1358 research outputs found
Sort by
Infection Prevention and Control Guidelines of Zimbabwe
No full textThe purpose of the Guidelines is to provide health workers, managers and supervisors the
standards and criteria against which to measure safe practice in infection prevention and
control. Additionally, it provides relevant information for communities and those providing
Home-Based Care.
The East, Central and Southern African College of Nursing (ECSACON) initiated the
preparation of the Guidelines and supporting activities. A team of senior nurses, members
of ECSACON, from Kenya, Malawi, Swaziland, Tanzania, and Zimbabwe designed an
assessment tool for the collection of data on infection prevention and control practices.
Subsequently, nurses from Malawi, Tanzania, and Zimbabwe conducted assessment
studies in their countries.
The findings of the three countries studies were presented at the 32nd Conference of
Health Ministers held in Swaziland in October 2000. The significance of the findings moved
the Ministers to pass resolution (CRHC/RHMC32/R5), indicating that countries should be
assisted to develop and/or strengthen their infection prevention and control practices.
In response to the resolution, World Health Organization Regional Office for Africa in
partnership with the East, Central and Southern Africa Health Community (ECSA-HC)
recruited a consultant Dr.Una V. Reid to assist countries in the development and/or
strengthening of their infection prevention and control policies and guidelines, and to
develop a related training programme. This work resulted in the prototype Manual of
Infection Prevention and Control Guidelines, which provided a framework and details for
the establishment of infection prevention and control in all health care facilities
(government, mission and private), homes and communities. These Guidelines have now
been updated by a multi-disciplinary team with the support of CDC- Zimbabwe.
The Guidelines are very comprehensive but simple to follow and are appropriate for use by
all disciplines. They are designed with sections, which outline the different aspects of
infection prevention and control that may be adapted/adopted to meet specific
institutional or community requirements. However, like all guidelines, they should be
considered a work in progress.
Infection prevention and control practices are a multidisciplinary endeavour, and require
compliance by all categories and levels of staff. Such compliance is obligatory to the
prevention and control of hospital associated/nosocomial and other infections in the health
care facilities and settings, as well as in the community.Ministry of Health and Child Care, PEPFAR, CDC Zimbabwe, World Health Organization Regional Office for Afric
The relationship between knowledge level on self-care and occurrence of aggression in schizophrenic patients aged 18-45 years attending the out patients department at Parirenyatwa hospital psychiatric unit Annex
No full textThe Parirenyatwa Group of Hospitals Psychiatric Unit is a government referral hospital for psychiatry for all the provinces in Zimbabwe. The extent of occurrence of aggression was 11.1% for 2012 which is a cause for concern. In Ethiopia the prevalence of aggression in the community is 19.6% whereas in America 80.9% of aggression in schizophrenic patients . The purpose of the study was to examine the relationship between knowledge level on self-care and occurrence of aggression in schizophrenic patients attending the Outpatients clinic at Parirenyatwa Group of Hospitals Psychiatric Unit in April/May 2013. Orem’s self-care conceptual model was used to guide the study particularly that the model emphasises on empowering the self-care agency. A descriptive correlational study design using a probability simple random sampling method was used to select a sample of 80 subjects from the Outpatient’s clinic attendances. A structured interview schedule was used to collect data. The instrument used had three sections, demographic, occurrence of aggression and knowledge on self-care data questionnaires. SPSS version 10 was used for statistical analysis. Descriptive statistics were used to analyse demographic , occurrence of aggression data, knowledge on self care data. Inferential statistics were used analyse knowledge on self care. Sixty percent of the participants were aged between 25-45 years, (52.5%) were women, and (41.2%) were married. Though the majority (95%) had gone through formal education (90%) of these were from the lower socio-economic class . Fifty percent had 1-5 episodes of aggression. Pearson’s coefficient correlation showed a moderate negative correlation between knowledge level and occurrence of aggression (r= -.390, p< .01). Regression analysis of occurrence of aggression data indicated a moderate linear relationship R – Squared=0.16(F=0.159) at p<0.01 therefore only 16% of aggression is accounted for by level of knowledge on self care. Patients require more input from nurses on self care to reduce the occurrence of aggression
The relationship between cultural factors and initiation of antiretroviral therapy among HIV-positive people aged 18 to 49 years at Chitungwiza central hospital O/I clinic
No full textPeople living with HIV who are eligible for Anti Retro viral therapy at Chitungwiza Central hospital OI clinic appear to be delaying initiating ART. Late initiation of HIV positive people on ART poses a major public health challenge. Timely initiation of HIV positive people on Anti retro Viral Therapy (ART) has shown to improve clinical outcomes such as improving the quality of life, prolonging life, reduction of mortality and morbidity rates, prevention of development of opportunistic infection and transmission of HIV infections. It is possible that cultural factors are playing a major role in influencing the initiation of ART among HIV positive people who are eligible for ART.
The purpose of this study was to examine the relationship between cultural factors and initiation of ART among HIV positive people aged 18 years to 49 years. The health belief model was used to guide the study and a descriptive qualitative correlational study was used as the research design. 80 participants were recruited for the study and 20 being males and 60 being female. Non-probability convenience sampling was used to select the participants. A structured interviewers schedule was used to collect the data. The data was analysed using descriptive statistics such as averages, percentages, mean and standard deviation. Inferential statistic using Pearson’s correlation coefficient was used to examine the relationship between cultural factors and initiation of ART.
Analysis of the results on cultural factors and initiation of ART showed that there is no significant correlation (r=-219) between the cultural factors and ART initiation. This means that as cultural factors are addressed or reduced there is an increase in the rate at which ART is initiated. This therefore implies that the cultural factors that facilitate initiation of ART should be addressed and those that hinders should be removed so as to improve the quality of life of people living with HIV and AIDs. It also calls for the determination and addressing other issues that hinder early initiation of ART. This research seeks to establish the relationship between cultural factors and initiation of anti-retro viral therapy among HIV positive people attending OI clinic at Chitungwiza Central Hospital. The Human Immunodeficiency Virus (HIV) pandemic continues to be one of the most serious emergencies faced by most of the developing world. Late initiation of HIV positive people on Anti-retro viral therapy (ART) poses a major public health challenge and timely initiation of HIV positive people on ART has shown to improve clinical outcomes such as improving the quality of life, prolonging life, reduction of mortality and morbidity rate, prevents the development of opportunistic infections and reduces transmission of the HIV infection. Cultural factors play a major role in influencing the initiation of ART among HIV positive people
Baseline Serological Markers of Hepatitis B Virus Co-Infection in the Development of Antiretroviral Therapy for Africa (DART) Population of Human Immuno Deficiency Virus Infected Patients
No full textHepatitis B virus (HBV) seroprevalence and serology profiles were retrospectively determined for 957 individuals in the Development of Antiretroviral Therapy for Africa (DART), human immunodeficiency virus (HIV) infected population. Baseline HBV serology markers were tested for and samples identified for viral load test in the HBV sub study investigating development of HBV Tenofovir (TDF)/lamivudine (3TC) resistance in HIV-1 positive treatment naïve individuals initiating TDF/3TC combination therapy as part of HAART. The patients received TDF/3TC combination therapy as part of HAART and samples were taken at baseline and at 4, 12, 24 and 48 weeks and every 48 weeks thereafter until last visit, up to 6 years. All samples were tested for anti-HBc and HBsAg with further testing for anti-HBs and HBe markers in anti-HBc+/HBsAg- and anti-HBc+/HBsAg+samples respectively using enzyme immune assays. In this population 164 patients were HBsAg positive giving a 17.1 % HBsAg seroprevalence (males 18.3 %, females 15.8 %). Five hundred and thirty (530) samples or 55.4 % were positive for the anti-HBc marker. One hundred and thirty five patients had isolated anti-HBc and will be tested for occult HBV, 103 were anti-HBc+/HBsAg+/HBe marker + and were identified for viral load tests on baseline and follow up samples to investigate HBV TDF/3TC resistance evidenced by viral rebound. The results infer a high prevalence of HBV co-infection in HIV infected individuals in Zimbabwe. HIV positive individuals are at risk of co-infection with HBV because of the shared routes of infection of HIV and HBV. This is supported by the high level of exposure to HBV evidenced by 55.4 % anti-HBc seroprevalence in the DART cohort. There was evidence of active hepatitis, 103 individuals with positive HBe markers, and HBV DNA tests can be done on these baseline and follow up samples to monitor the efficacy of TDF/3TC combination therapy in suppressing viral rebound. Viral load tests can also be done on 135 samples with isolated anti-HBc to determine the prevalence of occult HBV in this cohort.
KEY WORDS: HBV seroprevalence, HIV co-infection, HBV tenofovir/lamivudine resistance
iii
ACKNOWLEDGEMENTS
This thesis was made possible through the support of the Development of Antiretroviral therapy for Africa (DART) study group who provided the samples. I am grateful to Dr Chirara, Prof Robertson and other members of the DART study for allowing me to contribute to the DART HBV sub study through this project. Dr Chirara and Prof Robertson provided me with invaluable support, guidance and mentorship throughout the project.
The University of Zimbabwe department of medical microbiology virology laboratory members provided me with the necessary training to do this work and opened the doors of their laboratory for me to work in, for that I am most grateful. Thank you Ms Berejena and Mr T. Mamvura.
I also thank my classmates in the MSc medical microbiology program for the shared experiences throughout this program
The prevalence and morbidity associated with ectopic pregnancies at Harare central and Parirenyatwa hospitals
No full textIntroduction
Ectopic pregnancy is amongst the top causes of maternal morbidity and mortality in the first
trimester of pregnancy. It represents one of the commonest gynaecological surgical
emergencies in Zimbabwe and other developing countries because most of the women
present to health care facilities after rupture has occurred.
Objectives
i. To determine the prevalence of ectopic pregnancy at Harare and Parirenyatwa
Hospitals.
ii. To determine the risk factors associated with ectopic pregnancy at Harare and
Parirenyatwa Hospitals.
iii. To determine the morbidity and mortality associated with ectopic pregnancy.
Design
Cross-sectional study.
Setting
Harare and Parirenyatwa Central Hospitals in Harare, Zimbabwe.
Subjects
Women attending the two hospitals with suspected ectopic pregnancy from 01 December
2012 to 30 April 2013.
Methods
All women with a suspected ectopic pregnancy who consented to participate in the study
were recruited. They were managed by the attending team in the acute phase of the illness.
Face to face interviews were conducted to collect information and probe for risk factors of
ectopic pregnancy. The management offered to the patient was then analysed using patient’s
notes. An HIV test was done on all consenting subjects after pre-counseling. The mortalities
were noted and the morbidity was assessed by checking the pre-operative haemodynamic
state of the patient, pre-operative haemoglobin count, use of blood or its products, need for
intensive care post-operatively and the mean hospital stay.
Results
During the study period there were a total of 11239 deliveries attended at the two hospitals. A
total of 138 suspected cases of ectopic pregnancy were recruited into the study. Of these, 126
(91.3%) were surgically confirmed as ectopic pregnancies and the remainder (12) were
wrongly diagnosed. The overall incidence of ectopic pregnancy was found to be 1.12%. Most
women were in the 21-30 year age group and had 2 children or less. The risk factors
identified were a reported history of sub-fertility, previous history of STI, previous abdominal
or pelvic surgery and a previous ectopic pregnancy. There was one maternal death due to
rupture (case fatality rate of 0.8%). The morbidity was significant with 87.3% presenting
after rupture, 38.8% being attended with signs of shock, 11.1% requiring intensive care
admission and 77% being transfused with blood. The mean hospital stay was 5 days
following salpingectomy via laparatomy. The prevalence of HIV amongst those with ectopic
pregnancies who were tested was 13.1%.
Conclusion
The morbidity associated with ectopic pregnancy remains high in young women of low parity
as the majority present after rupture. The subsequent impact on future fertility of these
women could be improved significantly if health strategists focused on primary prevention
and early diagnosis to prevent tubal rupture. This means ensuring universal reproductive
health care access thereby working towards achieving Millennium Development Goal 5
(MDG 5) by 2015
Risk Factors for Cervical Precancer Lesions among Women Attending Cervical Cancer Screening Clinics in Harare, 2013
No full textBackground: Cervical cancer is the most common cancer in women in Zimbabwe. Preliminary analysis of the prevalence of precancer lesions of the cervix in Harare City revealed that the prevalence is around 7%. This is relatively high compared to those in the southern African region (3%). If the burden of the cervical cancer is to be reduced then risk factors for the precancer cervical lesions (precursor to cancer) for women in Harare have to be established. Methods: A total of 180 women who were attending Visual Inspection with Acetic acid and Cervicography (VIAC) clinics in Harare were enrolled in a case control study. A case was a woman 18 and above years with histologically confirmed cervical dysplasia. Data on demographic characteristics and risk factors for precancer lesions of the cervix were obtained with consent and these were then compared between the cases and controls. Results: The significant risk factors were having more than one sexual partner (OR=1.9; 1.21-3.72), being HIV positive (OR 8.4; 4.17-17.09), early sexual debut (<15years) (OR=3.4; 1.18-9.8), a previous history of any form of STI (OR= 3.06; CI= 1.64-5.69) and being single (OR=2.30; 1.12-6.56). HIV infection was found to have an effect modification for the association of sexually transmitted infections (STIs) and precancer lesions. History of genital warts appeared to have the strongest association (OR=4.29; CI= 1.37-13.40) with precancer lesion compared to other forms of STIs. Conclusion: The association of precancer lesions and HIV, STIs suggest that there is need to reduce the prevalence of HIV and STIs if the prevalence of the cervical precancer lesions is to be reduced. To achieve this strengthening health education on use of barrier methods to prevent STIs and HIV is required and there is need for integration of HIV services with cervical cancer screening for early detection in these women at higher risk
Identifying motivational factors in job performance and how they relate to attrition among village health workers in Shurugwi and Chirumanzu districts, Zimbabwe.
No full textBackground: Motivation is one of the key determinants of village health worker performance. Motivation is difficult to assess and can be measured by a series of questions which can be grouped into smaller sets that accurately define motivation, through factor analysis. Motivation predicts job related behaviours like attrition. Such behaviours are also difficult to measure; however, proxies can be used, like intent to quit. Logistic regression can then be used to determine how the motivation groups are related to attrition.
Method: The village health worker survey enrolled 338 village health workers working in Chirumanzu and Shurugwi. All the respondents were asked a series of questions that assess motivation when they came for their routine meetings. Factor analysis was used to reduce the number of items assessing motivation from 16. Logistic regression analysis was used to determine the association between motivation factors and attrition.
Results: The 16 items measuring motivation were reduced to 2, namely peer support and dissatisfaction, through factor analysis. Logistic regression analysis showed that peer support was 36% protective to attrition while the odds of attrition were 3.20 times when there is dissatisfaction.
Conclusion: Peer pressure and dissatisfaction are two major variables that define motivation and both are associated with attrition. Peer pressure is a protective variable while dissatisfaction is a risk factor
Application of citrus sinensis solid waste as a pseudo- catalyst for free cyanide conversion under alkaline conditions
No full textIn this study, Citrus sinensis (C. sinensis) solid waste was used to catalyze the conversion of free cyanide (F-CN) under alkaline conditions; conditions which represent most industrial wastewater containing F-CN. Acid hydrolysis of the solid waste increased the catalytic conversion of F- CN by 3.86 compared to the unhydrolysed solid waste. The conversion of F-CN using unhydrolysed and hydrolysed solid waste increased linearly with an increase in pH and temperature. The maximum catalytic conversion of a 100 mg F-CN/L solution containing 0.1% (w/v) of unhydrolysed and hydrolysed C. sinensis solid waste was 17.82% and 62.48%, respectively, at a pH of 12 and a temperature of 50 °C. The catalytic process was largely dependent on the availability of activated hydroxyl groups in the solid waste. As most wastewater contains heavy metals, it was determined that the presence of metallic species (Ni, Zn, and Cu) reduced the conversion of F-CN as the metallic ions attached to the hydroxyl groups. The observed reduction was 26.35% when 10 mg/L of heavy metals were present in the F-CN solution containing the hydrolysed solid waste at a pH of 12 and 40 °C.This research was sponsored by a Cape Peninsula University of Technology, University Research Fund (URF RK16). Ms. H. Small, Prof. V. Hugo, Ms. M. Ackerman and Mr. Alvyn Bester are hereby acknowledged for their technical contribution to this study
An assessment of the sustainability of the food security, protracted relief programe implemented by Non Governmental Organisations in Zimbabwe: A a case of Zimbabwe Red Cross Society (2005 - 2009)
No full textThe study focused on the assessment of the sustainability or persistence of positive effects of the Protracted Relief Programme (PRP) implemented by the Zimbabwe Red Cross Society over the period January, 2005 and December, 2009. The overall objective was to assess the sustainability of the PRP implemented by NGOs in Zimbabwe after external funding ended, focusing on the Zimbabwe Red Cross Society over the period January, 2005 and December, 2009.
Using the case of Chivi district, the study adopted a qualitative approach to explore the factors that have an impact on the continuity / sustainability of projects in the context of rural Zimbabwe. A sample of 108 was selected from a target population of 197.The main data collection instrument used was the questionnaire administered to beneficiaries of the programme and key informants and interview guides to focus groups and two managers.
To this effect the study argues that stakeholder consultation, beneficiary identification, beneficiary training and frequent monitoring are critical factors in determining the continuity of any project in the context of rural communities.
The study recommended that for projects to be successful and continuous there is need for a mixed beneficiary selection process, on-going training, needs assessments, capacity building at managerial level and a sound exit strategy has to be in place.
Further studies are required on the impact of management on project implementation
A comparative evaluation of the performance of the Viroseq HIV-1 genotyping system v2.0 against an in-house assay using specimens from the national HIV drug resistance monitoring survey, in Zimbabwe.
No full textThis study was carried out to assess the performance of the Viroseq HIV-1 genotyping
system v2.0 (Celera, Alameda, California, USA) on Zimbabwean samples at the National
Microbiology Reference Laboratory (NMRL) in Harare and to compare the results obtained
with those obtained at a World Health Organization accredited genotyping laboratory in
Entebbe, Uganda, which genotyped the same samples using an in-house method.
Study samples: Thirty eight (38) plasma samples were used in this study. They were selected
from samples stored at NMRL, which had been collected from patients eligible for
commencement on antiretroviral therapy just prior to taking antiretroviral drugs at sentinel
sites for the National HIV Drug Resistance Monitoring Survey in Zimbabwe.
Results: Viral RNA extraction and RT-PCR reactions were successful at first attempt for all
the 38 study samples. The success rates of cycle sequencing reactions using the 7 proprietary
Viroseq sequencing primer mixes on the 38 samples, at first attempt were: Primer A (81.6%),
primer B (86.8), primers C and G (84.2%), Primer D (10.5%), Primer F (73.7%) and Primer
H (94.7%). Thirty seven out of the 38 samples (97.4%) were successfully genotyped.
However, 14 (37.8%) of these pol region consensus sequences obtained were unidirectional.
Thirty two out of the 37 (86.5%) Viroseq genotyped samples clustered in pairs with their
corresponding sample sequences generated in Uganda with bootstrap support values ≥70
(median bootstrap support value, 97.5: range 31-99) on neighbour joining tree phylogenetic
analysis. All of the genotyped study samples were found to be HIV-1 subtype C (n=37).
Nineteen of the 37 (48.6%) genotyped samples had at least one drug resistance mutation
detected by either Viroseq or the Ugandan in-house assay. The detected mutations as reported
by the two genotyping systems were fully concordant in 11/19 (57.9%), partially concordant
in 2/19 (10.5%) and discordant in 6/19 (31.6%) of these specimens with drug resistance
mutations. Overall, all the reports generated by the two systems with or without any
mutations were 78.4% fully concordant, 16.2% partially concordant and 5.4% discordant.
Conclusions: The Viroseq system can be reliably used to genotype Zimbabwean samples by
adequately trained operators at NMRL. Sequencing Primer D is not suitable for sequencing
Zimbabwean subtype C isolates due to its high sequencing reaction failure rate