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Factors Associated With Developing Ophthalmia Neonatorum in Harare City, 2013
No full textIntroduction: Ophthalmia neonatorum is defined as any conjunctivitis with discharge from the eyes during the first 28 days of life. Ophthalmia neonatorum is preventable. Gonococcal ophthalmia, if untreated, may progress rapidly to corneal ulceration, perforation, corneal opacification, staphyloma formation and eventually blindness. Globally the prevalence of ophthalmia neonatorum has been on the decline. In Harare Province alone, the cases increased by a massive 65% from 1023 cases in 2010 to 1688 cases in 2011 although the total number of deliveries increased by only 8%. This study was conducted in order to determine the factors associated with developing ophthalmia neonatorum in Harare City.
Materials and Methods: An unmatched 1:1 case-control study was conducted. A case was defined as any newly born baby with eye discharge in the first 28 days of life in Harare City while a control was any newly born baby in Harare City who did not develop eye discharge in the first 28 days of life. Pretested questionnaires were used to collect data and antenatal records were reviewed. 22 eye swabs were collected and analysed in the laboratory.
Results: 77 cases and 75 controls were recruited into the study. Independent factors associated with developing ophthalmia neonatorum were being born to HIV positive mother AOR 0.35 (CI 0.13-0.92), having received Tetracycline Eye Ointment (TEO) prophylaxis at birth AOR 0.21 (CI 0.07-0.50) and being born of a planned pregnancy AOR 0.38 (CI 0.17-0.87). Only 43 (28%) study participants received TEO prophylaxis. On thirteen (62%) of the eye swabs collected the microorganism isolated was resistant to tetracycline. Sixteen (73%) of the isolated microorganisms were staphylococcus species, with 8 (50%) of the staphylococcus species being resistant to tetracycline.
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Conclusion: The huge increase in the cases of ophthalmia neonatorum was partly because the majority of health workers were not giving prophylaxis and treatment according to national guidelines, and partly due to widespread resistance to tetracycline. We recommended therefore that the Ministry of Health and Child Welfare in Zimbabwe consider replacing TEO with ciprofloxacin eye ointment for use as prophylaxis against ophthalmia neonatorum
Effect of Community Infant and Young Child Feeding Counseling on Infant Feeding Knowledge, Attitudes and Practices in Harare City 2013
No full textBackground
A preliminary review of nutrition reports for Harare City revealed that set targets for exclusive breastfeeding rate, timely initiation of breastfeeding, median duration of breastfeeding and stunting were not met. All these are a consequence of poor infant feeding knowledge, attitudes and practices on the child. This study aims to find out the effect of community infant and young child feeding counseling on maternal knowledge attitudes and practices on optimal infant feeding in Harare City.
Methodology
A prospective cohort study was conducted in Harare City on pregnant and lactating women. The exposure was receiving counseling in community infant and young child feeding. Interviewer administered questionnaires, key informant interviews, focus group discussions and record reviews were used to collect data.
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Results
Mothers who received counseling in community infant and young child feeding had better knowledge on optimal infant and young child feeding at endpoint (mean knowledge score = 7.8, SD = 1.36 ) compared to the unexposed group (mean knowledge score = 5.4, SD = 1.53) and this was statistically significant (p = 0.005 ). Community infant and young child feeding counseling had an effect on timely initiation of breastfeeding, giving water, exclusive breastfeeding and giving solids. Most of the respondents, 92% in the exposed group had a positive attitude towards optimal infant and young child feeding practices as compared to the non-exposed group.
Conclusio
An investigation into the effectiveness of performance based financing (PBF) in Non-governmental Organizations in Zimbabwe: A case of result based finance program for health in Marondera District 2011 to 2013
No full textPerformance-Based Funding (PBF) has become increasingly popular in global health financing. PBF is defined as the transfer of resources for health on condition that measurable action will be taken to achieve predefined health system performance targets. Due to the apparent incentives that tailored resource transfers offer, PBF is increasingly promoted by leading global actors as a way to efficiently and effectively reform the way health systems are planned, financed, co-ordinated and steered, particularly in low- and middle-income countries. The concept of PBF started from the notion that even though resources are limited in low income countries, it must be possible to improve the effectiveness of the health sector by increasing the performance in terms of service quality, service utilization as well as improving staff motivation. World Bank is currently funding the implementation of a program called Results Based Financing (RBF) in Zimbabwe, through a NGO called CORDAID. There is limited systematic research evidence to confirm that PBF is (or is not) an effective strategy for reforming health system governance in a participatory, universally equitable and sustainable way as such, the researcher was prompted to study the concept. The main purpose of this study was to assess the effectiveness of PBF in non-governmental organizations in Zimbabwe using a case of Results Based Financing program for health implemented in Marondera district between the periods July 2011 to March 2013. The analysis from the empirical findings showed that PBF has improved health worker motivation, improved service quality and increased service utilization. The findings from this study were confirmed by findings from various studies done in other countries. The research was quantitative in nature and used self-administered questionnaires to collect primary data. Secondary data were also used to triangulate the findings from the primary sources. The main recommendation from the researcher is that donors in all the sectors of development should move away from the current “merit pay reward” system to a method that promotes challenges and accomplishments, by ensuring that recipients are paid for services after they have accomplished pre agreed targets. The researcher believed effective implementation of PBF will contribute to the reduction in donor dependency within the country and a quick recovery towards achievement of the Millennium Development Goals
Genotypic characteristics of rotavirus strains detected in children aged less than five years with gatroenteritis hospitalized at the three sentinel sites: Parirenyatwa central hospital, Harare central hospital and Chitungwiza central hospital; Zimbabwe, 2010
No full textA total of 784 faecal samples collected during the 7 months period, January to July 2010 from children under 5 years old with diarrhoea who were admitted at the 3 referral hospitals; Parirenyatwa Hospital, Harare Hospital and Chitungwiza hospital, were tested for presence of rotavirus antigen using enzyme immune-assay (EIA). Fifty faecal samples from children without diarrhoea were also tested for rotavirus antigen. Sixteen (32 %) of 50 non-diarrhoeal samples and 515 (65.7 %) diarrhoea samples were rotavirus positive. The association between diarrhoea and detection of rotavirus in faecal samples was statistically significant with an overall odds ratio of diarrhoea patients of 4.08 (p<0.0001). The rotavirus diarrhoea prevalence (59.4 %) was high in children ≤ 18 months old diarrhoea patients. The high prevalence of rotavirus diarrhoea was found during the dry cool season in diarrhoea patients < 59 months of age. Fifty rotavirus positive isolates from diarrhoea patients were genotyped using reverse-transcription polymerase chain reaction. A large proportion of samples could not be genotyped; 28.6 % did not produce G genotype result, and 43.2 % did not produce P genotype result. Of the strains that could be genotyped, G9 (24.3 %) was more predominant, followed by G2 (10.9 %), and P[6] (31 %) was more predominant followed by P[4] (14.3 %. The G and P combinations which were more predominant were G1P[6], G9P[6] and G8/G12P[4]. The RNA electrophoresis of the rotavirus genome was performed on 30 rotavirus positive samples, 90 % produced migration patterns typical of the group A rotavirus: 70.4 % were long electropherotypes and 22.2 % were short electropherotypes. The identification of unusual P and G combinations in Zimbabwe may affect the efficacy of currently available rotavirus vaccine formulations and may contribute to the design and development of a broadly reactive rotavirus vaccine for use in African countries
SCREENING OF TRADITIONAL MEDICINAL PLANTS FROM ZIMBABWE FOR PHYTOCHEMISTRY, ANTIOXIDANT, ANTIMICROBIAL, ANTIVIRAL AND TOXICOLOGICAL ACTIVITIES
No full textFourteen indigenous medicinal plants used by traditional medical practitioners in treating sexually transmitted diseases including HIV/AIDS and opportunistic infections were selected after an ethno-botanical pilot survey of five districts from Zimbabwe. The plant materials were collected and extracted separately with methanol. The 28 extracts were lyophilized and screened for phytochemical groups, and biological: antioxidant, antiviral, antibacterial, antifungal and toxicological activities. The phytochemical screening was carried out using Thin Layer Chromatography and UV detection, followed by standard confirmatory tests. The results indicated that seven (25.9%) extracts were positive for alkaloids, ten (35.7%) for anthraquinones, thirteen (46.4%) for coumarins, seventeen (60.7%) for flavonoids, twenty-three (82.1%) for saponins and twenty-five (89.3%) for tannins. Flavonoids, saponins and tannins were the most frequent phytochemical groups found. All extracts contained at least three of the chemical groups. In order to determine the antioxidant activity, the plants were screened for Radical Scavenging Activity using DPPH (2,2-diphenyl-picrylhydrazyl) with β-carotene as reference and their Total Phenolic Contents were measured by the Folin-Ciocalteu reagent using gallic acid as reference. Eight extracts exhibited antioxidant activity with percentages higher than 90% (Rhus chirindensis leaves & roots-both 96.9%; Khaya anthotheca bark-96.1%) and the lowest result was 27.4% for Dichrostachys cinerea roots. Their TPCs ranged from 0.596mg/mg GAE for Khaya anthotheca bark to 0.105mg/mg GAE for Dichrostachys cinerea roots. The phenolic compounds in the extracts correlate with their antiradical activity (r2=0.57), confirming that the phenolics are likely to cause the radical scavenging activity. The antiviral activity was examined using End Point Titration Technique (EPTT) and Neutralisation Test (NT) after calculating the cytotoxicity of the plant extracts on VERO cells. The HSV-2 virus titre was calculated using the Reed and Muench method (TCID50 = 10-8.5 per 0.1ml). The reduction factor (RF) was calculated and it was considered a promising antiviral result if the RF was ≥ 103. Out of 26 extracts, 13 (50%) showed considerable antiviral activity against the HSV-2 virus. The best results were obtained from the extracts of Dichrostachys cinerea leaves (RF 104), Kigelia africana fruit (RF 104) and Hypoxis rooperi tuber (RF 103) with concentrations ranging from 10.41μg/ml (Dichrostachys cinerea leaves) to 125.0μg/ml (Flacourtia indica roots). The reference acyclovir was active at 1.50μg/ml. Their cytotoxicity could also be beneficiary in developing new anti-tumour drugs. The antibacterial and antifungal activities of the plant extracts (10mg/ml) were investigated by the agar well assay. The chosen microorganisms were Staphylococcus aureus, Streptococcus group A, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and Aspergillus niger. The best results were Terminalia sericea roots, Warburgia salutaris roots, Gymnosporia senegalensis roots and Kigelia africana bark which were active against all micro-organisms. T. sericea roots inhibited the growth of S. aureus with inhibition zone of 7.88±0.48mm where the reference amoxicillin (10μg) gave a zone of 9.00±0.41mm and against P. aeruginosa, gave a larger zone of inhibition, 10.00±0.82mm, than the reference gentamicin (10μg), 7.00±0.40mm. W. salutaris roots were active against both fungal strains with inhibition zones of 10.00±0.82mm for C. albicans and 8.25±0.50mm for A. niger which were even bigger than the zones of the reference amphotericin B (10μg) 6.35±0.50mm and 6.75±0.58mm respectively. The toxicity tests were conducted using the Brine Shrimp (Artemia salina) Lethality Test (BSLT). Five of the extracts showed significant toxicity levels of LC50< 300μg/ml. The lowest readings of LC50, Terminalia sericea leaves (66.7ppm) and Kigelia africana fruit (117.4ppm) were even lower than the positive control, Nerium oleander leaves (141.7ppm) which is a plant with well-established anti-tumour activity. These results confirm the ethno-botanical claims by traditional medical practitioners treating viral, bacterial and fungal infections caused by HIV/AIDS, cancer and cardiovascular diseases with traditional medicinal plants due to the rich phytochemistry, their high levels of antioxidant activity as well as bioactivity of the plants. They should be preserved and harvested with caution not only because of their medicinal value but also the role they play in the rich African heritage
Faculty Development Workshop Summary Notes 26-28 July 2011
No full textUniversity of Zimbabwe, College of Health Sciences under the NECTAR programme conducted a
three day Faculty Development training workshop. The workshop which was facilitated by Associate
Professor Eva Aagaard, Professor Nancy Madinger, and Dr. Jake Gray from the University of
Colorado Denver, USA recorded an average of 50 participants on a daily basis. The objective of the
workshop was to introduce and acquaint participants to basic knowledge on: Curriculum Development;
Team Based Learning; Bedside Clinical Teaching and Lecture methods. The workshop was officially
opened by Professor Midion Chidzonga, the current Dean of the College of Health Sciences. The
workshop was conducted in sessions with each of the 3 instructors facilitating specific sessions. This
report is a summary of how the workshop unfolded.
Workshop Objectives:
To introduce faculty to the theory and practice of:
• Curriculum Development
• Medical Education Pedagogies
• Student Assessment
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Factors associated with utilization of Adolescent Sexual and Reproductive Health services offered at Harare Youth Friendly Corner by the youths in Harare Urban District, 2013
No full textIntroduction:
Youth Friendly Corners were developed in Zimbabwe as a strategy to address Adolescent Sexual and Reproductive Health issues. Harare Youth Friendly Corner provides HIV/STI counseling and testing, pregnancy testing, contraception, post rape services, health education, and other serves to youths in Harare. There was a declining trend in utilization of services at Harare Youth Friendly Corner by youths in Harare from 0.15% in 2010, 0.25% in 2011 and 0.14% in 2012. The current rate of utilization of services of 0.2% is far below the expected 30% that was targeted when the YFC was set up. We therefore set out to find out the factors associated with utilization of the services at the Youth Friendly Corner.
Methods:
An analytic cross-sectional study was conducted at Harare Central Hospital in Harare, were 340 youths were randomly selected and interviewed using an interviewer administered questionnaire and focus group discussion guide.
Results:
Associated with utilization of the services were: Awareness of the Youth Friendly Corner [OR=6.2; 95%CI(2.41-16.18)], being employed [OR=5.72; CI(2.21-14.83)], staying alone [OR=3.51; CI(1.78-6.92)], and awareness of other places providing HIV/STI counseling and
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testing, pregnancy testing, contraception, post rape services, health education, and other serves services similar to Harare Youth Friendly Corner [OR=3.5; CI(1.59-7.71)].
Conclusion:
Youths who were employed, stayed alone, aware of Harare Youth Friendly Corner and places offering similar services were more likely to utilize services offered at Harare Youth Friendly Corner compared to those who were not
Factors associated with hospital admissions among registered diabetes mellitus patients in Guruve and Mazowe districts, Mashonaland Central province, Zimbabwe.
No full textIntroduction
Diabetes mellitus is among the top five chronic conditions contributing to Out Patients Department attendance in Mazowe and Guruve Districts. This study sought to identify the contributory factors that are associated with the increase in hospital admissions among diabetes mellitus patients in Guruve and Mazowe Districts so as to inform interventions.
Methods: The study was an analytic cross-sectional study. A census of all the 202 registered patients attending diabetes mellitus review appointments at Guruve, Howard, Concession and Mvurwi hospitals was done. Interviewer-administered pretested questionnaires were used to collect data. Epi info version 3.5.1 was used to create frequencies, proportions and prevalence odds ratios to determine associations. Logistic regression analysis was done to identify independent risk factors and to control for confounding variables. Ethical approval was sought from all relevant authorities while informed consent was obtained from all study participants.
Results: Of the 202 study sample, 43.6% had an admission history due to diabetes mellitus. Being female [POR 2.43 (95%CI: 1.25-4.73)], being unemployed [POR 1.97 (95%CI: 1.09-3.56)] and being less educated (primary level and below)[POR 2.56 (95%CI: 1.38-4.77) were statistically significant risk factors for hospitalisation due to diabetes mellitus.
Those patients on insulin [POR 2.93 (95%CI: 1.33-6.48)], those resident in communities where diabetes was not discussed at public meetings and gatherings [POR 3.73 (95%CI: 1.68-8.28)], those with longer duration on treatment for diabetes (4+ years) [POR 2.30 (95% CI: 1.30-4.41)], older cases (>1 year) [POR 3.04 (95%CI: 1.47-6.28)] and support group members [POR 4.77 (95% CI: 1.50-15.18)] had a higher likelihood of getting hospitalised and this was statistically significant.
Insulin medication [AOR 2.74 (95% CI: 1.22-7.27) p= 0.0168], low educational level (primary and below) [AOR 2.74 (95% CI: 1.34-5.58) p= 0.00570], having long been diagnosed with diabetes (1year+) [AOR 3.06 (95% CI: 1.38- 6.79) p=0.00570] and residing in areas where there is no diabetes mellitus education at community level [AOR 3.86(95% CI: (1.60-9.32) p=0.00260], were independent factors associated with hospital admissions due to diabetes
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mellitus in Guruve and Mazowe districts that remained statistically significant after logistic regression analysis.
Conclusion and Recommendations
Independent predictors of hospitalisation due to diabetes were type of treatment, level of education, community based health education and time lapse after diabetes diagnosis. In addition to provision of adequate services and supplies to diabetes mellitus clients, the District Health Executive needs to take an ecological approach towards the inclusion of the wider family and community support structure in effecting lifestyle modifications among diabetes mellitus clients that is conducive to sustain control measures
Controversies surrounding the use of Parathyroid hormone as a marker of bone metabolism in chronic kidney disease(CKD) patients on haemodialysis in Zimbabwe: The way forward
No full textBackground
The progressive loss of renal function in chronic kidney disease (CKD) necessitates the eventual use of dialysis. Renal Osteodystrophy (ROD) is a serious complication of CKD with diverse and non-specific manifestations. Serum biochemical markers such as Parathyroid hormone (PTH) are used worldwide to monitor bone changes in patients on haemodialysis although bone biopsy has remained the gold standard. The use of PTH as a marker for bone changes has however been associated with a lot of controversies linked to its measurement and interpretation. Recommendations from several studies have been proposed on how to improve its clinical robustness in monitoring bone changes of patients on haemodialysis. Evaluation of these recommendations has however not been done extensively especially in Zimbabwe.
Objectives
To determine which serum marker(s) of bone offers the best diagnostic and monitoring sensitivity in CKD patients on haemodialysis before and during three months on haemodialysis.
Materials and methods
A short prospective study was carried out on CKD patients admitted on haemodialysis at three selected Renal Units (Parirenyatwa, Chitungwiza, PSMI). A total of 32 patients aged 22-75 years (Mean 50.5 ± 16.5 years) were randomly selected. Study group was divided into
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those who had been on dialysis for more than three months (Group 1) and those who had been enrolled to start haemodialysis (Group 2). Serum levels of calcium, phosphate, PTH and bALP were determined over a three month period.
Results
There were significant increases in bALP (P=0.02) in group 1. A 69.6% increase in mean phosphate was observed in participants using low calcium concentration dialysate fluid.PTH and bALP showed a positive correlation at both 0.05 and 0.01 level of confidence interval using Pearson correlation 2-tailed test. Significant gender differences (P<0.05) in PTH were observed in both groups. Statistically insignificant decreases in PTH were noted for both groups.
Conclusion
The study findings have shown that PTH levels in an individual patient on haemodialysis fluctuate greatly and therefore diagnosis and monitoring of bone changes in these patients ought to be based on trends rather than a single value of PTH. The study concludes that bALP is indeed a potentially useful bone marker if we are to make headways in resolving some of the issues associated with the use of PTH alone
Relationship between knowledge on infant nutrition and infant feeding practices among mothers aged 15 to 40 years with infants 7 months to 1 year old at Marondera’s three urban health centres
No full textPoor infant feeding practices contribute to infant morbidity and mortality. The purpose of this study was to examine the relationship between knowledge on infant nutrition and infant feeding practices. Pender and Pender’s Health Promotion Model was utilised to provide a theoretical framework to guide this study. A descriptive correlation research design was used to guide the research. Simple random sampling of 80 subjects was done with mothers whose infants were 7 months to 1 year. The relationship between knowledge on infant nutrition and infant feeding practices among mothers with infants 7 months to 1 year was examined. Data was collected using a self administered questionnaire. On analysis of data on the relationship descriptive statistics were used that was, percentages and frequencies. Relationship was examined using inferential statistics. The major findings of the study showed that the majority of the women were aged 20-24years and the majority had moderate to high knowledge levels. The mean score for knowledge on infant nutrition was 29.74, and mean score on infant feeding practices was 22.48. Results revealed that there was an imperfect positive relationship between infant feeding practices and knowledge on nutrition. As knowledge increased, the infant feeding practices also improved indicated by r=.259 at p=, .05 level of significance. However, there are other factors which can influence infant feeding practices other than knowledge. Midwives need to use evidence based knowledge in their practice in order to improve the standard of care. Research will build body of knowledge to the profession hence it is wise for nurses and midwives to carryout research