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Factors associated with paediatric ART uptake in Bindura and Guruve districts, Zimbabwe 2015
No full textPaediatric ART coverage in Zimbabwe remains low despite effort to improve it. Currently it stands at 56.7% compared to an adult ART coverage above 75%. Major reasons for this are largely unknown although assumptions are these children are not being tested for HIV. This is a presentation of the results of a study on factors affecting paediatric ART uptake among children aged one to fourteen years in Bindura and Guruve districts of Mashonaland Central Province.
Methods
An analytic cross sectional study was conducted among caregivers of HIV positive children and health workers in Bindura and Guruve Districts. Data were collected on socio-demographic, socio-economic, psychological and programmatic factors associated with pediatric ART uptake. Quantitative data were analysed using Epi info to calculate odds ratios. Stratified and multivariate analyses were done to check and control for effect modification and/or confounding.
Results
A total of 213 caregivers were interviewed. Control of household finances [aPOR=11.7 (95% CI 4.71 – 29.23)], sex of caregiver [aPOR=11.2 (95% CI 3.48 – 36.28)] and ethnicity [aPOR=8.38 (95% CI 3.01 – 23.31)] were the independent risk factors associated with up taking paediatric ART. Age of child [aOR=0.26 (95% CI 0.07 – 0.97)] was the independent protective factor associated with up taking paediatric ART.
Conclusion
Socio-demographic factors were significantly associated with uptake of paediatric ART among respondents. Education on the importance of paediatric ART for caregivers who visit the PMTCT needs to be reinforced by the nurses attending to the caregivers on their review dates
Factors associated with late presentation to HIV/AIDS care in Harare City , 2015
No full textIntroduction: Despite widespread awareness and publicity concerning HIV care and advances in treatment, many patients still present late in their HIV disease. Preliminary review of the ART registers at Wilkins and Beatrice Road Hospitals indicated that 67% and 71% of patients enrolled into HIV/AIDS care presented late with baseline CD4 of <200 cells/uL and/or WHO stage 3 and 4 respectively. We therefore sought to explore factors associated with late presentation, with a view to encourage early health seeking behaviour.
Methods: We conducted a 1:1 unmatched case control study in Harare City where a case was an HIV positive individual (>18 years) with a baseline CD4 of 18 years) who had a baseline CD4 of >200/uL or WHO clinical stage 1 or 2 at first presentation in 2014.
Results: A total of 268 participants were recruited (134 cases and 134 controls). Independent risk factors for late presentation for HIV/AIDS care were illness being reason for test (AOR=7.68, 95% CI=4.08-14.75); Being male (AOR=2.84, 95% CI=1.50-5.40) and; experienced HIV stigma (AOR=2.99, 95% CI=1.54-5.79). Independent protective factors were receiving information on HIV (AOR=0.37, 95% CI=0.18-0.78) and earning more than US250). Based on this evidence, we recommended targeted interventions to optimize early access to testing and enrolment into care
Co-morbidity of diabetes mellitus and HIV in patients attending the ART clinic Parirenyatwa hospital 2015
No full textBackground: Zimbabwe has a double burden of diseases, with HIV epidemic and increased prevalence of diabetes mellitus. Since the roll out of Anti Retroviral Therapy in 2004 at Parirenyatwa OI clinic, Nucleoside Reverse Transcriptase Inhibitors have been the backbone of antiretroviral therapy. At least 10% of OI clients at the institution are on 2nd line regimen with Protease Inhibitors. These drugs cause metabolic derangements which are potentially Diabetogenic. With improved care in HIV management, patients are living long enough to experience environmental and behavioural risk factors for diabetes mellitus. However diabetic screening is not done at Parirenyatwa OI clinic and the disease burden of HIV/Diabetes co-morbidity is not known.
Methods: An analytic cross-sectional study was conducted. Questionnaires were used to collect data on patient’s socio-demographic characteristics, medical history and symptoms of diabetes mellitus. Random blood sugar and glycated haemoglobin tests were done to ascertain diabetes status.
Results: Prevalence of diabetes was 15.42%. Treatment with Protease inhibitors (POR 2.36; 95% CI 1.06-5.23) and a CD4 count at diagnosis of HIV greater than 500 (POR 3.74; 95% CI 1.26-11.09) were associated with development of diabetes mellitus with statistical significance. Smoking (POR 2.34; 95% CI 0.69-7.96), alcohol abuse (POR 1.81; 95% CI 0.74-4.40) being overweight (POR 1.79; 95% CI 0.85-3.79), were also associated with the development of diabetes but not statistically significant.
Conclusions: Behavioural risk factors like smoking, alcohol use and being overweight were associated with developing diabetes. Protease inhibitors use was also associated with the development of diabetes mellitus
Assessing the impact of the predictors of organisational citizenship behaviour in the hospitality industry in Zimbabwe
No full textThe importance of Oganisational Citizenship Behavior (OCB) is widely acknowledged by many practitioners and academicians in Zimbabwe and the world over. However, there is generally limited literature on OCB in Zimbabwe as there are few studies that were carried out especially on the Zimbabwean hospitality industry. To address this dearth of published studies, the current study attempts to examine the factors that influence OCB. The conceptualised model and four hypotheses are empirically validated using a sample of 200 non-managerial hospitality industry employees who were randomly selected from three identified categories of hotels which were stratified according to the hotel star rating (3, 4, and 5 star hotels categories). The data were analysed using descriptive, correlation and regression analyses. The results indicate that the individual, organizational and leadership characteristics are significant predictors of OCB. However, task characteristics emerged as an insignificant factor to OCB. The findings have implications to hospitality management in Zimbabwe who are advised to make efforts of ensuring proper individual, organizational and leadership characteristics among employees and management so as to enforce OCB
Assessing potential economic costs and benefits from a Zimbabwe-China Free Trade Agreement
No full textThis study investigated the potential impacts of the formation and implementation of a
Zimbabwe-China Free Trade Area (FTA). The study employed the World Integrated Trade
Solution (2015), Software for Market Analysis and Restrictions on Trade (WITS?SMART), to
investigate the potential impacts of the FTA on exports, imports, tariff revenue and the overall
welfare in Zimbabwe. The findings were that 34.9 million trade will be diverted resulting in a positive
net trade effect of 44.68 million in tariff revenue. The study recommends that if Zimbabwe is
going to commit itself to trade liberalization with China, it will have to come up with a new
fiscal revenue base to compensate for the loss in tariff revenue. This can be done through
putting more emphasis on non-trade taxes revenue sources as well as putting in place efficient
fiscal revenue collection mechanisms. The study also recommends that since the FTA is also
likely to affect welfare through employment losses welfare losses in Zimbabwe as imports
from China will displace local production, there is need for undertaking adjustment programs
that enhance skills and productivity in order to facilitate the relocation of labour into sectors
where production will be expanding as a result of the FTA
Resourcing Policy to National Health Coverage 2016
No full textDFID, EU, UNICEF, UNDP, WHO, World Ban
Comparison of retention in care rates among HIV-infected older persons and young adults on higly active antiretroviral therapy at a tertiary hospital in Harare, Zimbabwe
No full textObjective: To evaluate differences in retention in care rates between older individuals and young adults initiated on HAART and to determine the baseline characteristics that are associated with retention in care.
Design: Retrospective cohort study using routinely collected clinic data
Setting: A public sector HIV adult facility at the Parirenyatwa Hospital Family Care
Centre, Harare, Zimbabwe.
Participants: 444 HIV infected elderly patients (age 50 years and above) and young
adults (age 25 to <50 years) who initiated HAART between 1 January 2009 and 31
December 2011.
Main outcome measures: Primary outcome: Retention rate among older individuals
(=50 years) compared to younger individuals(25-49 years).
Secondary outcomes: Factors associated with attrition.
Methods: Analysis of patient records was done. Survival analyses were performed
using Kaplan-Meier method. Univariate analyses were done to determine factors
associated with retention in care.
Results: Older individuals had a significantly lower retention in care rate than young
adults(67.0% versus 81.8%) after 24 months on HAART in the final survival analysis(p<0.0001). Baseline CD4+ T-cell counts were significantly lower in the older
age group(p=0.042) who also presented with more advanced WHO clinical stages 3
and 4(p<0.0001). Time from HIV diagnosis to HAART initiation was significantly shorter in older persons compared to younger individuals(31days versus 47.5days). In the older age group, baseline characteristics associated with attrition were WHO clinical stage 3and 4 OR 3.11 p=0.048[95%CI:1.96-4.05, CD4+ T-cell counts=100cells/mm³ OR 2.27 p=0.041 [95% CI: 1.82-3.22 ]and presence of at least one co-morbidity OR 2.07 p=0.028 [CI:1.71-6.02].
Conclusion: Retention in care was lower in older persons as compared to younger
individuals. Older patients need to be tested for HIV and commenced on HAART early in order to maintain their continuity in care and prevent death
Evaluation of the status of water quality of the Great Usuthu River, Swaziland.
No full textSurface water quality is deteriorating due to pollution caused by a number of factors that include anthropogenic activities, poor water quality management and climate change. The evaluation of River Water Quality (RWQ) status remains beneficial in controlling river water pollution and ensuring suitability of river water for intended uses. The Great Usuthu River is a primary water supply source for towns, rural areas, irrigation water and industrial water uses in Swaziland. Its water quality status has raised concerns from the general public and Environmental Management Agency in Swaziland. The study assessed river water quality status, its spatial and temporal variation and suitability for predominant uses. The study also sought to determine the magnitude of pollution. Bimonthly samples of RWQ were collected from 6 sites from 7 January 2016 to 29 March 2016. The collected water samples were analyzed at the Swaziland Water Services Corporation laboratory and the Water Services laboratory of the Department of Water Affairs in Mbabane. Parameters analyzed using standard methods included temperature, pH, Electrical Conductivity (EC), Dissolved Oxygen (DO) Biological Oxygen Demand (BOD), Total Coliforms (TC), Escherichia coli (E.coli), chloride, Total Alkalinity (TA), Total Hardness (TH), nitrates and colour. These parameters were required in deriving the Dinius Water Quality Index (DWQI) for assessing the overall RWQ status as is the practice in Swaziland. The study utilized the Principal Component Analysis (PCA) and Cluster Analysis (CA) to find critical parameters and optimal sampling points. Repeated measurements analysis of variance (ANOVA) was used to assess the significance of variations in water quality between the sampling sites and sessions. RWQ results were compared to local and international limits for domestic, irrigation and industrial water uses. The pollution load was estimated for the principal parameters. Average DWQI values ranged from 52.7 to 59.9, suggesting marginally suitable quality. PCA identified EC, E.coli, TC and colour as the key water quality parameters as they accounted for a total of 99.9% of the variance and individually 10.4%, 8.7%, 65.4% and 15.4% respectively. CA identified 4 key sampling points using the k means clustering algorithm. ANOVA showed statistically significant variation (p0.05). Suitability analysis indicated the RWQ was not suitable for the predominant uses in the study area. Pollution loads were in the range 0.2 tons/day – 256.4 tons/day for the biological oxygen demand, chloride, nitrates and total dissolved solids during the study period. Generally, it was concluded that the RWQ is not suitable for the current uses. EC, TC, E.coli and colour were the principal parameters and four monitoring points were identified as optimal. Addition of two more monitoring sites to the current 2 by the Department of Water Affairs (Swaziland) and treatment of river water prior to use is recommended. More awareness rising to rural people on the use and safety of river water is recommended to discourage raw use of river water. Monitoring of the principal water quality parameters more regularly is recommended. The study also recommends monitoring of pollution load more regularly.WaterNe
Parting the long grass: Public International law and the right to self determination
No full textThe right to self-determination is perhaps one of the most fundamental group rights entrenched, espoused and conferred by various international legal instruments. However, it is also axiomatic that the right to self-determination has been used as a rickety chariot for the conveyance of fallacious and contesting ideologies. It is indeed arguable that the right to self-determination is one of the most over used and at times abused terms. The enormous political and emotional overtones have tended to cloak and cloud the precise nature, scope of operation as well as limits to the right to self-determination. To further exacerbate the uncertainty and malaise have been the contra distinct and varied perceptions regarding the existence of an external right to self-determination. The object of this writing will therefore be to explore the various legal
instruments, judicial decisions and various state practices in an attempt to proffer an exposition of the meaning, nature of the right to self-determination as well as the limits thereto
