1358 research outputs found
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Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross sectional study
No full textObjective'. To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were born in a national HIV prevention programme. Design'. This was a community based cross-sectional study. Setting: A resource poor peri-urban setting with high prevalence of HIV infection. Subjects: School aged children six to 10 years old who were bom in a national mother-to-child HIV prevention programme. Main Outcome Measures: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels. Results: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb 8.3pg/L) were 15%, 4% and 2% respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children. Conclusion: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia. HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential
Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy
No full textBackground: Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe. Aim: To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure. Objective: To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results. Design: Adescriptive cross-sectional survey. Setting: Harare Central Hospital adult opportunistic infections clinic. Participants: One hundred and eighteen (118) HIV positive participants on Is' line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovuume combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled. Main Outcome Measures: First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines. Results: Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% Cl 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% Cl 1.3-14.7], Factors associated with lower odds of treatment failure were age =42 [OR 0.3; p-value 0.007; 95% Cl 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% Cl 0.05-0.8], time on ART >4 years [OR 0.6; p-value 0.02; 95% Cl 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% Cl 0.2-0.8], There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% Cl 3.6-21.2], Conclusion: Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failure
Lung pathology in Human Immunodefiency Virus positive patients an autopsy study
No full textAim:
To accurately describe the lung pathology occurring in deceased Human Immunodeficiency Virus (HIV) positive individuals by way of an autopsy study and to attempt to do a clinicopathological correlation.
Materials and methods
Sixty one subjects were autopsied at Parirenyatwa Hospital with forty two (42) showing lung pathology; thus the sample size used for the study was forty two (42). Lungs were preserved with formalin and three (3) sections per lobe taken and subjected to hematoxylin and eosin (H&E) stain. Additional special stains were applied as required after review of the H&E.
Results:
By histopathological analysis bronchopneumonia was the leading cause of death from lung disease observed in eleven cases (26%), followed by pneumocystis jiroveci pneumonia seven (17%) then pulmonary tuberculosis (PTB) six (14%) cases. Mixed disease of pulmonary tuberculosis, bronchopneumonia and pneumocystis jiroveci pneumonia (PTB/BPN/PJP) and pulmonary tuberculosis and bronchopneumonia (PTB/BPN) were seen in two (5%) instances Pulmonary embolism (PE) was a surprising find accounting for six cases (14%) with an additional two (5%) cases being found mixed with hilar node tuberculosis (PE/PTB) and bronchopneumonia (PE/PTB).
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Conclusion:
There is a tendency to favour diagnosing pulmonary tuberculosis over PJP , two diseases with similar presenting signs and symptoms but very different treatment regimes. All cases of PJP were diagnosed as PTB. There is a reluctance to start treatment despite there being lack of further tests such as BAL to rule out PJP. Such reluctance is not shown with antituberculosis treatment. Pulmonary embolism remains under diagnosed in HIV. Methods to identify and stratify risk in HIV positive patient need to be devised
Evaluation of apolipoprotein b 100 against ldl-cholesterol in profiling cardiovascular disease risk in HIV infected patients
No full textBackground
This study was carried out to assess the potential clinical utility of measuring apo B 100 in evaluation of CVD risk. The study focused on measurement of the classic parameters of assessing CVD risk. LDL cholesterol and HDL cholesterol have been the cornerstone of stratifying CVD risk. LDL cholesterol is considered to be the major lipid risk factor but it has emerged that apo B 100, as a proxy for all atherogenic lipid particles, is a better marker for CVD risk. Risk of CVD in the HIV infected population appears to be relatively higher than in the general population and thus appropriate screening measures for CVD are needed. There is growing support that addition of apo B 100 measurement to the routine lipid panel would enhance patient management.
Methods
Sixty ART naive (35 females), 62 HIV positive on ART (47 females) and 64 HIV negative participants (52 females) were recruited from Harare Hospital adult OIC. These participants were aged between 18 and 65 years old and consented to participate in the study and the mean age was 38.4 + 10.4. A questionnaire eliciting socio-demographic and medical history was administered prior to collection of a blood sample for evaluation of lipid status. Total cholesterol, LDL cholesterol, HDL cholesterol, apo B and glucose were determined on the Dimension, Dade Behring analyser (Siemens Healthcare Diagnostics S.A). Ten-year CVD risk scores were calculated using an online calculator formulated by Dr Rupert Payne of the University of Edinburgh in May 2010.
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Results
There was an increase in mean total cholesterol, LDL cholesterol and apo B levels from HIV negative people to HIV positive ART naive patients and finally to HIV positive on ART patients which was statistically significantly different (p value< 0.001). There was a decrease in mean HDL cholesterol from 1.6 to1.4 to 1.1 mmol/L across the three groups which was also statistically significantly different (p value<0.001). Generally risk of CVD in the HIV infected population appeared to be relatively higher than the other two groups. Diabetes, age, gender, smoking, and systolic blood pressure had a positive effect on the lipid parameters. There was a weak positive significant correlation between Framingham risk score and apoB (r=0.26, p<0.001).There was no correlation found between Framingham risk score and LDL-c (r=0.144, p=0.11). A moderate positive significant correlation (r=0.44, p<0.001) was found between apo B and LDL-c.
Conclusion
In this study it was observed that ART increases lipid parameters like total cholesterol, LDL-c and apo B levels thereby increasing risk of CVD. HDL-c levels were decreased in patients on ART. ART therefore seem to affect lipid parameters. The current guidelines should recommend routine monitoring of lipid parameters in HIV patients on ART to actively investigate these changes. Apo B should be included in lipid profiles since there was a weak positive correlation with the Framingham risk score in assessing risk of developing CVD. Apo B also reflects the atherogenic particles not only LDL but also VLDL and IDL
Determining the rate, nature and predictors of adverse drug reactions associated with the use of Highly Active Antiretroviral Therapy (HAART) in a resource limited setting (Zimbabwe)
No full textBackground: Dilemmas exist between balancing cost and toxicity of antiretroviral therapy (ART) in resource limited settings (RLS). Most pharmacovigilance programmes in RLS are unable to monitor adverse drug reactions (ADRs) due to inconsistent support systems. The study was carried out to implement a 3-step approach in identifying ADRs in patients on ART. The study was also designed to determine the rate nature and predictors of toxicities associated with ART in a RLS (Zimbabwe).
Methods: The 3-step approach involved a pharmacist, physician and a drug regulatory agency (Medicines Control Authority of Zimbabwe, MCAZ) at each respective step. The pharmacist (investigator) was responsible for collecting data of suspected ADRs from the patient charts. The physician documented patient information in the patient charts, while the drug regulating body ascertained the causality of the suspected ADRs. The 3-step approach was used in ascertaining causality of cutaneous ADRs in 221 patients. To determine the rates and predictors of ADRs, 388 HIV positive adults stable on first line ART dispensed from Parirenyatwa Hospital, Harare, Zimbabwe were interviewed and their respective patient charts were consulted. Data analysis was carried out using the Statistical Analysis System (Version 9.2, Cary, North Carolina, USA). Three regression models, one multiple linear regression model and two logistic regression models were run to identify predictors of ADRs.
Results: Of the 221 patient case report forms that were reviewed for causality assessment by the MCAZ, 39 patients had cutaneous drug eruptions. The rates of ADRs that were observed in the population included peripheral neuropathy (42%), skin rash (26%), lipodystrophy (3%), abdominal pain (8%), gastro-intestinal symptoms (7%) and headache (3%). Peripheral neuropathy and skin rash were mainly observed with stavudine (93%) and nevirapine (88%) based regimens respectively. Lipodystrophy occurred only in participants on stavudine based therapy. 161(58%) ADRs were grade 1 events (World Health Organization’s ADR grading system), 96(34%) were grade 2, 15(7%) were grade 3 and 1(0.3%) was grade 4. One patient on a nevirapine containing regimen had grade 4 Stevens - Johnson syndrome. In a logistic regression model, two indigenous herbal remedies were associated with the occurrence of ADRs in participants. Rates of toxicities were higher in the population receiving stavudine and nevirapine based therapies.
Conclusion: Implementation of the 3-step approach in a RLS can an accurate technique in implementing pharmacovigilance programmes in RLS. The results of this study showed that 3 in every 4 patients initiated on first-line HAART in the government roll-out programme experienced a clinical adverse drug event
Summary of an Intervention Study on Selected Aspects of Teenage Reproductive Health with Policy and Program Implications
No full textCRHC
The impact of direct marketing on sales performance: The case of seed potato co-op
No full textThe general conclusion from literature is that direct marketing strategies namely face-to-face selling, direct mailing, catalogue selling, telemarketing, online marketing and direct response advertisements if carried out properly result a number of benefits which include increased sales and profitability, increased loyalty and business with existing customers and expansion of business to new customers. However, most of the existing literature in direct marketing mainly refers to direct marketing experiences in other countries like North America, Europe, Asia and Australia . Therefore, the aim of this study was to was to attempt to fill the research gap by investigating the the impact of direct marketing on sales performance in the potato seed industry in Zimbabwe.
This research was carried out as a single case design of the Seed Potato Co-op (SPC). The data was obtained from face to face interviews of the employees and customers of the Seed Potato Co-op who had been employed or affiliated with the company for a minimum of 3 years .The questions asked were semi-structured and provided rich, in depth information. A qualitative research philosophy was followed and the data that was gathered was analysed through data displays in the form of content analytical summary tables
The study found that there was no formal marketing plan at the Seed Potato Co-op which resulted in poor communication of marketing activities in the company. The company also only practised one major direct marketing strategy and there was a weak relationship between direct marketing and sales performance. The study showed that several constraints which include a lack of properly trained marketing personnel, no dedicated finances or marketing budget, a lack of a proper customer database and no proper blueprint for carrying out marketing activities inhibited the Seed Potato Co-op from fully undertaking direct marketing during the period under study.
In view of the above, the study recommended that the company to carry out formal marketing planning to give direction to their marketing activities. It was further recommended that the Seed Potato carry out direct marketing using several direct marketing strategies, and also generate, and maintain a customer database
A study of the relationship between corporate governance board characteristics and practices, and business performance of Zimbabwe Stock Exchange listed banks
No full textThe overriding aim of this study was to study the relationship between corporate governance board characteristics and practices, and business performance of banks listed on the Zimbabwe Stock Exchange (ZSE) at the end of 2013. Board characteristics investigated in this study were Board composition and diversity; Board size, meetings frequency and board members’ attendance at meetings; Chief Executive Officer (CEO) status and succession planning; and Board committees, with a particular emphasis on Audit, Remuneration and Nomination committees. Both financial and non-financial business performance measures were considered.
The study sample was selected using a stratified random sampling approach. Further in pursuit of the study a quantitative research methodology was employed, utilizing both descriptive and inferential statistics in analyzing the data. For inferential statistics, correlation and regression analysis models were used. In addition, independent t-tests and analysis of variance (ANOVA) models were also performed on the data.
The study found a significant negative relationship between all the board characteristics and practices under study and business performance. The study also found a good level of compliance with corporate governance good board practices by ZSE listed banks. Finally the study found that the identified corporate governance board characteristics and practices cannot be used as a good predictor of business performance of the ZSE listed banks.
The study recommended less board diversity and fewer non-executive directors on boards. Also smaller boards were recommended together with fewer board meetings. On CEO status and succession planning it was recommended that both positions be occupied by the same person. Finally on board committees, it was recommended that ZSE listed banks have as much as possible less of such boards for enhanced business performance