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Learning from others: An insight into the experiences in the enforcement of ESC rights in comparative foreign and international law jurisdictions
No full textThis paper was originally presented at the Economic Social and Cultural Rights Symposium held on the 17th of April 2015 and was organised by the International Commission of Jurists (ICJ) in collaboration with the Zimbabwe Law Students Association. The purpose of this paper is to provide some ideas around the lessons which Zimbabwean courts can draw from South Africa and India as comparative foreign jurisdictions as well as international law, in order to enforce and or implement the ESC rights guaranteed under the new Constitution of Zimbabwe.International Commission of Jurists (ICJ
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
Molecular detection and identification of genital human papillomavirus genotypes in female college students by polymerase chain reaction and DNA sequencing in Harare
No full textIntroduction and objectives: The human papillomaviruses (HPVs) are the most common sexually transmitted infections worldwide and are a major cause of morbidity and mortality amongst women. World-wide, data on HPV infection in young women is scarce. It is thus important to determine the prevalence of HPVs per region as the distribution of genotypes differs according to geographic location, race and the genetic make-up of individuals. The objective of the study was to detect and identify genital human papillomaviruses in young female college students in Harare, and to assess their knowledge, attitudes and practices (KAP) with regards to HPV infection.
Materials and methods: Self-collected vaginal swab specimens from female college students aged 20-25 years were processed and genomic DNA extracted. Human papillomavirus-DNA was amplified by consensus polymerase chain reaction (PCR) with two pairs of primers (MY09/MY11 and GP5+/GP6+). PCR products were visualised by gel electrophoresis and positive specimens genotyped by DNA sequencing. A socio-demographic questionnaire was also administered to the students.
Results: One hundred and fourteen out of 125 swabs had genomic DNA successfully extracted. Of the 114, 36 (31.58%) tested positive for HPV-DNA with the MY09/MY11 primer set and 26 (22.80%) with the GP5+/6+ primer set. MY09/11 primers showed higher sensitivity in HPV-DNA detection. The most prevalent HPV genotypes identified by sequencing were high-risk HPV (16, 18, 45, 58) and low-risk HPV (6 and 81) all detected at a prevalence of 7.69 %. The age range of participants recruited was 20-25 years. They collectively had a mean age of first sexual activity of 19.22 years. There was a lack of HPV related knowledge in the study population.
Conclusion: A high prevalence of HPV infection in young college women in Harare was observed. Demographic data and HPV prevalence also suggested a statistical link between HPV infection and multiple sexual partners, having more than one previous sexual partner and an early onset of sexual activity. The KAP survey showed poor knowledge on HPV issues amongst the study participants
Assessment of the absorption profile of ascorbic acid as a biomarker for moringa oleifera lam absorption after a bolus oral dose
No full textMoringa oleifera Lam is a medicinal plant used in the management of various ailments in many countries. Despite being used widely, the rate and extent of absorption of these
compounds from the ingested Moringa leaf powder is unknown. As a result there is no a
standard dosing regimen for Moringa oleifera Lam leaf powder. There is also potential for herb-drug interactions if Moringa is taken concomitantly with conventional medicines.
Aim. The aim of the study was to estimate the absorption profile of Moringa oleifera Lam
leaf extract after oral dosing using ascorbic acid as a bio-marker.
Methods:
Extract preparation. Harvested Moringa oleifera Lam leaves were dried under shade and
kept away from direct sun light before being ground into powder and macerated with a water and methanol mixture followed by drying.
Experimental animals. Six male rabbits of about 6 months were used.
Feeding and blood sample collection. The rabbits were fasted overnight preceding dosing. Three rabbits receiveda weighed amount of the Moringa oleifera Lam extract at a dose of 300mg/kg body weight. Three rabbits received de-ionised water only, and were used to obtain control plasma. Blood samples were collected at 0, 0.25, 0.5, 1, 2, 4 and 8 hrs after dosing. Plasma was taken and assayed by uv/visible spectrophotometry.
Results. The Moringa extract percentage yield was 16%. The content of vitamin C in the
extract was 1.371g per 100g of extract. The average bioavailability was 33%.The average
Cmax was 0.91mg/ml.This occurred at an average Tmax of 1.04 hours. The average time to reach plasma was 0.37 hours.
Conclusion. Moringa oleifera Lam is a good source of vitamin C. Usingthe absorption
profile of the vitamin C it was estimated that Moringa compounds may reach the systemic circulation after37.33 minutes and reaches maximum concentration in plasma after about one hour following oral ingestion. It was also estimated that by the end of eight hours following oral ingestion all the accessible vitamin C in Moringa will have been absorbed
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
Factors associated with defaulting among women initiated on option B+ in urban clinics- 2015
No full textIntroduction: We carried out this study to describe the demographic characteristics of the mothers on Option B+ at Budiriro, Mabvuku, Rutsanana and Kuwadzana poly-clinics. To determine the patient level factors, the service related factors, the provider-patient relationship factors, the environmental, socio- cultural factors and the drug related factors associated with defaulting among women initiated on Option B+ at the four poly-clinics, 2015.
Methods: A 1:2 unmatched case control study was conducted. A total of 195 participants were recruited, 65 cases and 130 controls. The study was carried out at four polyclinics, Rutsanana, Mabvuku, Kuwadzana and Budiriro. Simple random sampling technique was used to select study participants from the Option B+ registers. A case was an HIV positive pregnant or lactating woman registered and initiated for Option B+ at any one of the four sites from January to April 2015 but missed at least one resupply visit or medicine pick up appointment for ART. A control was an HIV positive pregnant or lactating woman registered and initiated on Option B+ at any one of the four sites from January to April 2015 and attended all resupply visits or medicine pick up appointments for ART. Data were collected using interviewer administered questionnaires, in depth interviews, focus group discussions and key informant interviews. Quantitative data were analysed using Epi infoTM 7 to generate tables and graphs. Qualitative data were analysed manually using themes. The median age for cases was 27 years (Q1 = 23.5, Q3 = 32 years) while that of controls was 30 years (Q1 = 26.5, Q3 = 35.5 years).
Results: Non-disclosure of HIV status and having experienced stigma because of HIV status were significant patient level factors that were associated with defaulting with OR 16.6 and 14.3 respectively, (p<0.05). Running short of medication at some point and having experienced drug side effects were significant drug related factors associated with defaulting with OR 52 and 4.0 respectively, (p<0.05). Receiving inadequate information during counselling and not having attended individual counselling sessions were significant service related factors associated with defaulting with OR 9.4 and 3.7 respectively, (p<0.05).
Conclusions: Factors associated with defaulting among women initiated on Option B+ vary. Some of the factors have to do with the patient while some are related to the service that they receive and their relationship with the health care provider. Some are however related to the availability and the effects of the drugs themselves. We recommend providing adequate information on all the factors that might affect the women, encouraging disclosure of status so that they get support from others and strengthening of follow up mechanisms
The prevalence of coronary heart disease in human immunodeficiency virus positive individuals in Harare, Zimbabwe
No full textCoronary heart disease is complex with several well established as well as postulated risk factors and pathogenetic mechanisms. This public health problem is a major cause of morbidity and mortality in the industrialised world. HIV is now well recognised as a risk factor for coronary and ischaemic heart disease in the industrialised world but has been hitherto not studied in the black African population. In this study a case control autopsy series of HIV-positive and negative deceased black Zimbabweans was done with the objective of estimating the coronary heart disease rates in these individuals and establishing an association, if any, between HIV-infection and CHD. CHD was present with prevalence rates of 18.1% and 9.5% in HIV-positive and negative individuals respectively, although these prevalence rates were not as high as those in industrialised countries where CHD has reached epidemic proportions. There was however no statistically significant association between HIV infection and CHD. It has therefore become necessary for clinicians treating HIV-positive black African patients to actively investigate for and manage coronary heart disease and its risk factors. There is potential to reduce previously unrecognised morbidity and mortality in HIV. In addition coronary heart disease is now prevalent in the general black Zimbabwean population and may be a source of clinically apparent disease
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