1358 research outputs found
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Assessment of risk perception of teratogenicity of commonly used drugs among pregnant women
No full textBackground: Drug therapy in pregnancy is common practice and most women are concerned about effects of drugs to the unborn child.
Objective: To determine the teratogenicity risk perception of commonly used medicines
among pregnant women.
Method: A cross-sectional descriptive survey was conducted at five antenatal clinics in
Harare. An interviewer administered questionnaire which collected information on socio-
demographic characteristics, information sources, medicine use, risk perception and health beliefs was used. Descriptive and bivariate statistics was used to analyze the data. Multivariate linear regression and logistic regression analysis were conducted to identify predictors of risk perception and medication use in pregnancy respectively.
Results: Out of 450 women approached, 368(81.3%) agreed to participate in the study. The majority (70.9%) of the women used medicines during pregnancy. Paracetamol (48.6%), magnesium trisilicate (31.5%), ferrous sulphate (25.5%), folic acid (20.4%) and methyldopa (15.2%) were the most commonly used drugs. The majority (70.4%) estimated correctly the baseline teratogenic risk to be <5%. In bivariate analysis, women who had health related jobs (.2=13.592, p=0.0005) and multiparious (.2=45.403, p=0.0005) were more likely to use medicines during pregnancy. Similarly, multiparious women (p=0.0005), women with health related jobs (p=0.003) and women with at least secondary level of education (p=0.048) had a lower risk perception. In multiple linear regression, parity (ß=-0.155, p=0.004), perceived danger (ß=0.215, p=0.001), perceived severity from harm (ß=0.292, p=0.005), perceived barrier to not taking medicines (ß=-0.095, p=0.041) and cues to action (ß=0.101, p=0.025) were significant predictors of risk perception. In logistic regression, parity (OR=9.525; 95% C.I: 3.848; 23.575; p=0.005), personal exemption from harm (OR=0.809; 95% C.I: 0.686; 0.954; p=0.012), perceived danger (OR=1.210; 95% C.I: 1.053; 1.390; p=0.007) and perceived barriers to not taking medicines (OR=0.754; 95% C.I: 0.643; 0.885; p=0.001) were significant predictors of medicine use.
Conclusion: Although medication use was high among pregnant women, the majority
overestimated the teratogenicity risk associated with individual medicines. There is need for health care providers to play a bigger role in provision of pregnancy related drug information so that positive attitudes and beliefs concerning medication use in pregnancy are reinforced.
Key words: Risk perception, Pregnancy, Medication, Belief
Experiences of health science students during clinical placements at the University of Zimbabwe
No full textBackground: Clinical placement is an essential component of training in health sciences because it is where theory and practice interface. Objective: To explore experiences of health sciences students during clinical placement in terms of supervision, challenges and coping strategics. Design: It was a cross sectional survey. Setting: University ofZimbabwe, College of 1 lealth Sciences. Participants: 179 multidisciplinary health science students. Materials and Methods: A cross-sectional survey was conducted using a self-administered questionnaire. Ethical clearance was obtained. Descriptive statistics were used for analysis. Main Outcome Measures: These were perceptions of students with regard to supervision, challenges faced during clinical placement and coping strategics used. Results: 179 participants responded to the questionnaires. Participants enjoyed linking theory to practice. Perceptions on supervision were both positive and negative. Inadequate supervision and inappropriate behaviours by supervisors were some of the challenges faced. Almost 89% used stress-relieving strategies such as focusing on why they were doing the clinical placement and the importance of successful completion. Ninety-one per cent had never used cannabis/mbanje but 41% had engaged in sexual activity to cope with challenges. Conclusion: This study found that the perceptions of health sciences students about supervision clinical placement, challenges faced and the coping strategics arc almost the same as those found elsewhere. It is therefore important to plan clinical placement with the involvement of clinical educators. Recommendations: .Supervisors' workshops should be held to create a forum to discuss clinical placement issues. Follow-up of students by academics is recommended. Students should be empowered to cope with challenges
The prevalence and morbidity associated with ectopic pregnancies at Harare central and Parirenyatwa hospitals
No full textIntroduction
Ectopic pregnancy is amongst the top causes of maternal morbidity and mortality in the first
trimester of pregnancy. It represents one of the commonest gynaecological surgical
emergencies in Zimbabwe and other developing countries because most of the women
present to health care facilities after rupture has occurred.
Objectives
i. To determine the prevalence of ectopic pregnancy at Harare and Parirenyatwa
Hospitals.
ii. To determine the risk factors associated with ectopic pregnancy at Harare and
Parirenyatwa Hospitals.
iii. To determine the morbidity and mortality associated with ectopic pregnancy.
Design
Cross-sectional study.
Setting
Harare and Parirenyatwa Central Hospitals in Harare, Zimbabwe.
Subjects
Women attending the two hospitals with suspected ectopic pregnancy from 01 December
2012 to 30 April 2013.
Methods
All women with a suspected ectopic pregnancy who consented to participate in the study
were recruited. They were managed by the attending team in the acute phase of the illness.
Face to face interviews were conducted to collect information and probe for risk factors of
ectopic pregnancy. The management offered to the patient was then analysed using patient’s
notes. An HIV test was done on all consenting subjects after pre-counseling. The mortalities
were noted and the morbidity was assessed by checking the pre-operative haemodynamic
state of the patient, pre-operative haemoglobin count, use of blood or its products, need for
intensive care post-operatively and the mean hospital stay.
Results
During the study period there were a total of 11239 deliveries attended at the two hospitals. A
total of 138 suspected cases of ectopic pregnancy were recruited into the study. Of these, 126
(91.3%) were surgically confirmed as ectopic pregnancies and the remainder (12) were
wrongly diagnosed. The overall incidence of ectopic pregnancy was found to be 1.12%. Most
women were in the 21-30 year age group and had 2 children or less. The risk factors
identified were a reported history of sub-fertility, previous history of STI, previous abdominal
or pelvic surgery and a previous ectopic pregnancy. There was one maternal death due to
rupture (case fatality rate of 0.8%). The morbidity was significant with 87.3% presenting
after rupture, 38.8% being attended with signs of shock, 11.1% requiring intensive care
admission and 77% being transfused with blood. The mean hospital stay was 5 days
following salpingectomy via laparatomy. The prevalence of HIV amongst those with ectopic
pregnancies who were tested was 13.1%.
Conclusion
The morbidity associated with ectopic pregnancy remains high in young women of low parity
as the majority present after rupture. The subsequent impact on future fertility of these
women could be improved significantly if health strategists focused on primary prevention
and early diagnosis to prevent tubal rupture. This means ensuring universal reproductive
health care access thereby working towards achieving Millennium Development Goal 5
(MDG 5) by 2015
Compliance and loss to follow up of HIV negative and positive mothers recruited from a PMTCT programme in Zimbabwe
No full textObjective: To describe the methodological challenges of a nine months follow up study of mothers recruited from a national Prevention of Mother To Child Transmission (PMTCT) programme with regards to defaulters, drop outs and compliance. Design: Nested case control study. Setting: Three peri-urban clinics in Zimbabwe namely: Epworth, St Mary's, Seke North. Method: Pregnant women who enrolled at 36 weeks of gestation were recruited for a follow up of mother and child from delivery, six weeks, four and nine months post purtum. Follow up trend of these women was compared between the HIV positive and negative mothers with regards to defaulting, drop outs, full and partial compliance. Statistical significance was computed using the Chi-square test. Results: Of the enrolled 1 050 pregnant women with a known HIV status (594 HIV negative and 456 HIV positive) 851 (457 HIV negative and 394 HIV positive) showed up at one or more visits scheduled up to nine months. The denominator was dropping at each point and time. The overall dropout rate was 19% without a significant difference between the HIV positive and negative women at delivery. At six weeks the drop out rate was 35 (7.7%) for the HIV positive versus 75 (12.9%) p=0.010 and at four months 12 (2.9%) versus 39 (7.7%) p=0.002 respectively. However, at nine months the drop out rate was not different (p=0.747). The defaulter rate was significantly different at every stage between the HIV positive and negative mothers from delivery to six weeks, becoming even more significant at the four and nine months visit (p=<0.001). The overall full compliance at nine months was 46.1% with a significant difference between the HIV positive (55.6%) versus (37.9%) for the HIV negative (p=<0.001). Conclusion: Drop out is highest among the HIV negative as opposed to the HIV positive with the peak period being at “six weeks”. There is high defaulting among the HIV negative compared to the HIV positive with the peak being at “four months”. The study has shown that the HIV negative women arc more likely to drop out whereas the HIV positive were twice as likely to fully comply. It is surprising that the peak drop out period, “six weeks visit” is a cardinal existing national scheduled visit where both mother and baby undergo a full medical examination with the mother having a pap smear taken.Letten Foundatio
A study to determine the relationship between pregnancy and knowledge of pregnancy related complications among adolescents aged 13 to 19 years in Marondera urban.
No full textAdolescents’ pregnancy is a global concern because they are biologically and emotionally immature. Pregnancy predisposes them to pregnancy related complications. Knowledge on pregnancy related complications are of importance to empower and promote good health behaviour in adolescents. The purpose of the study was to examine the relationship between pregnancy and pregnancy related complications among adolescents. A revised Health Promotions Model (HPM) by Pender N. (1996) was used as the guiding framework. A descriptive correlation study design was used with the pregnancy as the dependent variable and knowledge of pregnancy related complications as the independent variable. A sample size of 66 adolescents pregnant and with children was randomly selected. The sample size was estimated using power analysis, power .80, medium effects size of 0.05 and the significance level of 0.5. A structured interview schedule with three sections questions namely demographic data, pregnancy and knowledge of pregnancy related complications utilizing face to face interview was carried out to obtain data. Data was analysed using statistical package of social sciences (SPSS). Descriptive and inferential statistics (Pearson Moment Product, Correlation Co-efficient) was used to determine the relationship. The results of the study indicated that 11(16.7%) were pregnant at the time of the interview. 54(81.8%) had one child while 1 (1.5%) had two children. The birth interval was 63 (95.5%) had only one child, 2(3.0%) had a birth interval of one year while 1 (1.5%) birth interval was two years. With regards to knowledge of pregnancy related complications 39(59.1%) had no information while 27(40.1%) knew the pregnancy related complications. The study showed a weak negative significance between pregnancy and knowledge of pregnancy related complications. Recommendations were made to add to the body of knowledge in Maternal and Child Welfare/Midwifery
Effects of different frequencies of loading on healing in partial rupture of the achilles tendon in a rat model
No full textObjective: To determine the histological effects of different frequencies of loading in a healing Achilles tendon following partial rupture.
Design: Experimental laboratory study.
Setting: University of Zimbabwe, Department of Physiology, Animal house.
Subjects: Sixty female Sprague-Dawley rats
Intervention: Partial tenotomies of the right Achilles tendon were performed surgically. From day 1 post operatively, the animals were allocated to treadmill running at different frequencies (once (OD), two (BD), three (TDS) and four(QID) times daily) up to 21 days. Histological sides of the tendons were made at days 7,14 and 21 and interpreted by a blinded pathologist
Main Outcome Measures: Collagen fibre orientation, inflammatory cell populations, fibroblast morphology and neoangiogenesis were observed and scored using the Grande Biomechanical Histological Correlation Score.
Results: Mean weight was 209.67g ±30.14. The best and worst arrangements of collagen were in the QID group (73%) and OD group (46.7%) respectively. These differences were not statistically significant (p=0.487). The BD group had the most mature fibroblast nuclei and the QID tendons had the least mature (p=0.577). Inflammatory cell populations were independent of loading frequency (p=0.132).
Conclusion: Changing the frequency of the same type of loading in a healing tendon does not have an effect on the healing process in partially ruptured Achilles tendons during the inflammatory and proliferative
Phases
Patterns of visual function abnormalities in HIV positive children attending Harare Central Hospital's paediatric opportunistic infections clinic
No full textVision is composed of five simultaneous functions: visual acuity, colour vision, contrast sensitivity, visual field and stereopsis. These functions of vision are affected by disease processes that affect individual structures of the eye and the visual pathway. Human Immune Deficiency Virus (HIV), Highly Active Antiretroviral Therapy (HAART), Opportunistic Infections (OI) and the drugs used in their treatment have an effect on the eye and the visual pathway. This makes HIV positive children more likely to have poor visual function than the general paediatric population, however there is limited data available on visual function in HIV positive children both in Zimbabwe and sub- Saharan Africa.
OBJECTIVES
1. To characterise the patterns of selected visual function abnormalities (contrast sensitivity and colour vision) in HIV positive children attending an Opportunistic Infections clinic.
2. To quantify the prevalence of contrast sensitivity and colour vision abnormalities in HIV positive children.
3. To establish the existence and type of association between either of these visual functions and CD4+ T cell count, WHO HIV clinical stage and previous anti-Tuberculosis treatment.
DESIGN
This was a cross sectional study of patients attending the Harare Central Hospital’s paediatric Opportunistic Infections Clinic, Harare, Zimbabwe.
METHODOLOGY
Systematic sampling was used to recruit participants. A structured questionnaire was used to gather patient information. A complete ocular examination was done inclusive of Visual acuity (Snellen chart), colour vision (Ishihara plates), Contrast sensitivity (Pelli Robson chart), Slit lamp and dilated fundus examination.
RESULTS
1. A total of 168 participants were enrolled into the study (age range 7-12 years). BCDVA was better or equal to 6/12 in 98.8% of the participants.
2. The mean Log CS was 1.71 (range 1.2-1.95), with a standard deviation of 0.12.
3. The prevalence of poor contrast sensitivity was 12.5%, that of colour vision abnormality was 1.8%.
4. An association was established between poor contrast sensitivity and decreasing CD4+ T cell count (p=0.05).
5. Participants on HAART had a lower Log CS than those not on HAART (p=0.002).
6. Participants on second line HAART therapy had a lower Log CS than those on first Line HAART therapy, (p=0.02).
7. There was no associations established between previous anti TB treatment in participants and abnormalities in contrast sensitivity (p=0.63) and colour vision (p=0.50).
CONCLUSION
This study showed that poor contrast sensitivity is common in HIV positive children, with decreasing CD4+ T cell count being associated with poor contrast sensitivity. Contrast sensitivity abnormalities were found to occur even with good visual acuity.NECTA
Factors associated with perinatal mortality in Umguza and Bubi rural areas, 2015- the effect of maternal human immunodeficiency virus status.
No full textIntroduction: The perinatal mortality rate (PMR) is used as a proxy for the quality of maternal and child health care services accessible to women during pregnancy, delivery and the postnatal period. The PMR increased from 8.9 to 33 deaths and 21to 23 deaths per 1000 live births in Umguza and Bubi districts between the years 2010- 2014. The study seeks to understand the determinants of perinatal mortality in the two districts so that appropriate measures can be put in place.
Methods: An unmatched 1:2 case control study was conducted using a pretested interviewer administered questionnaire. A total of 73 cases and 146 controls were recruited in the study. A case was a woman who resided in Umguza and Bubi districts who had a perinatal death from January 2014 to June 2015. A control was a woman who resided in Umguza and Bubi Districts whose baby survived the early neonatal period from January 2014 to June 2015. Two focused group discussions (FGD) were done one in each district using the FGD guide. The FGD consisted of 12 women for Bubi and nine women for Umguza district.
Results: The median age of cases and controls was 22years (Q1=19; Q3=29) and 23 years (Q1=19.5; Q3=28) respectively.Gestational age of < 36 weeks OR 8.28 (3.67; 96.6), having a male baby OR 1.4 (1.09; 2.88), low birth weight of <2500g OR 1.37 (1.27; 6.96) and no antenatal care booking OR 24.6 (2.67;226.3) were independent risk factors for perinatal mortality. Antenatal booking OR 0.30 (0.14; 0.65) and secondary education were protective factors against perinatal deaths. Women’s cultural believes and poor nurse attitudes, resource shortages and patient delays were cited as contributory to perinatal mortality.
Conclusion: Gestational age of less than 36 weeks, not attending antenatal care, having a male baby and low birth weight were risk factors. The majority of perinatal deaths were
macerated. Having early neonatal deaths occurring during the first 24 hours after delivery might be indicative of the quality of neonatal care provided
Some observations on anorectal malformations in Zimbabwe
No full textForty-six cases of anorectal malformations (ARM) were seen over a period of 28 months in the elective paediatric surgical service of the two teaching hospitals in Harare, Zimbabwe, of whom 20 (43,5%) were males and 26 (56,5%) were females. Twenty-two (47,8%) of the cases had a 'high' anomaly while 21 (45m7/5) had a 'low' anomaly, and the remaining 3 cases (6,5%) had a 'cloaca' malformation. Twelve (26%) of the cases were shown to have major associated congenital anomalies affecting mainly the urogenital, musculo-skcletal or cardiovascular systems. About three-quarters of the cases were referrals from other hospitals. The apparently peculiar geographical distribution of ARM in Zimbabwe and some of the problems encountered in the management of these cases are presented and discussed.
A plea is made for the rational and skillful management of this major and challenging paediatric surgical problem in Zimbabwe
Pain: friend or foe
No full textPain, the most urgent of symptoms usually signals the presence of potential or on-going injury to tissue which requires attention.The warning that pain provides is, therefore, a good thing and in a way friendly. When pain continues or resumes after the healing process of injury is complete, it is no longer signalling on-going tissue damage but becomes a disease in its own right. That, in essence, is the presentation of most chronic pain syndromes referred to Pain Clinics for investigation and treatment