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Role of the sympathetic nervous system in the development of hypertension and metabolic syndrome in low birth weight offspring
No full textThe sympathetic nervous system plays a pivotal role in the development of the metabolic syndrome particularly hypertension in low birth weight offspring. The Barker hypothesis reported that individuals born with low birth weight were at risk of developing chronic diseases later in life. Animal and human studies have since confirmed this relationship, however the mechanisms involved remain unknown. Therefore, this study investigated the role of the sympathetic nervous system in protein restricted rats and pre-clinical University of Zimbabwe students whose birth weights were less than 2.5kg. According to the Barker hypothesis adverse influences early in foetal development can result in permanent changes in the metabolism and physiology with such changes resulting in increased disease risk of the metabolic syndrome in adulthood. It was hypothesized that the sympathetic nervous system was the mechanism by which themetabolic syndrome particularly hypertension occurred in low birth weight and intrauterine growth restricted offspring.
An intrauterine growth restricted (IUGR) rat model was developed using local Zimbabweans diets. Using this model, mean blood pressure (mmHg) measured using the tail cuff method was significantly higher within 10 weeks in IUGR rats than in normal rats (122.46±2.73 vs 106.50±5.81 p=0.0001). The blood pressure significantly decreased in IUGR rats whose renal nerve (sympathetic influence) had been denervated (103.44±8.17mmHg vs 98.49±7.85mmHg p=0.013).
A series of human experiments were then conducted in young adults from the University of Zimbabwe. The students were put through exercise paces to allow the expression of the autonomic nervous system. Heart Rate Variability (HRV) ratio, and Pulse Wave Amplitude (PWA) responses to activation of the muscle metaboreflex were exaggerated in low birth weight (LBW) compared to normal birth weight (NBW) offspring (HRV: 1.015±1.034 vs 0.119±0.789 p<0.05) PWA: -1.320±1.064 vs -0.735±0.63 mV p=0.28. This suggested that the exercise pressor reflex, which is involved in tight regulation of the cardiovascular response to exercise, is persistently dysregulated into early adulthood for LBW individuals.
The study showed a significant difference in decrease in diastolic function (E/A ratio) in LBW than NBW groups ( 0.48±0.27 vs 0.19±0.18 p=0.031) and a significant association between LBW and exercise induced cardiac fatigue with diastolic dysfunction (p<0.001 odds risk ratio 7.5[95% CI 2.7-20.7]). Furthermore, the mechanisms of exercise induced cardiac fatigue involved transient myocardial stunning and a decrease in sensitivity of myocardium to catecholamines reducing the effect of adrenaline in improving both systolic and diastolic function during exercise.
LBW was associated with exercise induced hypertension (EIH) (62% vs 32% p<0.05) and post exercise hypotension (PEH) in young adults, a phenomenon hypothesised to be mediated by two processes; physiological down regulation of the cholinergic sympathetic vasodilator receptors in peripheral tissues due to chronic sympathetic stimulation; and increased wall thickening (EIH) and derangements in sympathetic tone (PEH). In the glucose tolerance study in LBW young adults had elevated sympathetic activity and were glucose intolerant (after 60mins 8.4±.56 mmol/l vs 7.57±0.36mmol/l p=0.035).
It is concluded that the sympathetic nervous system possibly has a role in the development of the metabolic syndrome in low birth weight humans and intrauterine growth restricted rats
Modelling spatial distribution of tsetse (Diptera: Glossinidae) in Masoka area, an unexplored part of Mbire District, Zimbabwe
No full textA study was conducted from March 2015 to December 2015 in order to model the distribution of two savannah species of tsetse (Glossina sensu stricto), Glossina morsitans morsitans and G. pallidipes in the Masoka area of the Mid-Zambezi valley in Zimbabwe. Two approaches were used. The first approach sought to model the probability of presence of both species in areas which were sampled but recorded zero tsetse catches using trap efficiency, sampling effort and suitable habitat cover. A probability threshold of 0.05 was used to distinguish areas which could be potentially infested from those that had low chances of tsetse occurrence. The resultant probability model pointed to an area of 104 km2 in size where G. m. morsitans could possibly be present (P > 0.05) whilst all areas which did not record G. pallidipes had a low probability of presence for the species (P < 0.05). This study showed that there was a high probability of tsetse presence in areas where the habitat was less degraded and low probability in settled areas where suitable tsetse habitat has been disturbed due to agricultural activities. The probability model therefore has the potential to optimize vector control strategies by streamlining areas of intervention. The second model was a predictive one built using tsetse presence-only data and climatic and environmental covariates. The model had an Area Under the Curve (AUC) of 0.80 for G. m. morsitans and 0.94 for G. pallidipes, indicating that the ability of the model to predict suitable tsetse habitat in the Masoka area was better than random (AUC = 0.5). Glossina morsitans morsitans occurrence was positively correlated to Normalised Difference Vegetation Index (NDVI), riverine forest and mopane woodlands whilst crop lands and temperature indices exhibited a strong negative correlation with its occurrence. Glossina pallidipes, on the other hand, had extremely specialised habitat requirements and was positively correlated to riverine forest. The species also had a positive correlation with NDVI but a negative correlation with mopane woodland.This work was conducted within the framework of the Research Platform “Production and Conservation in Partnership” (www.rp-pcp.org). The European Union and African Carribbean Pacific Group of states funded this research through the GeosAf project and I would like to acknowledge their contribution which made it possible to conduct all the fieldwork. The GeosAf project, implemented by CIRAD also imparted geomatic techniques which were essential in the spatial analysis of data in this project. Satellite images used in this research were provided by SPOT ISIS-CNES
A survey of anaesthetic drug availability: Impact on practice of anaesthesia and patient care in Harare
No full textObjectives:
To investigate how common anaesthetic drug shortages are, how they affect the practice of anaesthesia and patient care in Harare.
Methodology:
A multicentre prospective observational study of anaesthetic drug availability was carried out involving a self-administered questionnaire completed by anaesthetists working in 3 Public hospitals and 6 Private hospitals in Harare daily over the period; 1 August 2014 to 31 October 2014. A total of 422 completed questionnaires were collected out of 619 that had been distributed. In the last week of October 2014, a once off survey of the hospitals’ chief pharmacists was done using a different questionnaire.
Results:
The incidence of reporting at least an anaesthetic drug shortage by anaesthetists was 79.86% and 100% for pharmacist. There is a statistically significant difference in the availability of drugs between private and public hospitals, p < 0.001. Private hospitals tend to have less drug shortages compared to public hospitals. Anaesthetic drug shortages are associated with a high frequency of negative adverse effects on the practice of anaesthesia and patient care.
Conclusion:
Anaesthetic drug shortages are common in Harare and they are associated with high incidences of adverse effects on anaesthesia practice and patient care
Cryptococcal infection in the era of anti-retroviral therapy (ART) amomg HIV infected patients with meningitis at a tertiary hospital in a low - resource setting.
No full textBackground: Despite improved access to anti-retroviral therapy (ART) in Africa, HIV-associated cryptococcal meningitis (CM) appears to remain a cause of substantial morbidity and mortality in sub-Saharan African. This study determined the prevalence, associated factors and outcomes of CM among HIV positive meningitis patients at a tertiary hospital in Zimbabwe.
Methods: Eligible HIV positive patients admitted with clinical features of meningitis
were recruited into the study. CM was diagnosed on the basis of a positive cerebrospinal fluid (CSF) culture for cryptococcus species, a positive CSF cryptococcal antigen test (CRAG) or a positive CSF India ink test. Patients’ demographic information, clinical features and laboratory test values were recorded.
Results: One hundred and forty-four participants were enrolled into the study. CM was diagnosed in 41% (59/144). Of the patients with CM, slightly more than half [54.2% (32/59)] were on ART and 53% (17/32) had initiated ART within one year prior to the diagnosis of CM. Median current CD4 counts were significantly lower among CM patients [32 .0(IQR 10.5 – 64.0)] compared to non-CM patients [158.0(IQR: 47.0–324.0)] (p<0.001). In-hospital mortality associated with CM was 45%.
Conclusions: The proportion of cryptococcal meningitis cases and the associated in-hospital mortality were very high in the study. This suggests that cryptococcal disease burden is still significantly high despite improved access to ART. Expansion of prevention strategies, such as screening for asymptomatic cryptococcal infection among patients with low CD4 count (less than 200), has the potential to improve the morbidity and mortality associated with cryptococcal meningitis
A study to determine the relationship between level of woman empowerment and level of self-care among HIV positive pregnant women aged 15-49 years at Morgenster mission hospital in Masvingo province
No full textHuman immunodeficiency virus (HIV) continues to be a major public health problem locally, regionally and internationally (Arron, 2007). Global UNAIDS 2013 report stated that 35, 5-38, 8 million people were living with HIV by December 2012 and approximately 60% of them being women. HIV prevalence among women aged 15-49 years in Zimbabwe is 16.4%, Avert Zimbabwe (2014) reported. Zimbabwe like any other countries which adopted the June 2013 WHO new integrated HIV treatment guidelines recommending lifelong antiretroviral therapy Option B+ for all HIV positive pregnant women and lactating mothers for their own health and prevention of mother to child transmission. Culture, socioeconomic status, and religion have left HIV positive pregnant women vulnerable to inability in accessing health care services. The purpose of this research was to determine the relationship between empowerment and self-care among HIV positive pregnant women aged 15-49 years at Morgenster Mission Hospital Antenatal Clinic in Masvingo Province. The study utilised Orem’s self care model. A quantitative descriptive correlation design was used in the study, whichdescribes the relationship between variables only without exploring cause and effect relationships. A sample of 96 HIV positive pregnant women aged 15-49 years was selected conveniently. A structured interview schedule was used for data collection after a pre-run of the study instrument for validity and reliability. The questionnaire had closed and open ended questions which took 15 to 20 minutes to answer. Data was analysed using the statistical package for Social Science (SPSS -PC). The research questions were analysed using descriptive and inferential statistics. Linear regression analysis was used to test the strength of the relationship between empowerment and self care. Only 32 (33.3%) were empowered and 31 (31.3% could self care
An investigation of the factors that negatively affect the success of judicial management as a corporate rescue strategy in Zimbabwe
No full textThe continual survival of companies as going concerns is vital to every country and failure of
these companies has far reaching consequences that go beyond the owners and creditors of the
companies. It also affects the community at large. Corporate rescue mechanisms have been put in
place in different countries to try and ensure the continual existence of companies. In Zimbabwe
there is Judicial Management [JM], the corporate rescue mechanism that has been incorporated
into the Companies Act [24:03]. However, since dollarisation, the number of JM attempts that
have failed is disconcerting, with more and more distressed companies finding themselves
ushered into liquidation. This has called for an investigation into the factors why JM attempts
have flopped, with an intention of addressing these to make the procedure sounder.
This paper attempted to identify the factors that have hindered successful implementation of JM
and possibly propose counter measures or remedies to these negative factors. The research
started from a proposition that the costs of JM, choice and make up of JM practitioners,
regulation and monitoring of JM practitioners, macroeconomic failure to access capital had the
biggest influence on the performance of JM as a corporate rescue strategy in Zimbabwe. A
qualitative exploratory and inductive research was carried out and in-depth interviews used to
collect data, which was then analysed through the content approach method. Multiple factors
were discovered through the research findings for the failure of JM, within ability to access
capital and the incompetence of the JM practitioners cited as the major reasons for the failure.
Several other factors revealed from the research were misaligned legal framework, interference
by shareholders, the role of the directors, poor timing for initiating the JM attempts, poor
regulation and monitoring of the JM industry, unethical conduct by the JM practitioners, the
heavy workload of the JM practitioners, role of the creditors, lenience towards creditors’ plight
and inadequate provisions for JM. All the factors identified more than validated the research
proposal but went on further to provide other factors that were critical to the success of JM. It
was concluded that indeed, since dollarisation, JM had failed as a corporate rescue strategy and
several recommendations were made to enhance the JM procedure and recommendations for
further study were also provided
Strategic planning practices: The antecedents and business perfomance outcomes in Zimbabwean Small to Medium Enterprises (SMES)
No full textDespite Zimbabwe sharing with the rest of the world, the notion that SMEs are the impeccable
engines to economic revival, growth and development, many of the nation`s SMEs are plagued
with high failure rates, a phenomenon which motivated the need to carry out this study. Previous
studies carried out in most foreign countries suggested that the high failure rate of SMEs was
attributable to lack of strategic planning among a host of other factors.
Notwithstanding the globally acknowledged efficacy of strategic planning towards business
performance of SMEs, there is little evidence indicating whether Zimbabwean SMEs practice
strategic planning and how their engagement in strategic planning impact the firms` business
performance. The focus of this study was, therefore, on ascertaining the driving factors of
strategic planning practices in Zimbabwean SMEs and also to establish the impact of strategic
planning on business performance of these enterprises.
This study hinged on the positivist research philosophy and a quantitative approach was adopted
where proportional stratified random sampling was used to sample 150 SMEs operating within
the Harare Metropolitan Province. The unit of analysis was the owners and managers of the
sampled SMEs, who were purposively chosen for their superior knowledge of strategic planning
practices of SMEs. Data was collected using self-administered structured questionnaires. The
collected data was then coded and analyzed using Statistical Package for Social Sciences (SPSS)
version 23.
This study confirmed that the four perceived driving factors (globalisation, business ownership
motivations, environmental dynamism and innovation & technological advancement) had a
positive and statistically significant influence on the adoption or practice of strategic planning
among SMEs. In addition, the study partially confirmed the claim that adoption or practice of
strategic planning has a positive impact on business performance of SMEs. Only two strategic
planning factors (environmental scanning and strategy implementation) showed that they had
positive and statistically significant impact on business performance of SMEs. It was on this
basis that the study recommended SME owners/managers to prioritize the scanning of
environment and strategy implementation in order to enhance business performance of their
enterprises
Acceptability of neonatal circumcision among mothers: A case study of Hatcliff and Rutsanana clinic
No full textThe acceptability of neonatal circumcision among mothers at Rutsanana and Hatcliffe clinics in Harare.
Background Male Circumcision is regarded as part of an integrated response to HIV prevention. Zimbabwe has not started implementing neonatal male circumcision. The purpose of this study was to identify factors that may facilitate or hinder the acceptance of neonatal circumcision.
Methods: A cross-sectional survey was carried out on 258 pregnant and mothers of newly born babies at Harare City Health department clinics, Rutsanana and Hatcliffe clinics. Data was collected using face to face interviews and group discussions. Data was analyzed using Stat version 12. Univariate, bivariate and multivariate analysis and the chi square test were used to determine the independent association between each variable.
Results: There was a significant association between acceptance of neonatal circumcision and knowledge levels. Those with adequate knowledge levels were more likely to accept neonatal male circumcision (OR=2.04, 95% CI; 1.10-3.80), and this was statistical significant, p=0.025. Women with circumcised partners were more likely to have circumcised sons, OR=5.27, 95% CI (2.02 – 13.71) and this was statistically significant, p=0.001
Conclusions All participants thought that the male circumcision for infants and young boys was the best above the age of one with 25% agreeing that they favored the policy of within the first 8 weeks after delivery. The respondents were aware of the benefits of neonatal male circumcision as an HIV prevention strategy though they deferred the decision to circumcise their new born to a later stage
Outcome of stavudine induced peripheral neuropathy in HIV-1 positive patients switched or substituted to a non-stavudine-based regimen
No full textA study to assess the outcome of Stavudine induced peripheral neuropathy in HIV – 1 positive patients switched or substituted to a non-Stavudine-based regimen.
Background : Stavudine is used in combination with other antiretroviral agents for the treatment of HIV- 1 infection . Among several serious complications it can cause a potentially crippling peripheral neuropathy. It is for this reason that it is no longer considered an appropriate drug of choice in any antiretroviral regimen in developed and more recently developing countries. A study to assess the prevalence as well as the outcome of Stavudine induced peripheral neuropathy in individuals who are no longer on the drug has not been previously described in this setting.
Objective : To determine the outcome of Stavudine induced peripheral neuropathy following its discontinuation.
Methodology : Peripheral neuropathy was defined using the ACTG Brief Peripheral Neuropathy Score which requires the presence of at least one symptom of peripheral neuropathy plus one objective abnormal examination finding.
Study Design : A cross- sectional study of 385 participants performed over 10 months at Parirenyatwa Hospital Opportunistic Infections Clinic in Harare, Zimbabwe.
Subjects : Consenting adults aged 18 yrs and above , who were on a Stavudine-based regimen for at least one month prior to switch to a non-Stavudine-based regimen.
Primary outcome measures : The proportion of patients with persistent peripheral neuropathy following cessation of Stavudine as determined by the ACTG Brief Peripheral Neuropathy Score.
Secondary outcome measures : Demographic and clinical factors associated with persistence of symptoms of Stavudine induced peripheral neuropathy following cessation.
Results : A total of 385 participants were recruited into the study. Out of these (256)66.5% were female. The mean age, weight and height were 42.7 ± 11.7 yrs, 69.3 ± 14.8 kg and 163.7 ± 8.83 cm respectively. The median duration on Stavudine was 39 months (IQR 19.5-63). The median duration off Stavudine was 23 months (IQR 12.5-36.5). Out of the total number of participants, 45.19% had ongoing Stavudine induced peripheral neuropathy. Stavudine induced peripheral neuropathy was strongly associated with a low CD4+ count, concurrent hypertension as well as tuberculosis therapy (OR -2.69-[95% CI 1.61-4.48;p=0.0001],2.98-[95% CI 1.66-5.35;p=0.0002] and 7.03-[95%CI 0.84-58.99;p=0.037]) respectively. Individuals exposed to Stavudine for longer than 24 months were 46% less likely to develop peripheral neuropathy. (OR - 0.54-[0.35-0.82;p=0.004])
Conclusion : Stavudine induced peripheral neuropathy persists in a significant subgroup of patients after cessation of use. Its continued use as part of any antiretroviral regimen should therefore be discouraged. Identification of such patients following cessation of therapy with a simple screening tool will allow targeted early treatment to prevent further progression of peripheral neuropathy
Strategies for gaining and sustaining property management mandates in Zimbabwe's real estate industry
No full textReal estate agents firms in Zimbabwe like Knight Frank Zimbabwe are losing property
management mandates to subsidiary property investors’ in-house management teams,
contrary to the trend worldwide, were most corporates are now outsourcing corporate real
estate functions such as property management. The purpose of the study was therefore, to
investigate strategies that can be used by estate agents’ property managers to gain and sustain
property management mandates in Zimbabwe.
The research approach was both quantitative and qualitative. Seven interviews were carried
out with senior property managers in-order to investigate the problems and strategies to
sustain and gain property management mandates. Three further interviews were carried out
with key informants in-order to inform the policy recommendations. Over and above that,
400 interviews were carried out with commercial tenants through questionnaires in-order to
analyze the challenges facing the property users, which also lead to the loss of property
management mandates and their responses were analysed through the SPSS package. The
qualitative data was analyzed through thematic and content analysis.
The study found out that the major property owners in the CBD of Harare have lost a
considerable size of property management mandates as a result of the property investors
strategic shift, high voids, high rentals, high operating costs and the alarming increase in
tenant default on lease obligations. The study also found out that, not only are property
investments reeling from increasing voids, the occupied space is not operating at optimum
level due to rent defaults and in some cases tenants simply abscond after accumulating large
amounts in arrears. The challenges facing tenants include high rentals and operating costs,
parking challenges and the prevailing challenging economic environment. The study further
found out that, the strategies to gain and maintain property management mandates include
taking advantage of sales activities within and outside the organisation, leasing activities
within the organisation and new property development in the area, in-order to pitch for new
management mandates. Other strategies include the retention of current services, marketing
and communication, dialogue with tenants and management innovation. The study
recommends that a tenant credit bureau be set up in-order to reduce rental defaults and that,
the property management players engage the government on various policy issues. It is hoped
that the findings will help the real estate agents to turnaround their current fortunes