1358 research outputs found
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Development, safety and efficacy evaluation of actinic damage retarding nano-pharmaceutical treatments in oculocutaneous albinism
No full textIntroduction: There are at least 17 000 Persons living with albinism (PLWA) in Zimbabwe. Oculocutaneous albinism (OCA) is a congenital amelanistic pigmentation disorder that affects all known vertebrates and has no known cure. Melanogenesis is the body’s primary protection from actinic damage, which summarizes all the acute and chronic solar induced adverse dermatological conditions. This impairment therefore makes PLWA highly susceptible to all forms of this damage.
Problem statement: Commercial products for actinic damage in PLWA are not readily available. Chemical sunscreens used by PLWA are ineffective and do not treat symptoms of actinic damage. The possible use of promising broad spectrum physical sunscreens in albinistic treatments is hindered by their opaque and un-aesthetic nature.
Research hypothesis: A treatment based on nanometric TiO2 and ZnO incorporating the active extracts of A. excelsa, T. emetica and M. flabellifolia will be aesthetic, efficacious and safe in retarding and alleviating all forms of actinic damage in PLWA.
Research aims: To develop albinistic actinic damage treatments, using nano TiO2 and ZnO as sun-blocks and incorporating selected herbs. The dermato-pharmacokinetics, stability, efficacy, toxicity and aesthetics of the resultant formulation on albinistic skin types were also investigated in this study.
Materials and methods: Emulsion formulation was done according to FDA-CFSAN, COLIPA, and OECD mandated technical guidelines and testing methods. Formulation skin sensitivity were evaluated through Draize ocular and skin sensitivity tests as well as in-vivo patch tests guided by OECD 428/404 technical guidelines and opinion SCCNFP 0750/03. Percutaneous absorption and albinistic skin dermato-pharmacokinetics were evaluated ex-vivo using Franz diffusion tests and sequential adhesive tape stripping respectively according to OECD guidelines 428 and SCCNFP opinions as well as related work done by A O Gamer and Diembeck et al as guides. Analysis for Ti and Zn were done by ICP-AES and Flame AAS respectively. Efficacy and SPF testing was done as per FDA–CFSAN, Colipa and OECD M389/EN mandated test methods.
Principal Results: SPF 16, aesthetic and stable emulsions were formulated. Negligible irritation indices for the treatment were recorded for Draize and human patch testing. No percutaneous absorption was observed for ex-vivo diffusion tests and sequential tape stripping tests. Different skin reservoir properties were observed at different skin sites
Conclusions: The studies demonstrate, direct evidence that neither Zn nor Ti can penetrate actinic damaged skin regardless of anatomical site and that albinistic dermato-pharmacokinetics are depended on anatomical region and extent of UVR exposure. The high extraction yields and the phyto-constituents of the selected herbs show a correlation with the traditional uses of the plants in traditional medicine. All sensitivity tests showed negligible irritation potential. Based on the foregoing, it is concluded that, incorporation of nanometric TiO2, ZnO and herbs in treatments to retard actinic damage in PLWA is feasible, aesthetic, efficacious, and commercializable and does not pose any health risk
Socio-cultural realities of following through with prevention of mother- to- child transmission of HIV programme in Chiota district Zimbabwe: Implications for elimination of paediatric infection
No full textThe study assessed the social and cultural realities of following through with prevention of mother-to-child transmission of HIV during the postnatal and breastfeeding period in a rural community in Zimbabwe and its implications on elimination of paediatric infection. The assumption was that paediatric HIV infection was not only through mother to child transmission but other social and cultural practices. Following through with PMTCT was conceptualised as the mother’s ability to adhere to ART, exclusive breastfeeding for six months and protecting the baby from getting infected through having protected sex among other factors. The study was conducted in Chiota District, one of the districts with a pronounced HIV burden. A sequential model combining both qualitative and quantitative methods was used for the study. Qualitative data were obtained through in-depth interviews/narratives with mothers on the PMTCT programme from two rural health facilities, (n=15). Focus group discussions were conducted with community members (n=231), and key informant interviews with the health staff (n=8). Quantitative data were collected through a cross sectional survey of breastfeeding women (n=103) accessing PMTCT interventions. Qualitative data were analysed thematically whilst STATA version 11 was used for quantitative data analysis where descriptive statistics, bivariate and multivariate regression analyses were done.
Cultural practices, community, self and institutional stigma affected the effectiveness of the PMTCT programme. The prevalence of adherence to ART among the mothers was 82.5%. Only 6.8% of the mothers exclusively breastfed for the first six months. The major reasons for non-exclusive breastfeeding were the mother’s belief that the milk was unsafe (66%), inadequate (55%) and breastfeeding was not practical (67%). Risky traditional practices during PMTCT included ‘treatment’ of fontanelle by inserting the father’s male organ in the mouth of the child, toning of the girl child’s sexual libido through rubbing the father’s penis on the child’s vagina, improvement of eyesight and sense of hearing through use of mother’s milk among other practices. These practices exposed babies to bodily fluids like semen, precum, breastmilk and vaginal fluids, which are known to contain HIV.
Culturally embedded practices, self, community and institutional stigma compromised the ability of mothers to adhere to PMTCT. Evidence from this study suggests that culture plays a major role in following through with PMTCT. This calls for taking cognisance of culture in designing HIV programmes. There is a need for further research on PMTCT during the postnatal period. Programmes should be cognisant that a ‘onesize fits all’ approach does not work as women are different
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
Effectiveness of hermetic storage vessels in reducing aflatoxin B1 and fumonisin B1 in maize grain from Shamva and Makoni districts of Zimbabwe
No full textMaize, the major staple food in Zimbabwe is susceptible to infection with fungi and contamination with mycotoxins. Contamination of maize with mycotoxins including aflatoxins and fumonisins is of major human health concern. Practices that minimise contamination of maize with mycotoxins should be put in practice in order to prevent exposure of humans to mycotoxins. The current study was carried out in Shamva and Makoni districts from which 12 wards were purposively selected. In each ward, two villages were randomly selected from which households that produce and rely on maize as a staple food were recruited. A total of 448 households were recruited and randomly placed into three forms of treatment: recipients of hermetic metal silos, recipients of hermetic super bags and the control that stored maize in conventional storages namely polypropylene bags and traditional granaries. Maize that was being consumed in Shamva and Makoni before introduction of hermetic storage technology was collected in order to determine the current levels of aflatoxin B1 (AFB1) and fumonisin B1 (FB1) and current levels of human exposure to AFB1 and FB1 through consumption of maize. Maize produced during 2014/2015 cropping season was collected at harvest in order to determine levels of AFB1 and FB1 before grain was loaded into storage vessels. Factors that influenced levels of AFB1 and FB1 in maize before storage were determined. Maize that was produced during 2014/2015 cropping season was loaded into hermetic metal silos, hermetic super bags and conventional storage vessels between June and July 2015 and samples were collected in October 2015, January 2016 and April 2016 in order to determine and compare the levels of AFB1 and FB1 in maize. Aflatoxin B1 was determined using high performance liquid chramotography with post-column derivatisation and fluorescence detection whilst FB1 was determined using direct competitive ELISA. Deterministic approach was used to estimate levels of exposure of humans to AFB1 and FB1 through consumption of maize. One way analysis of varience with least significant difference post test was used to compare levels of FB1 in maize collected from different storage facilities. Fumonisin B1 was found in all maize that was being consumed in Shamva and Makoni before introduction of hermetic storage technology at mean concentrations of 265.11 and 331.90 μg/kg respectively. The levels of exposure to FB1 in populations of Shamva and Makoni exceeded 2 μg/kg body weight/day, the limit set by the World Health Organisation. Method of drying maize influenced levels of FB1 in maize and drying maize on the ground lead to high levels of FB1. Variety of maize influenced levels of FB1 in maize and the highest levels of FB1 were detected in SIRDA 113 variety of maize. Crop rotation influenced levels of FB1 in maize and cultivating maize in fields where maize and groundnuts were cultivated together in the previous cropping season lead to high levels of FB1 in maize. The application of organic or inorganic fertilisers in the fields of maize had no effect on levels of contamination of maize with FB1. Levels of FB1 increased with duration of storage of maize in hermetic and conventional storage vessels. Levels of FB1 in maize that was stored in hermetic storage vessels increased in a similar manner to levels of FB1 in maize that was stored in conventional storage vessels. Households that were consuming maize stored in hermetic and conventional storage vessels were exposed to levels of FB1 above 2 μg/kg body weight/day. Before introduction of hermetic storage technology, AFB1 was detected in 21.7% (N=166) of maize at mean concentration of 4.22±4.18 μg/kg in Shamva and 19.8% (N=222) of maize at mean concentration of 3.61±2.12 μg/kg in Makoni. Levels of exposure to AFB1 in households that were consuming maize that contained AFB1 exceeded 0.017 ng/kg body weight/day, reported to be of human health concern. Aflatoxin B1 was detected in 0.67% (N=448) of maize that was collected before storage at a mean concentration of 5.43 μg/kg. Proportion of maize that contained AFB1 in hermetic and conventional storage vessels increased with duration of storage. Hermetic metal silos and hermetic super bags were more effective than conventional storage vessels in reducing contamination of maize with AFB1 during storage. Number of households exposed to AFB1 and the levels of exposure to AFB1 were higher in users of conventional storage vessels than in users of hermetic metal silos and hermetic super bags.Financial support from Canada's International Development Research Centre (IDRC) and Australian International Food Security Centre (AIFSRC), represented by Australian Centre for International Agriculture Research (ACIAR), Grant number: 107838- 00
Prevalence of post-tuberculosis airflow obstruction in patients who have completed pulmonary tuberculosis treatment at two infectious disease hospitals in Zimbabwe
No full textTuberculosis (TB) is a major cause of death worldwide. About two thirds of patients develop impaired pulmonary function after completion of pulmonary TB treatment. It seems a high proportion of TB deaths are due to post-TB chronic airflow obstruction but data is lacking to support this assertion.
Research question- What is the prevalence of post-tuberculosis airflow obstruction in patients who have completed pulmonary tuberculosis treatment at Wilkins and Beatrice Road Infectious Diseases Hospital (BRIDH)?
Primary objective-
To determine the prevalence of post-tuberculosis airflow obstruction in patients who have completed pulmonary tuberculosis treatment at Wilkins and BRIDH hospitals.
Secondary objectives-
1 To identify factors that may influence lung function outcomes in post-TB patients.
2 To identify the pattern of spirometry values among post-TB patients.
Design, Setting and Participants
The study was a cross-sectional study at Wilkins and BRIDH hospitals in patients who had completed 6 months of anti-TB treatment.
Sample size- Three hundred and twenty-seven patients.
Methods
Spirometry was done in patients who had completed 6 months of anti-TB treatment. Participants were recruited from Wilkins and BRIDH hospitals after an informed consent. Eligible were adults aged 18-65 years who have completed 6 months of anti-TB treatment. Those with a history of smoking, occupational exposure, asthma, COPD, interstitial lung disease and bronchiectasis were excluded.
Results
The prevalence of post-tuberculosis airflow obstruction was 65.7%. Restriction probable was found in 14.4% and normal spirometry in 19.9% of the participants. Female sex (p=0.020) and recurrent episodes of TB (p=0.026) were associated with development of post-TB airflow obstruction.
Conclusion
There is a high prevalence of post-tuberculosis airflow obstruction, with moderate obstruction according to the GOLD criteria being most prominent. Recurrent episodes of TB and female sex were associated with development of post-TB airflow obstruction
Management and outcomes of antepartum hemorrhage at Harare maternity hospital
No full textBackground: Antepartum haemorrhage and its complications are responsible for a
significant proportion of maternal and neonatal morbidity and mortality worldwide. At Harare Maternity Hospital, the incidence, major causes, burden to the health system, overall contribution to complications is largely unknown.
Objectives: To assess the incidence, maternal and perinatal morbidity and mortality as well as to evaluate the management rendered to women presenting with antepartum hemorrhage
Study Design: Prospective cross sectional (observational) study carried out on 125 women recruited between August and December 2014.
Setting: Harare Maternity Hospital, Zimbabwe.
Main Outcome Measures: The study evaluated demographic data, incidence, causes,
maternal and neonatal complications and management of antepartum haemorrhage cases.
Results: A total of 6033 deliveries were recorded with an incidence of 2.1% for antepartum hemorrhage. The causes included placenta abruption 49(39.2%), placenta previa 44(35.2%), indeterminate 18(14.4%), heavy show 12(9.6%) and ruptured uterus 2(1.6%). Mean age was 29 years (range 17-43) and overall mean parity was 1.6±1.2. Evaluation of management of cases revealed that insertion of large bore cannula, cross matching of blood, catheterisation were achieved in between 70-80% of cases. Maternal complications included postpartum hemorrhage 50(40%), need for transfusion 41(32.8%) and caesarean hysterectomy 4(3.2%). Maternal deaths, 5(4%) were all due to placenta abruption. 44.8% of deliveries were preterm births and 53.6% were admitted to neonatal unit. Stillbirths occurred in 3(6.8%) of placenta previa and 35 (71.4%) of placenta abruption and 3 (9.4%) were due to other causes.
Conclusion: The study showed an incidence of anterpartum haemorrhage of 2.1% and a considerable maternal and perinatal morbidity and mortality attributable to antepartum
haemorrhage. There were gaps in adhering to the management protocol
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
The impact of time taken from referral to admission into the intensive care unit on mortality and duration of admission
No full textThis study investigated the effect of time taken from patient referral to ICU to the admission time and its effect on patient mortality and length of stay.
Methods
A prospective descriptive study of emergency medical and surgical patients admitted into the adult ICU at Parirenyatwa and Harare central hospitals between the months of February 2014- June 2014. Patients for whom an ICU bed was requested were followed up from the date and time they were referred to the date and time of admission. Further follow up of the length of stay and mortality was done. Delay was defined as a lead time of at least 4 hours and was compared with patients admitted within 4 hours of referral. Confounding variables examined were sex, National Early Warning System Score (NEWS), and age.
Results
A total of 128 patients participated in this study, 48% were delayed by more than 4 hours
from referral to admission whilst 52% were admitted within 4 hours with an average lead- time of 7.5 hours and more male patients were delayed by >4 hours(63% =0.003). Patients delayed for more than 4 hours had a higher mortality (22.9%) compared to those admitted within 4 hours (18.3%). There was no significant effect of lead time to length of stay in ICU.
Conclusion
There is an association between time taken from referral to admission and mortality. Earlier ICU admission will lead more likely to better mortality rates in ICU