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A study to determine the relationship between prevalence of late stage diagnosis of cervical cancer and number of comorbid illness in women aged 65 years and above in Zimbabwe
No full textThe elderly are currently the fastest growing population worldwide. Illnesses arising
with advancing age, like hypertension, diabetes mellitus, dementia, Alzheimer’s and vascular disorders are complicating cervical cancer diagnosis in elderly women. This descriptive, correlational study was done to explore the relationship between prevalence of late stage diagnosis of cervical cancer and number of comorbidities in women aged 65 years and above in Zimbabwe guided by Betty Neuman’s Systems Model. Non-probability sampling was used to recruit and interview 68 women aged 65 years and above with cervical cancer from Parirenyatwa Hospital and Spilhause Clinic at Harare Hospital. Data analysis was done using the Statistical Package for Social Sciences (SPSS), The Pearson’s Correlation coefficient and simple regression to describe demographic characteristics and dependent and independent variables. Study findings indicated that the average number of comorbidities suffered by elderly women before late stage cervical cancer diagnosis was 2.03 with a mean comorbidity score of 9.03 out of 38 using a modified Charleson Comorbidity Index. The prevalence of late stage diagnosis was 0.661. Pearson’s correlation coefficient showed a positive and
significant relationship between prevalence of late stage diagnosis of cervical cancer and number of comorbidities (r = .431, p < 0.01). This result means that the higher the number of comorbidities in elderly women, the later the stage of presentation with cervical cancer. There is need to focus early screening of cervical cancer efforts on elderly women to promote early detection and treatment. The effect of the independent variable is indicated by significant R² = 0.186 (b = 0.289). This result explains that the number of comorbidities suffered before cervical cancer diagnosis causes 18.6% of the prevalence of late stage diagnosis of cervical cancer. Further research is needed to clarify other factors leading to late stage diagnosis of cervical cancer in elderly women aged 65 years and above in Zimbabwe
Factors associated with Human Immunodeficiency Virus (HIV) testing and counseling among couples, Bulawayo city, 2015
No full textBackground: Majority of people in stable relationships are not aware of their HIV status.
Bulawayo City HTC data showed a decline in the proportion of urban couples who were
tested for HIV from 11% in 2010 to 6.7% in 2014.The study was conducted to determine
factors associated with HTC among couples in Bulawayo City.
Methods: A one to one unmatched case control study was conducted. A total of 254 women, 127 cases and 127 controls, were recruited. A case was a woman aged 16-35 years who did not receive HTC with her partner. A control was a woman aged 16-35 who had received HTC with her partner. A pretested interviewer administered questionnaire was used to collect data from conveniently selected participants. Bivariate and logistic regression analyses were conducted to identify effect modification and control for confounding.
Results: Staying within a distance of less than 5 km from the health the health facility
(AOR=0. 38, 95% CI: 0.21-0.71) and prior discussion of HTC as a couple (AOR=0. 43, 95% CI: 0.21-0.87) were independently associated with more likelihood of receiving HTC as a couple. Conflicting work schedules (AOR=2.99, 95% CI: 1.17-5.11) and perceived low risk (AOR=1.78, 95% CI: 1.02-3.10) were found to be independent risk factors for not receiving HTC as a couple.
Conclusion: Testing as a couple was as a result of factors relating to distance of less than 5 km from the health facility, prior discussion of HTC as a couple, low risk perception and conflicting work schedules. Encouraging communication among couples and health education may improve HTC among couples
Effect of irbesartan on blood glucose levels in a mice model of type 2 diabetes mellitus
No full textAngiotensin receptor blockers (ARBs) have been reported to affect glycaemic control in both animals and humans. A few studies have evaluated the effects of irbesartan on blood glucose levels. However, only one study evaluated the effect of irbesartan on insulin resistance and glucose tolerance.
Objective: To evaluate the effect of irbesartan on blood glucose levels and glucose tolerance in diabetic and non-diabetic mice
Method: A total of 48 mice were divided into 8 groups (n=6) where group 1-4were fed on
standard diet and group 5-8were fed on high fat diet. Diabetes was induced in mice fed on high fat diet using alloxan monohydrate 150mg/kg via the intra-peritoneal route. Group 1, 2 and 3 were non-diabetic and received irbesartan at 20mg/kg, 50mg/kg and 75mg/kg for 13 days, respectively. Group 4 acted as the non-diabetic control and received water. After induction of diabetes, group 5, 6 and 7 received irbesartan 20mg/kg, 50mg/kg and 75mg/kg for 13 days, respectively, whilst group 8 acted as the diabetic control and received distilled water. Drug administration was done via oral gavage. Blood glucose levels were measured on selected days. Oral glucose tolerance test was carried out on day 14 after the commencing of drug dosing via administration of 1g/kg body weight to all the mice and measuring the blood glucose levels at 15, 30, 60 and 120 minutes.
Results: Irbesartan at the dose of 20mg/kg and 75mg/kg significantly lowered (-39%, and 40%, respectively; p<0.05) blood glucose levels in diabetic mice. Irbesartan 20mg/kg, 50mg/kg and 75mg/kg did not significantly change blood glucose levels (-15%, -3% and 9%) in non-diabetic mice. In diabetic mice, irbesartan 20mg/kg and 75mg/kg improved glucose tolerance (Area under the curve [AUC] = 55.35mmol/Lmins and 45.54mmol/Lmins, respectively). However, the improvements were not statistically significant compared to the diabetic control group (AUC=63.53mmol/Lmins; p<0.05). Unlike in the diabetic mice, all the doses of irbesartan had no effect on glucose tolerance in non-diabetic mice (p<0.05)
Conclusion: Low and high dose irbesartan had significant hypoglycaemic effects and
improved glucose tolerance in diabetic mice. However, all doses of irbesartan had no
significant effects on blood glucose levels and glucose tolerance in non-diabetic mice
Association of serum c-reactive protein concentrations with severity of preeclampsia and imminent eclampsia in pregnant women in Zimbabwe
No full textPreeclampsia is a hypertensive disorder in 3-7% of all pregnant women characterised by elevated blood pressure and proteinuria. It is a chief source of morbidity and mortality worldwide. The health of both the preeclamptic woman and her infant are dependent on how long she carries the foetus. To date, delivery of the child is the only cure for preeclampsia. C-reactive protein (CRP) is part of the innate immune system. It scavenges for chromatin released by dead cells during the acute phase, activates complement and acts as an opsonin for various pathogens. Elevation of CRP is still considered the beacon of the acute-phase response. It has been shown that C-reactive protein concentration is elevated in preeclampsia. Measuring the CRP concentration in preeclamptic women could help in understanding the best course of action for the pregnant woman and the foetus, especially if there is an association between CRP levels and severity of preeclampsia.
Objectives:
To determine the levels of C-reactive protein in Zimbabwean women who have preeclampsia during singleton pregnancy.
To determine the association of CRP concentration and blood pressure in pregnant women.
Materials and Methods: This was a cross sectional study conducted at Mbuya Nehanda Maternity Hospital Antenatal Ward and Antenatal Clinic including pregnant women with singleton pregnancy. Blood was collected to yield serum for the CRP assay, a particle enhanced turbidimetric immunoassay. Uric acid and blood pressure were also measured.
Results:
There was a positive correlation between CRP and mean arterial pressure (p=0.0137) and also between CRP and uric acid (p=0.0095).
Conclusion:
In conjunction with other biomarkers and clinical signs, CRP can help to give a fuller picture of the state of the pregnant women who has preeclampsia. The aetiology of preeclampsia is not well established but having more information about the condition will help in the monitoring and treatment of the pregnant woman to ensure she and her baby are well.
Bionomics of malaria vectors in Mutare and Mutasa districts of Manicaland province, Zimbabwe
No full textBionomics of malaria vectors including species composition, resting and biting behaviour and insecticide resistance are important for insecticide-based malaria control and interventions. The lack of data on malaria vector species composition and relative abundance, resting and biting behaviour, as well as insecticide resistance, make the development of target control measures problematic in Mutare and Mutasa Districts. It is imperative to elucidate, characterize, and identify all members of the An. funestus group and the An. gambiae complex to determine their resting and biting behaviour, host-seeking activities, disease relationships, and resistance to insecticides. A longitudinal study was carried out to investigate the bionomics of malaria vector mosquitoes in Mutare and Mutasa Districts. Anopheline larval and adult sampling was conducted from May 2013 to December 2014 using scooping, pyrethrum spray catch, prokopac aspirator, exit window trap, pit shelter, and Centers for Disease Control (CDC) light trap methods. Indoor and outdoor resting mosquitoes were collected in randomly selected houses and pit shelters, respectively. Mosquitoes sampled by light traps were divided into two cohorts. In one cohort, traps were left overnight and mosquitoes collected the following morning, while in the other set, mosquitoes were collected hourly throughout the night. Mosquito samples for insecticide resistance testing were divided into two subsamples. One subsample was used immediately for WHO susceptibility assays and the other batch was allowed to oviposit in the insectary at the National Institute of Health Research, and females from the F1 progeny were used in further susceptibility assays. Mosquitoes were identified using morphological keys and polymerase chain reaction (PCR) techniques. The PCR-based assays showed the presence of four sibling species: Anopheles funestus sensu stricto (90.8%, 267/294) and An. leesoni (5.1%, 15/294) of the An. funestus group and An. arabiensis (41.9%, 13/31) and An. quadriannulatus (48.4%, 15/31) of the An. gambiae complex. Of the two malaria vectors, An. funestus sensu stricto was more abundant (95.4%, 267/280) than An. arabiensis (4.6%, 13/280). Endophilic collections of the An. funestus group and the An. gambiae complex were five times greater than exophilic catches. Nearly 90% endophilic An. funestus populations were collected on sprayable surfaces and the remainder was caught on unsprayable surfaces. Of the sprayable surfaces catches, 56% were collected on the roofs; with 44% on the walls. Of the gravid An. funestus caught, nearly two-thirds (218/330) were collected exiting recently pyrethroid-treated structures, with a 24-hour mortality of less than 10%. The CDC light trap catches were more abundant indoors (68%) than outdoors (32%). Anopheles funestus showed variable indoor and outdoor flight activity rhythms, with two peaks during the night; between 22:00-23:00 hours and 02:00-04:00 hours. Human blood index was 64.3%, with Plasmodium falciparum infection rate of 1.8%. Wild caught females showed resistance to lambda-cyhalothrin (3.3% mortality), deltamethrin (12.9% mortality), etofenprox (9.2% mortality), and bendiocarb (11.7% mortality).F1 An. funestus females showed resistance to deltamethrin (14.5% mortality), lambda-cyhalothrin (6.9 % mortality), etofenprox (8.3% mortality), and bendiocarb (16.8% mortality), but were susceptible to DDT and pirimiphos-methyl (100% mortality). Intensity resistance assay to bendiocarb had 100% mortality, while deltamethrin, lambda-cyhalothrin, and etofenprox had increased knockdown times with mortalities ranging between 66.7 and 92.7% after 24-hour exposures. The present work revealed important information on the behaviour of malaria vector mosquitoes in Mutare and Mutasa Districts, which if not addressed might threaten gains made in malaria control in the study area. It is imperative to change house-spraying insecticide from pyrethroids to organophosphates or DDT (organochlorine), develop an insecticide resistance management plan, provide extension lances to the house-spraying programme, complement mosquito nets with the use of mosquito repellents and long clothes, and establish a monitoring programme to determine the occurrence and distribution of An. funestus populations in Manicaland Province
Factors associated with delayed antiretroviral therapy initiation among Tuberculosis/ Human Immunodeficiency Virus co-infected patients in Lupane district, 2015
No full textBackground: Antiretroviral therapy (ART) should be given to all Human Immunodeficiency Virus (HIV)-positive Tuberculosis (TB) patients within the first eight weeks of commencing anti-tuberculosis treatment (ATT), to reduce risk of mortality. In 2012 and 2013, Lupane district initiated 62% and 37% respectively of TB/ HIV co-infected patients on ART against a target of 100%. The study was conducted to determine the prevalence of delayed ART initiation in 2015 and to identify factors associated with the delays.
Methods: An analytic cross sectional study was conducted at seven health facilities in
Lupane district. Two hundred and ten study participants were recruited into the study. A
checklist was used to assess for quality of care at the health facilities. Key informant
interviews were held with program Managers and health workers.
Results: Among the 210 patients studied, 19 % (n= 39) delayed ART initiation. The median delay between starting ATT and ART was 23 days (Q1= 18 days, Q3= 30 days). Independent factors associated with ART initiation were marital status; separated (AOR 6.21, 95% CI 1.63-23.71), single (AOR 9.58 95% CI 2.39 – 38.36) and widowed (AOR 14.23 95% CI 1.72 – 117.76), first HIV treatment at health centre (AOR 0.35 95% CI 0.13-0.94), transport cost more than US$1 (AOR 5.69, 95% CI 1.87-17.34), fear of medicine toxicity (AOR 7.68, 95% CI 2.63-22.41), and having a family member on TB treatment (AOR 0.22, 95% CI 0.07-0.67). ART follow up and outreach was not being one at all the facilities. Communication on referred TB/ART patients was not complete between facilities.
Conclusion: Intensifying ART preparation, streamlining clinic visit schedule protocols,
follow up on defaulting patients and outreach clinics are vital in averting delays. Health
workers should communicate on referred ART patients to expedite linkage in care
Prevalence and risk factors for diabetes chronic complications in Harare, Zimbabwe
No full textBackground: Diabetes is a chronic condition which often causes severe long term complications which compromise quality of life and burdens health care systems and can cause permanent disability and even death. The incidence of diabetes and the associated complications in Harare as reported through surveillance data has been on the increase. In order to reduce disease burden due to diabetes chronic complications, prevalence and risk factors for diabetes chronic complications must be determined through studies.
Methods: A total of 284 diabetics attending diabetic clinics at Parirenyatwa and Harare Central Hospitals were enrolled in this cross sectional analytic study. Interviewer administered questionnaires were used to collect data. The occurrence of diabetes chronic complications and their associated risk factors were analyzed. Written informed consent was sought and obtained from all the respondents.
Results: Overall, prevalence of diabetes chronic complications was high with 45% of respondents having at least one diabetes chronic complication. Significant risk factors associated with diabetes chronic complications were: age>50 years (OR=4.34, p10 years (OR=2.36, p10 years with diabetes (adjusted OR=5.34, p<0.001); high LDL-Cholesterol (adjusted OR=1.84, p=0.039) and type 2 diabetes (adjusted OR=6.48, p<0.001).
Conclusion: Overall prevalence of diabetes chronic complications was high but comparable to other studies. Several demographic, patho-physiologic and life-style related risk factors associated with diabetes chronic complications were identified. There is need to comprehensively address all risk factors in order to reduce diabetes chronic complications
Relationship between knowledge levels of high active antiretroviral therapy (HAART) and adherence levels of HAART among HIV positive pregnant women aged 15 to 49 years attending antenatal care at Marondera provincial hospital, Family Child Health department, Zimbabwe
No full textVertical transmission of HIV from mother to child remains a problem in Zimbabwe
and the world over. HAART adherence rate of at least 95% is essential and it is noted that it can reduce vertical transmission by less than 1%. However such high adherence rates could only be achieved when HIV positive pregnant women have optimum knowledge regarding HAART. The purpose of the study was to examine the relationship between knowledge of HAART and adherence levels among HIV positive pregnant women aged 15 to 49 years attending antenatal care Marondera Provincial Hospital Family Child Care Department. A descriptive correlation study design was used to guide the study. A sample of 80 participants was selected using systematic sampling. HIV positive pregnant women meeting the inclusion criteria participated in the study. Data was collected through interviews with the aid of a structured interview schedule. Pender’s Health Promotion Model was used to guide the study.
Frequency distribution, measures of central tendency and dispersion and inferential statistics were used to present findings in relation to the demographic variables, HAART adherence practices and knowledge regarding HAART. Pearson correlation coefficient test was (r = 0.197 p – value 0.081). The results showed that a weak positive non-significant correlation existed between adherence to HAART and knowledge regarding HAART. The findings of this study indicated that only 25% of the respondents had high levels of knowledge regarding HAART and only 17.5% had high levels of adherence hence one can safely infer that the moderate to low levels of knowledge in the majority of the respondents 75% could have a bearing on suboptimal adherence. The study recommends intensification of health education and counseling on HAART inorder to empower HIV+ pregnant women with relevant knowledge that could lead to attainment of optimum HAART adherence. Major challenges facing respondents on HAART were issues regarding disclosure for 33.3% and stigma and discrimination 23.1%. This points to need for midwives to address these important psychosocial barriers to optimum adherence by not only harnessing male participation in PMTCT issues but also through community involvement
Quality Assurance and Quality Improvement Strategy 2016-2020
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