Prevalence of major depression in deliberate self-harm individuals in Harare, Zimbabwe.

OBJECTIVE: To investigate the prevalence of major depression in deliberate self-harm individuals. DESIGN: A cross sectional descriptive study. SETTING: Three tertiary health care centres in Harare, Zimbabwe. SUBJECTS: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose. MAIN OUTCOME MEASURES: The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals. RESULTS: The prevalence of major depression was 20.7% (n=80, 95% CI=16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI=57.2-66.8) of the subjects with DSH were aged < or = 30 years. Significant differences (P<0.05) were found between DSH subjects with and without major depression related to age, education, life events and number of previous attempts. CONCLUSION: The most predictive factors associated with DSH risks are age, depression, recent loss, divorced, loss of job and history of previous attempts. Further studies are needed to address some causes of DSH.

Quality of life evaluation in patients with HIV-I infection: the impact of traditional medicine in Zimbabwe.

OBJECTIVES: To evaluate the impact of phytotherapy (traditional medicine) in persons with HIV infection and to assess the quality of life of those persons with respect to HIV disease progression, including sociodemographic characteristics. DESIGN: A community based open label non-intervention and uncontrolled cohort study. SETTING: Blair Research Institute Clinic. SUBJECTS: A total of 105 HIV infected persons at various stages of HIV infection. Seventy-nine percent were on phytotherapy (PT) and 21% on conventional medical care (CMC). MAIN OUTCOME MEASURES: (a) Assessment of quality of life of HIV infected persons on phytotherapy using the WHOQol instrument, and (b) assessment of quality of life of those persons in relation to the HIV disease progression using CD4 cell counts and viral load as measure of disease progression. METHODS: We interviewed 105 patients with various stages of HIV-I infection in a community based cohort study from June 1996 to May 1998, in Harare. The 96 (91.4%) asymptomatic and six (8.6%) symptomatic patients underwent regular physical examinations and had blood drawn for laboratory tests at the baseline afterwards at three month intervals over a period of two years. RESULTS: The mean (s.d.) age was 34.9 (7.3) years; 64.4% were women and 60.3% were married. In multi variate analyses, age was significantly correlated with the level of independence domains (p = 0.032), whereas, gender was significantly correlated with social relationships' domains (p = 0.034). The type of treatment received was significantly correlated with spiritual domains (p = 0.045). Proportions of scores on five domains measuring different aspects of quality of life for patients on phytotherapy were much lower than those on conventional therapy (p < 0.0001, for all variables). CONCLUSION: Our data support the role of phytotherapy in improving the quality of life of HIV-I infected patients, yet its pharmacological basis is unknown. The WHOQol instrument is a good measure of quality of life for patients with HIV infection.

Use of alcohol and tobacco among secondary school teachers in Zimbabwe.

OBJECTIVE: To measure the prevalence and frequency of alcohol and tobacco use among secondary school teachers in Zimbabwe. DESIGN: Cross sectional survey. SETTING: 17 secondary schools in Harare, Mashonaland East and West and Matabeleland North Provinces (including Bulawayo). SUBJECT: 442 secondary school teachers, of whom half were males. MAIN OUTCOME MEASURES: Prevalence of self-reported experience with alcohol and tobacco, frequency of alcohol use, alcohol type preferences and use of alcohol and tobacco by age and school type. RESULTS: Prevalence of alcohol was significantly higher among teachers at private schools as compared with the other school categories. Smoking varied between the school types for women but not for men. Except for private schools, both tobacco and alcohol prevalence among female teachers were significantly lower than for male teachers. Of the male teachers 44.6% and 64.1% of female teachers reported never drinking; 38.6% of male teachers and 8.2% of female teachers reported drinking every day or at least weekly. Alcohol type preferences varied in general across school categories and between male and female teachers. CONCLUSION: The study reveals a mixed picture of smoking and alcohol drinking among secondary school teachers. Relatively high levels of beer drinking among men as well as the particularly high levels of use programmes among private school teachers may constitute negative influence on the habits of students. This aspect should not be ignored when designing school-based prevention of substance use programmes among school children in Zimbabwe.

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe.

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.

Adolescent drug use in Zimbabwe assessed by their teachers.

OBJECTIVES: To obtain secondary school teachers' assessment of adolescent drug use in Zimbabwe. Secondly, to compare this assessment with some of the results from student drug use surveys undertaken in 1990 and 1994. DESIGN: Cross sectional. SETTING: 17 secondary schools in Harare, Mashonaland East and West and Matabeleland North Provinces (including Bulawayo). SUBJECTS: 442 secondary school teachers, of whom half were males. MAIN OUTCOME MEASURES: Teachers' assessment of how serious a problem adolescent drug use is in Zimbabwe in general and at the teachers' own school. Secondly, whether adolescent drug use is currently on the increase or decrease. RESULTS: The teachers assessed alcohol use as the most serious drug problem among secondary school students in Zimbabwe, followed in descending order by cannabis, tobacco, inhalants and other drugs. Drug use was considered less serious at the teachers' own school as compared to the assessment of the general situation. Student drug use is largely stable or increasing moderately. Alcohol appears to be increasing the most. Although partly corresponding with previous studies, the situation was assessed as more serious than what appeared from the student drug use surveys in 1990 and 1994. The largest gap between teachers' assessment and students' self-reported drug use was found for cannabis and inhalants. CONCLUSIONS: The study among teachers concur to some extent with results from previous studies among students. There are, however, variations in the assessment of drug use among secondary school students that do not correspond completely with the picture drawn by previous student surveys. It is argued that some of the variation in the assessment may in part be explained by sociocultural and normative differences between different sociocultural segments of Zimbabwean society.

Use of seclusion and restraint in psychiatric patients in Harare Hospital Psychiatric Unit, Zimbabwe: gender differences.

OBJECTIVE: To examine the frequency and indications for use of seclusion and restraint of psychiatric patients in relation to gender differences and risk factors in Harare Hospital Psychiatric Unit. DESIGN: Descriptive study. SETTING: Harare Central Hospital Psychiatric Unit, Harare, Zimbabwe. SUBJECTS: 95 consecutively secluded/restrained patients were recruited for the study. MAIN OUTCOME MEASURES: The frequency of seclusion and the characteristics of patients secluded/restrained. RESULTS: 54 (56.8%) patients were males and 41 were females. They had a median (Q1, Q3) age of 30 (Q1, = 24, Q3 = 36) years. Over two thirds (70.5%) of them were aged 35 years or less. The frequency of seclusion and restraint was 8.5% (95% CI 6.9 to 10.1) of the population of 1,115 patients admitted during the study period. The groups (male versus female) differed significantly with respect to marital status; single patients being 4.66 (95% CI 1.17 to 19.96) times more likely to be males when compared to the divorced/separated patients. Male patients were more likely to have been brought by police than by their relatives or friends (OR 3.30; CI 1.19 to 9.73; p = 0.020). CONCLUSION: Seclusion/restraints of psychiatric patients were common in a psychiatric unit. Male patients were more likely to be brought by police. Female patients resorted more to physically assaulting staff/other patients than did male patients.

A preliminary study of stress levels among first year medical students at the University of Zimbabwe.

OBJECTIVE: To assess stress levels among first year medical students at the University of Zimbabwe. DESIGN: A cross sectional study using two questionnaires. SETTING: Department of Anatomy, Faculty of Medicine, University of Zimbabwe, Mount Pleasant, harare, Zimbabwe. SUBJECTS: First year medical students aged between 18 and 24 years who have spent about seven months in the medical school. RESULTS: A total of 109 out of 123 first year medical students were used in the study. The two questionnaires produced similar results with an average of about 35.5% normal and an average of 64.5% of the students being at various levels of stress and or depression. About 11% reported very high levels of stress while the majority of the stressed students fell within the middle bracket. The number of affected students decreased as the level of stress and depression increased and demonstrates the differences in the stress threshold of the individual students. Estimation of suicide tendencies from both questionnaires showed that about 12% of the students were at serious risk and about 20% at lesser risk of psychological and emotional depression. The stratification of group 2 of SRQ-20 was valuable in isolating those students seriously stressed and/or depressed. CONCLUSION: This study has demonstrated that a number of first year medical students of the University of Zimbabwe were at various levels of stress and/or depression. Those students in the extreme stress or depression group need serious attention. This state of psychological and emotional distress in the subsequent years of medical training and during the professional years may lead to serious social consequences. A system of identifying students with low stress threshold early in their training is recommended as well as a means of helping them to deal with the stress and its causes.

Combining cultural, social and personality trait variables as predictors for drug use among adolescents in Zimbabwe.

A classroom survey among 3061 secondary school students in four provinces in Zimbabwe was conducted in 1994. This paper presents analyses of the relationship between a set of predictors including personality trait, social and cultural variables and drug use. A two-stage sampling strategy distinguished between four different socio-cultural groups. Multiple regression was applied to analyse the impact of sensation-seeking, addictive behaviour of significant others, and Global and Local cultural orientation on drug use, controlling for age, gender and socio-cultural subgroup. The model explained 29.7% of the variance in the dependent drug use variable and the two cultural orientation variables were found to contribute significantly in addition to the personality trait and the social variables.

Cultural orientation and use of cannabis and inhalants among secondary school children in Zimbabwe.

A survey among 3061 secondary school children in four provinces in Zimbabwe was conducted in 1994. In the present paper, the relationships between cultural and social factors and use of inhalants and cannabis are explored. Respondents were selected by means of a two-stage sample design, first based on a complete list of schools in the four provinces and subsequently on lists of students at the randomly selected schools. Stratification was based on the identification of four different sociocultural groups. Data collection followed standardised procedures and was conducted by a research team from University of Zimbabwe. Cultural orientation was operationalised by means of a Likert-type 14-item scale on choice of media, language and music. Exploratory principal component analysis revealed a two-factor solution, representing a global or Western cultural orientation and a local or Zimbabwean cultural orientation. Drug use by older siblings and best friends represented social factors. A combined model of cultural and social variables was subject to a multiple logistic regression analysis. Results revealed that the social variables and global cultural orientation were significantly associated with increased use of both drugs, whereas a local cultural orientation was found not to be associated with use of these substances. Findings are discussed in the light of historical and cultural factors.

Prevalence of psychoactive substance use among psychiatric in-patients in Harare, Zimbabwe.

OBJECTIVE: To determine the prevalence of psychoactive substance use among psychiatric in-patients in Harare. DESIGN: A cross sectional study that was conducted in 1994. SETTING: Harare Central Hospital Psychiatric Unit. SUBJECTS: A total of 194 consecutively admitted patients to Harare Central Hospital Psychiatric Unit, aged from 16 to 55 years with a mean (SD) age of 33.5 (11.4) years. MAIN OUTCOME MEASURES: The psychiatric diagnoses were made according to the ICD10 diagnostic criteria, while the substance abuse was evaluated by the modified WHO AUDIT core questionnaire, which was translated into the Shona language. RESULTS: The point prevalence rate of psychoactive substance abuse among the psychiatric in-patients were alcohol 28.4% (95% CI = 22.1, 34.7), tobacco 27.6% (95% CI = 18.7, 36.5) and cannabis 14.3% (95% CI = 7.4, 21.2). CONCLUSION: The data have provided scientific evidence on the moderate prevalence and pattern of substance abuse among psychiatric patients in Zimbabwe.

Serostatus surveillance testing of HIV-I infection among Zimbabwean psychiatric inpatients, in Zimbabwe.

OBJECTIVE: To investigate seroprevalence rates of HIV infection among Zimbabwean psychiatric inpatients. DESIGN: An identity-unlinked procedure, for ELISA and Western blot HIV testing of consecutively admitted psychiatric patients, was used during the four month period of the study. The seropositive groups were further categorized along the WHO case definition of HIV/AIDS infection criteria. The blood results were coded and linked to various demographic variables and risk factors. All data were measured at either nominal or ordinal levels. Comparisons between variables were made by chi-square test for proportion and independence. SETTING: Harare Central Hospital Psychiatric Unit, Harare, Zimbabwe. SUBJECTS: A total of 143 inpatients (60.8 pc males and 39.2 pc females), mean(SD) age 32.5 (10.5) years and the mean(SD) duration of psychiatric illness of 4.21 (1.7) years. MAIN OUTCOME MEASURE: Prevalence of HIV/AIDS infection among psychiatric patients. RESULTS: The seroprevalence rate of HIV infection was 23.8pc and was significantly related to high education attainment (p < 0.03) and unemployment status of the patients (p < 0.03). CONCLUSION: There is an urgent need to develop and apply preventive interventions for HIV infected psychiatric patients.

PIP: Psychiatric patients, like any other medical patients, are vulnerable to HIV infection and those infected with HIV could transmit the virus to others. Some studies have found that the severely mentally ill as a group are more vulnerable to HIV infection because of comorbidity with substance abuse. Unsafe sexual behavior has also been reported among the severely mentally ill. Blood samples from 87 male and 56 female patients consecutively admitted to Harare Central Hospital's Psychiatric Unit were tested with ELISA and Western blot for infection with HIV. The subjects were 17-70 years old of mean age 32.5 years with a mean 4.21 years of psychiatric illness. 23.8% were infected with HIV and HIV infection was significantly related to high education attainment and being unemployed. Preventive interventions are urgently needed for HIV-infected psychiatric patients in Zimbabwe.

Cultural orientation and adolescents' alcohol use in Zimbabwe.

A classroom survey was conducted in June 1994 among 3061 secondary school students in four provinces in Zimbabwe, with the main objective of measuring health behaviours, school performance and environmental and cultural factors as predictors for drug use. This paper presents an analysis of the relationship between cultural orientation and alcohol use. The survey instrument was based on previous studies undertaken in Zimbabwe and in Europe and adapted to the local situation. A two-staged stratified random sampling strategy distinguished between four different socio-cultural groups. Standardized instructions were given in classrooms by a trained research team. Respondents' mean ages were 14.9 years for boys and 15.1 years for girls, and 51.4% were boys. For a number of core questions, test-retest reliability was shown to be satisfactory. A 14-item scale focusing on language, mass media and music preferences was constructed to measure cultural orientation. Principal component analysis revealed two distinct factors with low interfactor correlation and acceptable scale reliability (alpha), one representing Western orientation and the other Zimbabwean or traditional cultural orientation. Zimbabwean orientation was found to be associated with lower alcohol use, whereas western orientation was associated with higher probability for alcohol use.

Adolescents' drug use in Zimbabwe--comparing two recent studies.

OBJECTIVE: To indicate trends in drug use among secondary school students in Zimbabwe by comparing results from surveys conducted in 1990 and 1994. DESIGN: Two classroom surveys using comparable instruments for data collection were conducted among secondary school children of different socio-economic subgroups in four provinces in Zimbabwe; one in 1990 and one in 1994. The comparison is restricted to Mashonaland. Both surveys applied a two stage sampling strategy with stratified random sampling of schools at first stage. Cross tabulations with age standardization and multiple regression analysis were applied to compare self reported drug use in the two studies. SETTING: 17 secondary schools in Harare, Mashonaland East, Mashonaland West, Bulawayo and Matabeleland North Provinces were involved in the study. SUBJECTS: Study A (1990): 2 581 secondary school students, 56pc boys, age range 12 to 21, mean age 15.5 years. Study B (1994): 3 061 secondary school students, 51.9pc boys age range 11 to 23, mean age 15.0 years. MAIN OUTCOME MEASURE: Prevalence of self reported use of tobacco, alcohol, inhalants and cannabis. RESULTS: Comparing results from the two studies indicates: a. Drug use is highest among private school students. b. Use of alcohol and tobacco increases with increasing socio-economic status. c. Use of inhalants and cannabis varies and is less pronounced between socio-economic subgroups. d. A general increase from 1990 to 1994 in life time drug use prevalence among private school students. e. An increase in life time alcohol prevalence among rural students. f. Increased frequency of use of alcohol and cannabis among boys. CONCLUSIONS: Sociocultural differences with regards to drug use is demonstrated, suggesting a two way diffusion of Western drug use habits to rural areas and of traditional drug use to urban areas. In taking the necessary reservations with regard to the comparability of results from the two studies, the analysis indicates an increasing trend in use of the four most common drugs primarily among private school students and an increase in alcohol use among rural students.

Drug use among secondary school students in Zimbabwe.

A survey of drug use carried out in Zimbabwe in 1990/91 involved 2783 students from five different school categories in two provinces. Results show existence of use and experimenting, although prevalence is generally lower than corresponding European figures. Alcohol and tobacco is more common among urban than rural students and more common among private than public school students. Cannabis prevalence varies less, although high density urban school students report higher figures than others. Prevalence of inhalants is highest at private schools. Use of alcohol, tobacco and cannabis increases with age for both sexes, contrary to inhalants which shows a decreasing tendency for females and minimal variations across age-groups for males. Scale analysis for urban students produced results similar to European studies, demonstrating a stage pattern beginning with alcohol and tobacco, followed by cannabis or inhalants. The same pattern could not be demonstrated among rural students. It is argued that drug use among urban students is more developed not only quantitatively but also in that the use of different drugs is systematically strongly intercorrelated. Pattern variations between school-types may also reflect a stronger external or western influence on urban than rural adolescent drug use behaviour.

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders.

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Epidemiological study of drug use in urban and rural secondary schools in Zimbabwe.

In this survey a total of 2,783 secondary school students of both sexes, mean age 15.5 years, from randomly selected schools in both rural and urban areas of Zimbabwe were studied using a self report questionnaire. The results strongly indicated that drug use was quite prevalent among the students. The main drugs involved, in descending order, were: alcohol, tobacco, inhalants (solvents), amphetamines and cannabis. Others included mandrax, tranquilisers, sedatives and the hallucinogen mudzepete. No students reported use of heroin, cocaine, LSD or opium. Drug use increased with age and involved both sexes, the problem being more acute in the urban schools. A differential use pattern is revealed, implying valuable information for targeted prevention efforts.

Alcoholism among outpatients of a rural district general hospital in Kenya.

This article presents the results of a study of alcoholism among outpatients of a rural district hospital in Kenya. One hundred and twelve outpatients aged 18 years or over attending Kisii District Hospital were interviewed using the alcohol section of the Diagnostic Instrument Schedule (DIS). The participants consisted of 56 males and 56 females. Of these, 54% of the males and 25% of the females met the DIS criteria for alcohol abuse and/or alcoholism. Those classified as alcoholics differed significantly from the non-alcoholics on variables associated with sex, age, past marital state, religion and types of alcoholic drinks consumed. No significant differences were found with respect to present marital state, education, occupation, family size, age of first intoxication or physical illness.