1358 research outputs found
Sort by
Determinants of demand for health care services in rural Zimbabwe: A case of Bikita District, Masvingo Province
No full textThe study investigated the determinants of demand for health care services in rural Zimbabwe using household data from Bikita District in Masvingo Province. Specifically the study examined the influence of socio- economic and institutional factors such as household income, household size, distance to the nearest health centre and availability of drugs on the probability of seeking of health care from health facilities. From 15 wards which were selected for the survey, 250 households were randomly selected and interviewed. A self-administered questionnaire was used to collect data between January and February 2013. The study used a logit model to find the determinants of demand for health care services based on 176 households that had reported illness of a member within the last three months before the survey. The study revealed the statistical significance of severity of illness, household size, education of the household head, household income, distance to the nearest health facility and availability of rugs as determinants of demand for health care services. Distance to the nearest health facility and household size were found to negatively affect the demand for health care services whereas household income and availability of drugs were
found to positively influence demand for health car e services. To increase the demand for health care services, the study recommends policies that aim to shorten the distance people travel to health facilities such as introducing community based mobile clinics. Other major recommendations of the study include increasing government funding to rural health facilities so as to ensure the availability of drugs and implementing income generating projects to improve rural household incomes
Immunological consequences of antihelminthic treatment in preschool children exposed to urogenital schistosome infection
No full textUrogenital schistosomiasis, due to Schistosoma haematobium, is endemic in sub-Saharan Africa. Control is by targeted treatment with praziquantel but preschool age children are excluded from control programs. Immunological studies on the effect of treatment at this young age are scarce. In light of studies in older individuals showing that praziquantel alters antischistosome immune responses and responses to bystander antigens, this study aims to investigate how these responses would be affected by treatment at this young age. Antibody responses directed against schistosome antigens, Plasmodium falciparum crude and recombinant antigens, and the allergen house dust mite were measured in children aged 3 to 5 years before and 6 weeks after treatment. The change in serological recognition of schistosome proteins was also investigated. Treatment augmented antischistosome IgM and IgE responses. The increase in IgE responses directed against adult worm antigens was accompanied by enhanced antigen recognition by sera from the children. Antibody responses directed against Plasmodium antigens were not significantly affected by praziquantel treatment nor were levels of allergen specific responses. Overall, praziquantel treatment enhanced, quantitatively and qualitatively, the antiworm responses associated with protective immunity but did not alter Plasmodium-specific responses or allergen-specific responses which mediate pathology in allergic disease
An investigation into total quality management (TQM) strategies that can be enforced by the Law Society of Zimbabwe (LSZ) to improve the quality of service offered by its membership (2005 - 2012)
No full textThe purpose of the research is to investigate TQM strategies that can be enforced by the Law Society of Zimbabwe (LSZ) with a view of improving quality of service amongst its membership drawn from registered Legal Practitioners practicing in Zimbabwe. The need to carry out the research arose from observations by the researcher of the gradual and significant decline in quality levels of the service offered by Legal Practitioners in Zimbabwe.
A self administered questionnaire was distributed amongst 75 Respondent drawn from stakeholders in the justice delivery system, namely, the LSZ, lawyers, the Ministry of Justice, Members of the Police, Members of the Judiciary, Court personnel and clients, in Harare. The population was first divided into strata made up of people in the various groups listed above. Respondents were then randomly selected from the strata. The response rate was 96%. The Statistical Package for Social Science (SPSS) and excel were used in analyzing data. Data was presented graphically to give a visual impression of the responses.
Generally as respondents were drawn from various backgrounds, they all showed appreciation of TQM and its principles though at varied levels. Respondents also indicated knowledge of the important but different roles played by both employers and employees in the implementation of TQM. Respondents also showed an awareness of the importance of adopting macro tools of quality such as Bench marking and ISO 9OOO law in order to achieve sustainable competitive advantage.
The recommendations of the study were drawn from the gaps from the objectives and include the need by the LSZ to lobby and advocate for laws on continuous legal training of lawyers, education and training of Senior and Managing Partners and all lawyers on TQM, its principles and associated benefits and putting in place a policy framework on the quality of acceptable leadership and Senior Partners in Law firms
Factors Associated with Untimely Antiretroviral Drug Pick-up by Patients in Bindura District.
No full textIntroduction
Timely antiretroviral drug pick up is one of the early warning indicators for monitoring HIV drug resistance. Timely antiretroviral drug pick up is essential in the prevention of emergence of HIV drug resistance. The scale up of ART programme is not directly proportional to clients picking their drugs on time. This study sought to establish ART drug pick up patterns of ART clients, prevalence of untimely drug pick up and the associated factors.
Methods: The study was an analytic cross-sectional study. Two hundred and seventy-seven (277) respondents were randomly selected from attendees of ART clinics at ART sites. Interviewer-administered pretested questionnaires were used to collect data. Epi info version 3.5.1 was used to create frequencies and proportions were calculated as well as Odds ratios to determine associations. Logistic regression analysis was done to identify independent risk factors and to control for confounding variables.
Results: Two hundred and seventy-seven (277) ART clients were included in the study. The prevalence of untimely drug pick up was 40.4%. The median number of times participants missed drug pick on time in the past 12 months was 1 (Q1=1; Q3=2) and the main reason for not picking up drugs on time was social problems like attending funerals and not having bus fares. Those who had short time (0-6 months) on treatment [POR = 0.45 (95% CI; 0.27 - 0.77)] and having one month or less supply [POR = 0.50 (95% CI: 0.30 - 0.81)] were significantly associated with a lower likeliness of missing drug pick up time. Barriers such as adverse effects [AOR = 1.84 (95% CI: 1.13 - 3.01)], user fees [AOR = 1.96 (95% CI: 1.06 - 3.60)], and long distances to ART sites [AOR 1.96 (95% CI: 1.11 – 3.47)] were significantly associated with high likeliness of missing drug pick up time. These factors remained statistically significant on logistic regression analysis and stratified analysis showed that age was modifying the relationship between distance and drug pick up time.
Conclusion and Recommendations
ART clients were mainly missing drug pick up time due to long distance to ART sites, user fees and adverse effects to drugs. The District Health Executive need to scale up ART outreach in order to provide services for those who stay far away from ART sites
The relationship between social support among HIV positive mothers and exclusive breastfeeding feeding practice during the first 6 months of life at Rusape district hospital.
No full textOne in three children under the age of 6 months are exclusively breastfed, this translates to 33% (ZDHS, 2011), which is very low that is against WHO (2010) recommendations. Study was conducted at Rusape District Hospital, respondents were HIV positive mothers who breastfed for the first 6 months (mean = 22, median = 23, mode = 25, SD = 3.616). Study sought to find out relationship between social support and exclusive breastfeeding (EBF) practice among HIV positive mothers and a quantitative descriptive correlational study design was utilized. Health Promotion Model (Pender, 1982) guided the study. Non-probability convenience sampling method and 85 respondents were selected. A structured interview schedule was used to collect data from demographics, social support and EBF practices. Data was analyzed using descriptive statistics and inferential statistics. Study findings were that 75% respondents initiated breastfeeding within an hour, while 100% respondents did not offer pre-lacteal feeds, 87.1% perceived that had adequate breast milk for baby up to 6 months, 96.5% agreed it was practical to EBF their babies while on ART. Only 69.4% EBF their babies, 83.5% respondents received informational support, and 95.3% respondents received material support. Eighty nine percent cited midwife as influential to their decision to EBF. Pearson Correlation revealed significant positive moderate relationship (r = .382, p = .01). Regression Analysis revealed linear relationship (Adjusted R2 = .136) social support was responsible for 13.6% changes in EBF practices. F statistics (F = 14.2, p = .00) showed significant R2, Beta (b = .382, p = .01) was .382 that is for every unit change in social support, EBF practices would improve by 38.2%. Midwives should capitalize being valued referent to shape EBF behaviors through health education
Evaluation of serum S100B as a biomarker of head injury in patients admitted into a neurological ward at Parirenyatwa hospital, Harare, Zimbabwe
No full textBackground: - CT scanning is the gold standard for head injury diagnosis. However, the high costs of imaging in Zimbabwe makes it difficult to manage patients with head injuries as most admitted in public hospital are unable to pay for the services. Use of cheaper serum biomarkers may improve patient management. Serum S100B has been introduced as a clinical tool for diagnosis of traumatic brain injury in some emergency departments in European healthcare facilities and has been reported as reducing the frequency of unnecessary CT scans.
Aim: - To validate the clinical utility of serum S100B in patients with head injury.
Materials and methods: - A cross sectional study in which 50 patients with suspected head injuries, 20 apparently healthy health workers and 20 non neurological patients in medical wards were enrolled at Parirenyatwa hospital. Blood samples were withdrawn from head injury suspects within 24 hours of admission and leftover serum samples for the non neurological patients were collected from Parirenyatwa Hospital laboratory. Serum S100B levels were measured and results were correlated with CT scan findings, Glasgow coma scale and Glasgow outcome scale obtained from audit reports. Results from head injury suspects were also compared with those of apparently healthy participants and those from patients with non neurological conditions.
Results: - Serum S100B levels were significantly higher in head injury patients [median 173.25 (IQR 50- 428.1)] compared to apparently healthy participants [median 8.3 (IQR 5.25- 9.8)] and non neurological participants [median 12.75 (IQR 12.75- 18.2)] p <0.001. Of the 50 head injury patients only 29 had a CT scan done of which 25 were positive
Hypertension awareness, treatment and control at Vubachikwe Mine, Gwanda, Zimbabwe, 2013
No full textBackground: In July 2012, according to the chronic disease register Vubachikwe mine had at least 1 in every 10 workers suffering from hypertension. However about 30 workers had defaulted hypertensive treatment that is offered free at the mine clinic. The management was concerned about lost to shift hours and high costs of medical care due to hypertension related illness among employees. Therefore we set out to evaluate the prevalence of hypertension and the reasons why employees defaulted treatment. Methods: An analytic cross sectional study was done at Vubachikwe mine. Systematic sampling was used. An interviewer administered questionnaire adopted and modified from the WHO STEPwise survey was used to capture; demographic data, risk factors and awareness of hypertension. Biophysical measurements; weight, height, random blood sugar and blood pressure were measured. Results: Ninety three percent of employees were aware of their blood pressure. The prevalence of hypertension was 27.2% while males were 6 times more likely to develop hypertension compared to females. Awareness of hypertension increased with age, (p<0.05). Thirty five percent of hypertensives were non-compliant to treatment and 70% of hypertensives had well controlled blood pressure. Earning more than US300 (POR 1.5; 95% CI, 0.46-0.93). ). However, heavy manual workers were less likely to be diagnosed of hypertension [POR 0.19 (0.042-0.852) 95% CI] and they also earned less than US600 which is associated with a sedentary lifestyle. Heavy manual workers who earned less than US$300 were less likely to be diagnosed of hypertension. Based on the study findings, the mine management has instituted interventions targeted at health educating workers on hypertension and defaulters will be traced, given psychosocial support and encouraged to comply with medication
Comparison of CD4+ T-Cell changes in response to highly active antiviral therapy (HAART) in adolescents and children enrolled at Parirenyatwa Hospital Family Care Centre (2005-2010) - Secondary Data Analysis
No full textBackground
In general, there is an increase in CD4 cell count after initiating on HAART. Despite an increasing trend of access to HAART there is a paucity of studies examining the changes in CD4 count over time in Zimbabwe and also no study has been done at PHFCC specifically comparing children and adolescents at the clinic. The PAP study data has not been analyzed to compare how CD4 count changes over time between different age groups and to find out the factors which predicts CD4 count response after initiating on HAART. The study aims to determine the factors associated with changes in CD4 count in adolescents and children and to compare the changes between these two age groups over time.
Methodology
Out of 2200 HIV infected children and adolescents who have been enrolled into HIV/AIDS care between January 2004 and December 2012, a total of 512 subjects who met the inclusion criteria were selected for this secondary data analysis study. Differences between groups in CD4 cell response at different time points was assessed using Wilcoxon rank-sum test. Mixed effects model was used to compare the pattern of changes in CD4 count over time between adolescents and children and to identify the factors which are associated with changes in CD4 count after HAART initiation.
iii
Results
A total of 512 subjects were selected for the study. More (59.6 %) of the subjects were adolescents and the female gender (52.3%) was mostly represented. The change in CD4 count in response to HAART between adolescents and children was different. The median (IQR) baseline CD4 count for children was 171.5 (51-298) cells/mm3 and 145 (50-254) cells/mm3 for adolescents (p=0.087). The response in children was significantly higher after 18 months on treatment compared to adolescents (p=0.004). Baseline CD4 counts and age group was found to predict the changes in the square root of CD4 count over time in the multivariate analysis. The increase in the square root of CD4 count over time for those who initiate HAART at adolescence stage were 0.0853 times less when compared to those initiated whilst they were still children (p=0.037) adjusting for other variables. Adjusting for other baseline variables, subjects with CD4 cell count less than 100cells/mm3 had a greater increases (beta=0.501, p<0.001) in the square root of CD4 cell count when compared to those with baseline CD4 count of more than 300cells/mm3. Subjects with baseline CD4 count of 100 to 200 cells/mm3 had a greater increase in the square root of CD4 count over time as compared to those with baseline CD4 count above 300cells/mm3 adjusting for other variables ( beta=0.340, p<0.001).
Conclusion
The change in CD4 count in response to HAART between adolescents and children was different. The baseline variables which were significantly associated with an increase in CD4 count over time were baseline CD4 cell count and age group after controlling for other independent variables
The effect of a single low dose propofol at the end of the operation in reducing post operative nausea and vomiting ( PONV) in women undergoing laparoscopic gynaecological surgery at Parirenyatwa hospital.
No full textObjectives
To determine the effectiveness of single low dose propofol in reducing PONV in women
undergoing laparoscopic gynaecological surgery.
To describe factors associated with nausea and vomiting in women undergoing laparoscopic
gynaecological surgery.
Study design: Randomized single blinded controlled study
Setting: Parirenyatwa Hospital
Subjects: Eighty women aged between 19-55 years booked for laparoscopic surgery.
Statistical methods:Summary descriptive statistics, student’s t-test, and Chi-square test.
Results: Incidence of nausea within one hour was 7.5% in the propofol group and 2.5% in the
nonpropofol group (P = 0.6) and 10% and 15% nausea incidence after one hour in the respective
groups. There were no reported incidences of vomiting after one hour from both study groups.
Two participants from the propofol group (B) vomited within the first hour postoperatively and
none from the nonpropofol group. Four participants (10.5%) complained of either nausea or
vomiting from the propofol group compared to 9 (21.4%) from the non-propofol group (P =
0.23) which was not statistically significant.
Conclusion: Administration of single low dose propofol 0.5mg/kg at the end of laparoscopic
gynaecological surgery does not reduce the incidence of PONV after propofol (2mg/kg)
induction
