (attained eight weeks of age in 2012) to HIV infected mother and had an HIV test at six to eight weeks of age in 2012. Primary care givers of HIV exposed infants were recruited for interviews to establish factors associated with uptake of DBS test among infants in Goromonzi district.
Results: 169 respondents were recruited, 54 were cases and 115 controls. Knowledge levels on HIV testing in infants among primary care givers were higher among controls than among cases (57% for cases, 79% for controls). Independent risk factors associated with non-uptake of HIV test among infants were belief that if a child is tested for HIV the child will be discriminated against O.R 3.61 (1.01; 12.9) and mother defaulted ART O.R 5.16 (1.48; 17.9). The independent protective factor associated with increased HIV test uptake was certainty on part of primary care giver that HIV test can be done to infants aged six to eight weeks in the district.
Conclusion: Knowledge levels among controls were better than among cases. Risk factors for infants not taking HIV test at six to eight weeks of age were the belief that once a child is tested the baby will be discriminated against and a mother who defaulted ART. The protective factor associated with increased HIV test uptake was certainty on the part of primary care giver that an HIV test could be done to infants in Goromonzi district
Best practices for intrapartum care in Zimbabwean health facilities
No full textEvidence-based interventions to ensure a good outcome during childbirth are widely available. Their applicability in various settings depends on local conditions and the resources available. Best practices during normal labour and delivery are described for Zimbabwean health facilities. Practices that have proved value are encouraged and those without benefit are discouraged
Patterns and characteristics of hypertension pharmacotherapy in Zimbabwe
No full textBackground: Hypertension is a non-communicable chronic disease that has been increasing in prevalence in developing countries in the last decade. On a global scale, mortality attributed to hypertension remains high (14%) affecting at least one billion people in the world; and approximately 80 million people in Africa. In Zimbabwe the prevalence of hypertension is currently estimated to be 27% of the total population; which is higher than HIV and Tuberculosis. As such successful management of hypertension is essential to reduce mortality from hypertension and associated complications. Systematic collection of information about hypertension pharmacotherapy is paramount to optimising patient care.
Objectives: The aim of this research was to investigate the patterns and characteristics of hypertension pharmacotherapy.The specific objectives were:(i) to determine the patterns of use of anti-hypertensive drugs, (ii) to determine the commonly experienced adverse effects, (iii) to assess the extent to which patients are compliant with drug therapy, (iv) to ascertain knowledge, attitude and practice about hypertension and
drug therapy and (v) to assess drug accessibility.
Methodology: A purposive sampling technique was used to recruit a sample of 400 patients with hypertension aged 18 years and above. The participants were from twenty randomly selected private pharmacies, Harare Central Hospital outpatients’ pharmacy and Parirenyatwa Group of Hospitals outpatients’ pharmacy. A structured questionnaire was used which was administered through interviews by the chief investigator and four trained research assistances. Data was analysed using SPSS- frequencies, descriptive statistics, cross tabulations, hypothesis testing and regression analysis.
Results: Systolic blood pressure of 57% of the participants was not under control. Age, body-mass index, waist size, alcohol taking, smoking, diabetes were some of the key individual characteristics that were found to explain hypertension. Hydrochlorthiazide, Nifedipine, Enalapril, Furosemide, Atenolol, Losartan, Amilodipine and Spinorolactone were the commonly used drugs. The commonly experienced adverse effects included headaches, dizziness, oedema and sexual dysfunction.Although Patients were taking drugs accordingly in terms of dosing and frequency 41% were not persistent. Lack of money and side effects were the main reasons for stopping drugs. Nineteen percent stopped taking medicines when they feel their blood pressure was under control. On assessing knowledge, 34% of the participants did not know that hypertension
is not curable. Sixty percent of the patients were not able to mention a single risk factor, complication or preventive measure and 47% did not know the normal range of blood pressure. Only 11% had home BP machines. Thirty-seven percent indicated that they use drugs only for the management of hypertension. Lifestyle modification like diet, exercise, and weight control were being practised by a few people. Herbs were
also being used to control HBP. Although drugs were readily available in the private sector, participants cited affordability problems.
Conclusion: The study has shown that current treatment practices to manage hypertension are not adequately controlling the condition in those affected. Intervention programmes which encourage healthy life- style, provision and supply of various drugs, patient education, counselling services and a national chronic diseases management policy are required to improve hypertension pharmacotherapy
Blood and Urine Lead Levels in Adults Attending Harare Polyclinics
No full textLead is a toxic environmental pollutant and exposure to it can produce serious adverse health effects in adults and children. There is no safe exposure to lead, however the CDC recommends adult blood lead level (BLL) of < 20μg/dl to be safe and <5 μg/dl for children. However evidence suggests subclinical toxicity at lower levels. In Harare, people are exposed to lead from exhaust fumes from leaded petrol, old leaching lead plumbing and flaking leaded paint.
The main objective of the study was to evaluate the level of lead exposure of ordinary residents in Harare. The secondary objective was to determine if lead levels were affected by serum protein levels.
Three urban areas were chosen for their potential of increased risk of environmental exposure. One rural area was chosen to act as a control. Water lead levels were also measured from the different study areas. The lead levels were measured using the inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Protein levels were determined using the Lowry method.
The mean blood lead levels that were obtained for the urban areas were 0.80±0.69μg/dl and 0.96±0.98μg/dl for the rural clinic. The urine lead levels for the urban areas were 0.57±0.67 μg/dl and 0.51±0.13μg/dl for the rural clinic. The water lead levels from the different study populations were 1.1μg/dl for Mbare, 1.6μg/dl for Highfield, 0μg/dl for Goromonzi and 0.4μg/dl, for Mabvuku/Tafara respectively.
The mean serum protein levels were 24.45±3.76g/l for the study population. The Pearson correlation coefficient for the serum protein levels and blood lead levels was 0.225 at a p-value of 0.124.
The ordinary residents in Harare urban have minimal environmental exposure to lead. There was no significant correlation between serum protein levels and blood lead levels