1358 research outputs found
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Modelling spatial variability of soil nitrogen using geostatistical methods and remote sensing
No full textThe aim of this study was to explore the use of geostatistical approaches involving remote sensing data to model and map soil nitrogen variability for use in precision agriculture. Precision agriculture is a management strategy aimed at reducing the costs of nitrogen fertilizers by matching site-specific nutrient applications with crop requirements and soil properties as both vary across a field. The study was conducted on a 4-hectare plot at the University of Zimbabwe farm in Zimbabwe. Three prediction models were applied to estimate soil nitrogen variability within the plots and these included; (1) Ordinary kriging with sample nitrogen data only, (2) Ordinary co-kriging with sample nitrogen and remotely sensed data as covariate data, and (3) spatial regression with remotely sensed data only. Landsat 8 was used as a source of remotely sensed data. Results showed that the Coastal/Aerosol, Blue and NIR spectral bands were highly correlated to soil nitrogen, and produced good prediction models in co-kriging with R2 values of 0.8593, 0.8606 and 0.8596 respectively. Ordinary kriging with nitrogen sample data alone also yielded similar results with R2 value of 0.8597. Finally, spatial regression analysis (SAR lag model) using the same spectral bands yielded R2 values of 0.527, 0.517 and 0.545 respectively while the other bands like Red, SWIR-1 and SWIR-2, and indices like NDVI, RVI and SAVI yielded values below 0.5. Comparison of the three prediction models indicated that there was no significant difference in the mean prediction values of the models. Thus, the results suggest that remotely sensed data can successfully be used alone and in combination with field sample data to model and map soil nitrogen variability in soils
Equity and Quality in Health: Leaving no one Behind
No full textThis strategic plan has been developed through a participative and consultative process involving
significant contributions and support from various individuals and institutions.
A specific Technical Task Team (TTT) was established to drive preparatory activities towards this
strategy. The TTT established Technical Working Groups (TWG) to focus on specific strategic pillars.
Various stakeholder workshops were conducted with health workers, community leaders, development
partners, government agencies and communities. The TTT also conducted a Strengths, Weaknesses,
Opportunities and Threats (SWOT) analysis based on the inputs from these stakeholders. The SWOT
analysis provided qualitative evidence on the status of the health sector. In addition, a Bottleneck
Analysis (BNA) was conducted on selected tracer conditions to unpack the underlying bottlenecks and
root causes to observed health system performance challenges. The results of the SWOT analysis and
the BNA, together with a comprehensive review of the performance of the previous strategy exploring
what worked and what did not was used to identify sector priorities and hence remedial strategies.
The Plan provides the framework that will guide the efforts of the Ministry of Health and Child Care
and all stakeholders over the next 5 years in contributing to the attainment of the Zimbabwe Agenda
for Socio-Economic Transformation and the Sustainable Development Goals.
The successful implementation of this plan will depend on the continued dedication of staff in the
Ministry of Health and Child Care and those of its partner institutions.
As a strategic policy document that we have put together, it is my sincere hope that it will become the
single most important point of reference for design of service delivery programmes, resource
mobilization and health financing framework, as it outlines how as Zimbabweans we will reach our
dream of delivering high quality health services to the citizens.
I therefore wish to extend my sincere appreciation to all those that contributed to the process of
developing this plan. I wish to pay special tribute to the members of the technical team and members
of the technical working groups for their significant inputs and commitment to this process. On behalf
of the Ministry of Health and Child Care, I also wish to acknowledge the financial and technical
support rendered to us by our Development Partners. Without the direction and valuable support of
our Cooperating Partners, we could not have managed to successfully complete this plan. Finally,
I wish to thank all the members of staff of the Ministry of Health, and Child Care, line ministries,
Community representatives and NGOs, for their participation, contributions and support to the process
of formulating this strategic plan.UKAid, IrishAid, GAVI, WHO
An analysis of the visual acuity outcomes following surgical repair of penetrating corneal injuries among patients seen at Sekuru Kaguvi Hospital (SKH), eye unit at Parirenyatwa Central Hospital in Harare, Zimbabwe
No full textTrauma is an important cause of morbidity and mortality in most disciplines in the practice of medicine and constitutes a great proportion of patients seen in emergency departments. Ocular trauma causes significant visual morbidity and fortunately mortality from purely ocular injuries is rare unless the patient develops complications that spread into the cranium. Although, studies have been done to find out causes of ocular trauma that result in hospital admission, including one at SKH, the prevalence of good visual outcomes has not been evaluated. This study was therefore conducted to evaluate the prevalence of good visual outcomes following penetrating corneal injury and surgical repair at SKH.
Objectives
The principal objective was to analyze the visual outcomes of patients in the study population who underwent surgical repair for penetrating corneal injuries at SKH. The specific objectives were to describe the demographics of the study population, to elicit the causes of penetrating corneal injuries and to evaluate the best corrected monocular visual acuities of the patients’ eyes under study.
Design of Study
A hospital based prospective study.
Study Setting
Study was conducted at Sekuru Kaguvi Hospital, Parirenyatwa Group of Hospitals.
Study Population
Patients who had surgical repair of penetrating corneal injuries at SKH between August 2012 and April 2013, meeting enrolment criteria were recruited.
Methods
Authorization to carry out the study at SKH was granted by the Joint Research and Ethics Committee. Patients with penetrating corneal injuries referred to SKH were managed as per standard operating procedure. Day 1 post operatively the researcher interviewed and examined patients for eligibility to enroll into study. Data about the patients' demography, history about the injury and examination findings were captured onto data sheet. Patients were followed up a total of 7 weeks post surgical repair and were seen Day 1, 2 weeks, 6 weeks and 7 weeks post operatively. At six weeks post op, corneal sutures were removed on the slit lamp. Best corrected monocular visual acuities of the injured eyes were evaluated at week 7 objectively and subjectively. Examination findings of state of anterior and posterior segments were recorded.
Results
Seventy (70) patients were recruited into study. Median age of the patients was 39 years, range 6 to 72 years. The male: female ratio was 2.7:1. The proportion of patients that achieved best corrected monocular visual acuities (BCVA) of 6/60 or better was 59% (n=41). There was an association between the BCVA and location of the corneal scar (p=0.001). The association between the BCVA and the status of the lens was also statistically significant (p=0.001). The main causes of bad visual outcome (BCVA worse than 6/60) were irregular astigmatism, vitreous hemorrhage and corneal scar in the visual axis and dense traumatic cataracts.
Males were more than twice at risk of getting injured. Age and gender were risk factors for injury with males below 40 years of age being more at risk of injury. The main causes of injury were vegetative matter and metallic objects. There was a statistically significant association between object of injury and gender (p=0.016).
Conclusions
The results showed that the proportion of patients that achieved good visual outcomes (BCVA of 6/60 or better) at Sekuru Kaguvi Hospital after surgical repair for penetrating corneal injury was 59% during the study period. Irregular corneal astigmatism, vitreous hemorrhage and central corneal scarring were the major causes of visual outcomes worse than 6/60. Males were affected more than females by a ratio of 2.7:1. The causes of injuries could suggest gender roles in society, where males were injured mostly by metallic objects and females by vegetative material
Prevalence of Cutaneous Human Papillomavirus infections at Parirenyatwa hospital's Kaposi Sarcoma Clinic and the Opportunistic Infections Clinic: Association with Non- Melanoma Skin Cancers
No full textHuman papillomavirus (HPV) types from the Betapapillomaviruses (ß-HPVs) genus are
ubiquitous in non-melanoma skin cancers (NMSC), hyperkeratotic skin warts and in cancer free skin biopsies among fair skinned races. There is paucity of information
regarding the prevalence and distribution of ß-HPVs among black Africans. To determine the prevalence of ß-HPV genotypes in cutaneous infections among black Zimbabweans and their association with NMSC, a cross-sectional study was carried out in which skin biopsies were collected from patients attending a referral hospital. HPV typing was done by Primer mix polymerase chain reaction (PM-PCR) and the
subsequent reverse hybridization assay (RHA) which is known to identify 25 cutaneous ß-HPV types implicated in skin lesions. We included 144 Black participants with clinically apparent cutaneous warts (n=28), suspected NMSC (n=98) and Kaposi sarcoma (KS) (n=18). The skin biopsies were analyzed for HPV DNA presence and type. The frequency of ß-HPV DNA was 70.1% (101/144). HPV DNA positivity was significantly higher in the HIV infected group 79.2% (57/72) compared to the HIV uninfected 61.1% (44/72), [OR=2.42, 95%CI (1.09-5.47), P=0.018]. All warts patients were HPV DNA positive and 89% (16/18) of those with KS and 58% (57/98) of those with NMSC. Single HPV infections were observed in 33.7% (34/101) of the participants that were HPV DNA positive, 66.3% (67/101) had multiple HPV types and 20.8% (21/101) had greater than five HPV types. The frequency and distribution of different HPV types did not show associations with neither age, sex, biopsy type but showed association with immune status. ß-HPVs are not uncommon in the Zimbabwean black population with skin lesions. There is a difference in the types of HPV genotypes detected in the skin lesions in this population (ß species 1 predominance) when compared to European populations, where there is a ß species 2 predominance. The study provides baseline molecular-epidemiological information for cutaneous HPV infections in Zimbabwe. However, wider national surveys using less invasive techniques are warranted to establish the exact extent of HPV cutaneous infections for more effective public health interventions
Preoperative anxiety levels in obstetric patients receiving spinal anaesthesia: Does an information booklet reduce anxiety and improve quality of anaesthesia?
No full textOBJECTIVE: To look at levels of preoperative anxiety in patients who are to have caesarian section under spinal anaesthesia and determine if availing an information booklet to the patients would reduce anxiety.
MATERIALS AND METHODS: One hundred and twenty patients were included on baseline assessment of anxiety. The anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Shona version of it was validated. Patients randomly selected into group A received the information booklet the day before surgery while those in group B did not. Anxiety was reassessed on the day of surgery. The day after surgery a survey of the patients’ satisfaction with the spinal anaesthesia was done.
RESULTS: Three patients out of the 120 were lost to follow-up for unforeseen reasons. Baseline anxiety assessment showed that 38 out of 60 patients in group A and 45 out of 60 patients in group B were anxious and this was statistically significant (p=0.000). There was an increase in the number of anxious patients in groups A and B on the day of surgery from 38 to 43 and from 45 to 48 respectively. This increase however was not statistically significant (p=0.1307 group A, p=0.1500 group B). Regarding need for information, those with none or little need for information were 42.7% (p=0.099), average need for information 18.8% (p=0.031) and with high need for information 38.5% (p=0.001). Regarding the relationship between anxiety and need for information there was a positive correlation for both group A and B(r=0.638, p=0.000 and r=0.797, p=0.000 respectively). One hundred and eleven (94.9%) of patients were satisfied with the spinal anaesthesia and 110(94.0%) were willing to have it if they were to have subsequent
caesarian section.
CONCLUSION: There was preoperative anxiety in patients scheduled for caesarian section. The information booklet did not reduce anxiety. The high need for information was significant in the group that did not have access to the booklet. Patients were however satisfied with spinal anaesthesia
Factors associated with occurrence of multi drug resistant tuberculosis in a Harare city, 2015
No full textIntroduction: Multi drug resistance tuberculosis (MDR-TB) is a form of tuberculosis (TB)
caused by bacilli resistant to Isoniazid and Rifampicin. Rifampicin and Isoniazid are the two most important first line anti TB medicines. The World Health Organisation has declared MDR TB a public health emergency of global concern. Drug resistance can either be primary or acquired during TB treatment. The MDR TB notification rate has been increasing in Zimbabwe since 2010. New MDR TB cases have also been on an increase from a low of 42 in 2011 to a high of 60 in 2014. Annual newly notified drug susceptible TB cases have been on a decline over the past five (5) years. A study was carried out to determine the major risk factors associated with occurrence of MDR TB in Harare, Zimbabwe.
Methods and Materials: An unmatched case control study was conducted in Harare City. The outcome of interest in the study was MDR TB. A semi structured interview guide questionnaire was used to collect information on exposure from the respondents. A case was a TB patient confirmed by Gene Xpert and Drug Sensitivity Test (DST) to have resistance to Rifampicin. A control was a TB patient who had completed treatment and had a recorded cured outcome. A checklist was used to assess case detection activities in the TB service at health facilities. Data collected were entered into the EPI Info 3.5.4. The same software package was used to calculate frequencies, means and odds ratios. Stratified and forward logistic regression was carried out to determine independent risk factors associated with MDR TB.
Results: A total of 42 cases and 84 controls were enrolled in to the study. A total of 5 poly
clinic Presumptive TB registers and Health Facility TB registers were reviewed. There was no delayed case finding for risk MDR TB presumptive case in Harare. The significant risk factors in the study were having a history of previous TB treatment (OR=65.9 95% CI 19-223), having been a TB contact before (OR=2.56 95% CI 1.06-6.15), history of stopping TB treatment in previous catergory (OR=6.62 95% CI 1.91-23).Smoking, alcohol use, HIV (OR=1.13 95% CI: 0.3-2.76) and diabetes mellitus (OR=1.15 95% CI=0.21-10.00) were not significantly associated with MDR TB in Harare. A history of travelling outside the country was associated with less risk of having MDR TB (OR=0.66 95% CI: 0.3-1.4). Those who were employed were less likely to have MDR TB (OR=0.12 95% CI 0.04-0.29). There was a significant difference in knowledge on risk of defaulting TB treatment (p=0.02) and treatment completion (p=0.007) between cases and control.
Conclusion: History of TB treatment was the leading risk factor. A history of being a TB
patient contact, a history of stopping TB treatment were significantly associated with having MDR TB in the City MDR TB. HIV and diabetes mellitus were not significantly associated with having MDR TB. Based on the findings of this study MDR TB in Harare City is likely to be acquired than primary, as those who had prior exposure to anti-TB medicine were more likely to have MDR TB. There was no delayed case finding for high risk presumptive MDR TB patients. Those who were employed were less likely to have MDR TB
Factors associated with Human Immunodeficiency Virus first line treatment failure in Zvishavane District, Midlands Province, 2014
No full textGlobally, first line HIV treatment failure remains a challenge particularly in resource constrained settings. Midlands Province 2013 data showed that Zvishavane district had the highest prevalence of first line treatment failure at 16% against a national average of 1%. First line ART failure comes with poor treatment outcomes. We conducted a study to determine factors associated with first line HIV treatment failure in Zvishavane district.
Methods: A 1:1 unmatched case control study was conducted. A case was an HIV positive patient who was on first line ART for >6 months in Zvishavane district and was switched to second line ART regimen because of treatment failure in 2013/2014. A control was an HIV patient in Zvishavane district who had been on first line ART for >6 months and had not failed first line ART. Pretested interviewer administered questionnaires were used to collect data from randomly selected participants from health facilities registers. Logistic regression analysis was conducted.
Results: A total of 246 participants, 123 cases and 123 controls, were recruited. Independent risk factors were poor adherence (<80% adherence) to ART [AOR=5.14, 95%CI (2.75-9.62)], drug stock outs [AOR=3.02, 95%CI (1.20-6.98)], baseline CD4 count of <50 cells/mm3 [AOR=3.25, 95%CI (1.47-7.16)] and baseline WHO Stage 3 or 4 [AOR=1.95, 95%CI (1.05-3.61)]. Drug stock outs were a significant determinant of poor ART adherence [OR=3.09, 95%CI (1.83-5.21)].
Conclusion: Low baseline CD4 count and WHO stage 3 or 4 at ART initiation is associated with treatment failure. Improving adherence and avoiding ART drug stock outs may reduce treatment failure
An analysis of the impact of coups on human security in Africa: The case of Central Africa Republic (CAR), 2013-2015
No full textThe overall objective of the research was to ascertain the impacts of the 2013 coup in CAR on human security. The research investigates the effects of the coup in CAR on all the seven elements of human security which are economic, political, food, community, health, environmental and personal or individual security. What was also essential to the research was to investigate the causes of unconstitutional change of government in Africa with particular focus on CAR. The other objective of the study was to explore factors which exacerbate coups in Africa with particular focus on CAR. The research also examines measures which were enhanced by the international community to avoid the recurrence of coups. The research also explores the hurdles faced in trying to implement the aforementioned measures. The last objective of the research was to proffer recommendations on what needs to be done to avert the menace of coups in Africa and CAR. The research was guided by the concept of human security, concept of state failure, frustration aggression theory and the concept of natural resource curse. The research used qualitative methods with a case study as the research design of the research. Primary data collection methods such as key informant interviews were utilised in the study. The research also used secondary data collection methods such as documentary search. Non Probability sampling techniques such as purposive sampling were used in order to select relevant and competent respondents. Data was analysed using thematic analysis. The study demystify that, the failure of Independent African regime and the authoritarian crisis are some of the factors which are making Africa and CAR to provide fertile grounds to coups and political instability. Natural resources mismanagement is also linked to the influx of coups in Africa and CAR as the failure to manage natural resources in CAR led to economic quagmire. The issue of resource skulduggery by government official in CAR was explored as evidence that buttress the claim that CAR is failing to utilise its vast resources. The interplay between sectarian cleavages and colonial legacy also fuels the economic crisis in CAR. The study noted that the 2013 coup in CAR had ramifications on human security. The recommendations which were proffered were that there is need for effective and robust management of natural resources in CAR, the country should transit from authoritarianism into a democratic state and there is need of a comprehensive DDR programme as the previous Disarmament, Demobilisation and Reintegration (DDR) programmes failed
Application of a homogeneously sulphonated polystyrene membrane in the purification of waste water
No full textThe homogeneous sulphonation of waste polystyrene and its subsequent use in waste water purification was studied. The targeted waste was white food trays collected from roadsides, bins and waste dumps. They were shredded and sulphonated using acetyl sulphate thereby converting them into adsorbent material. The pH, electrical conductivity, water uptake, ion exchange capacity and the degree of sulphonation were evaluated for each sample produced. To confirm sulphonation the Fourier Transform Infrared Spectroscopy (FTIR) was used. The modified polymer was tested for its effectiveness in the removal of heavy metals from water. The Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-OES) was used to test for the concentrations of residual metals (chromium, cadmium and manganese) after batch adsorption experiments were carried out. The sulphonated polymer provided high purification of waste water by reducing the concentrations of cadmium from 10ppm to 2.30 ppm and manganese from 10 ppm to 1.53 ppm respectively. This is comparable to conventional adsorbents
Assessment of risk perception of teratogenicity of commonly used drugs among pregnant women
No full textBackground: Drug therapy in pregnancy is common practice and most women are concerned about effects of drugs to the unborn child.
Objective: To determine the teratogenicity risk perception of commonly used medicines
among pregnant women.
Method: A cross-sectional descriptive survey was conducted at five antenatal clinics in
Harare. An interviewer administered questionnaire which collected information on socio-
demographic characteristics, information sources, medicine use, risk perception and health beliefs was used. Descriptive and bivariate statistics was used to analyze the data. Multivariate linear regression and logistic regression analysis were conducted to identify predictors of risk perception and medication use in pregnancy respectively.
Results: Out of 450 women approached, 368(81.3%) agreed to participate in the study. The majority (70.9%) of the women used medicines during pregnancy. Paracetamol (48.6%), magnesium trisilicate (31.5%), ferrous sulphate (25.5%), folic acid (20.4%) and methyldopa (15.2%) were the most commonly used drugs. The majority (70.4%) estimated correctly the baseline teratogenic risk to be <5%. In bivariate analysis, women who had health related jobs (.2=13.592, p=0.0005) and multiparious (.2=45.403, p=0.0005) were more likely to use medicines during pregnancy. Similarly, multiparious women (p=0.0005), women with health related jobs (p=0.003) and women with at least secondary level of education (p=0.048) had a lower risk perception. In multiple linear regression, parity (ß=-0.155, p=0.004), perceived danger (ß=0.215, p=0.001), perceived severity from harm (ß=0.292, p=0.005), perceived barrier to not taking medicines (ß=-0.095, p=0.041) and cues to action (ß=0.101, p=0.025) were significant predictors of risk perception. In logistic regression, parity (OR=9.525; 95% C.I: 3.848; 23.575; p=0.005), personal exemption from harm (OR=0.809; 95% C.I: 0.686; 0.954; p=0.012), perceived danger (OR=1.210; 95% C.I: 1.053; 1.390; p=0.007) and perceived barriers to not taking medicines (OR=0.754; 95% C.I: 0.643; 0.885; p=0.001) were significant predictors of medicine use.
Conclusion: Although medication use was high among pregnant women, the majority
overestimated the teratogenicity risk associated with individual medicines. There is need for health care providers to play a bigger role in provision of pregnancy related drug information so that positive attitudes and beliefs concerning medication use in pregnancy are reinforced.
Key words: Risk perception, Pregnancy, Medication, Belief