May Measurement Month 2021: an analysis of blood pressure screening results from Zimbabwe.

The May Measurement Month 2021 campaign in Zimbabwe was aimed at assessing the frequency of hypertension and improving awareness among the population of the sequelae of elevated blood pressure (BP). Participants aged 18 years and above were recruited at outdoor booths to fill out a questionnaire and provide three BP measurements with 1-min intervals. Of the 2094 participants, over one-third (37.3%) were hypertensive, half of hypertensives (49.7%) were aware they had elevated pressure, and less than half (45.0%) of the hypertensive patients were on antihypertensive medications. Increasing age was directly proportional to hypertension with a large leap from 9.5 to 27.7% between the 18-29 and 30-39 age groups. Hypertension remains a major public health challenge in Zimbabwe. Improving access to preventive health screening services as well as treatment facilities is essential to early detect and control hypertension.

Factors leading to the late diagnosis and poor outcomes of breast cancer in Matabeleland South and the Bulawayo Metropolitan Provinces in Zimbabwe.

INTRODUCTION: Breast cancer (BC) is the leading cause of female cancer deaths in Africa, and in Zimbabwe, >80% present with advanced disease. A Needs Project (NP) was carried out to determine the key factors responsible for delayed diagnosis and poor BC outcomes and to investigate possible solutions in 6 rural and urban districts of Matabeleland South and Bulawayo Metropolitan Provinces. METHODS: A mixed method approach was used to collect data in 2 phases. Phase 1: an exploration of key factors leading to poor BC outcomes with >50 professional stakeholders and patient representatives. Phase 2: (i) Quantitative arm; validated questionnaires recording breast cancer knowledge, demographic information and perceived barriers to care administered to women and their relatives (Group 1) and health professionals (HPs) (Group 2). (ii) Qualitative arm; 10 focus group discussions with medical specialists and interested lay representatives (Group 3). The Cochran sample size formulae technique was used to determine the quantitative sample size and data was aggregated and analysed using SPSS Version 23™. Purposive sampling for the qualitative study selected participants with an understanding of BC and the NP. Focus group discussions were recorded and a thematic analysis of the transcriptions was conducted using NVivo9™. RESULTS: Quantitative analysis of Group 1 data (n = 1107) confirmed that younger women (<30years) had the least knowledge of breast cancer (p<0.001). Just under half of all those surveyed regarded breast cancer as incurable. In Group 2 (n = 298) the largest group of health workers represented were general nurses and midwives (74.2%) in keeping with the structure of health provision in Zimbabwe. Analysis confirmed a strong association between age and awareness of BC incidence (p = 0.002) with respondents aged 30-39 years being both the largest group represented and the least knowledgeable, independent of speciality. Nearly all respondents (90%) supported decentralisation of appropriate breast surgical services to provincial and district hospitals backed up by specialist training. Thematic analysis of focus group discussions (Group 3) identified the following as important contributors to late BC diagnosis and poor outcomes: (i) presentation is delayed by poorly educated women and their families who fear BC and high treatment costs (ii) referral is delayed by health professionals with no access to training, skills or diagnostic equipment (iii), treatment is delayed by a disorganised, over-centralized patient pathway, and a lack of specialist care and inter-disciplinary communication. CONCLUSION: This study confirms that the reasons for poor BC outcomes in Zimbabwe are complex and multi-factorial. All stakeholders support better user and provider education, diagnostic service reconfiguration, targeted funding, and specialist training.

The prevalence of and risk factors for stillbirths in women with severe preeclampsia in a high-burden setting at Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVES: Stillbirth remains a global public health issue; in low-resource settings stillbirth rates remain high (>12 per 1,000 births target of Every Newborn Action Plan). Preeclampsia is major risk factor for stillbirths. This study aimed to determine the prevalence and risk factors for stillbirth amongst women with severe preeclampsia at Mpilo Central Hospital. METHODS: A retrospective cross-sectional study was conducted of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariable logistic regression was used to determine risk factors that were independently associated with stillbirths. RESULTS: Of 469 women that met the inclusion criteria, 46 had a stillbirth giving a stillbirth prevalence of 9.8%. The risk factors for stillbirths in women with severe preeclampsia were: unbooked status (adjusted odds ratio (aOR) 3.01, 95% (confidence interval) CI 2.20-9.10), frontal headaches (aOR 2.33, 95% CI 0.14-5.78), vaginal bleeding with abdominal pain (aOR 4.71, 95% CI 1.12-19.94), diastolic blood pressure ≥150 mmHg (aOR 15.04, 95% CI 1.78-126.79), platelet count 0-49 × 109/L (aOR 2.80, 95% CI 1.26-6.21), platelet count 50-99 × 109/L (aOR 2.48, 95% CI 0.99-6.18), antepartum haemorrhage (aOR 12.71, 95% CI 4.15-38.96), haemolysis elevated liver enzymes syndrome (HELLP) (aOR 6.02, 95% CI 2.22-16.33) and fetal sex (aOR 2.75, 95% CI 1.37-5.53). CONCLUSIONS: Women with severe preeclampsia are at significantly increased risk of stillbirth. This study has identified risk factors for stillbirth in this high-risk population; which we hope could be used by clinicians to reduce the burden of stillbirths in women with severe preeclampsia.

Determinants of eclampsia in women with severe preeclampsia at Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVE: Globally, preeclampsia is a significant contributor to adverse maternal outcomes. Once women develop eclampsia, they face considerable risks especially in countries with limited resources to deal with such a life-threatening complication. This study was carried out to investigate determinants of eclampsia in pregnant mothers with severe preeclampsia. STUDY DESIGN: This institutional based study was completed at Mpilo Central Hospital, a quaternary referral unit from 1st January 2016 - 31st December 2018. In this study, pregnant women with severe preeclampsia/eclampsia were the study participants. The independent variables included socio-demographic and clinical characteristics, and maternal outcomes. Multivariable logistic regression analyses were used to determine independent association with p < 0.05 taken as statistically significant with 95% Confidence Interval (CI). MAIN OUTCOME MEASURE: Eclampsia. RESULTS: Development of eclampsia was more frequent in women aged 14-19 years compared to women aged ≥ 35 years (adjusted odds ratio (AOR) 6.64, 95% CI 1.20-22.06, p = 0.02) and in primiparous women compared to women with parity ≥ 3 (AOR 2.76, 95% CI 1.48-5.15, p = 0.001). Eclampsia was more frequent in women with diastolic blood pressure of 131-150 mmHg (AOR 5.48, 95% CI 1.05-28.75, p = 0.04), and ≥ 150 mmHg (AOR 5.78, 95% CI 1.05-31.78, p = 0.04) compared with those with diastolic blood pressure of ≤ 110 mmHg. Symptoms of visual disturbances were also associated with eclampsia (AOR 2.13, 95% CI 1.08-4.18, p = 0.03). CONCLUSIONS: This study has identified independent determinants of eclampsia which can be used to identify which women should receive magnesium sulphate prophlyaxis or more intensive monitoring to prevent deterioration in maternal condition.

Development and validation of risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVES: Hypertensive disorders of pregnancy are major causes of global maternal and neonatal morbidity and mortality. This study aimed to develop and validate models to predict composite adverse maternal and neonatal outcome in severe preeclampsia in low-resource settings. STUDY DESIGN: A retrospective cross-sectional study of women with severe preeclampsia giving birth in a tertiary referral centre in Zimbabwe between 01/01/2014-31/12/2018. Candidate variables identified from univariable logistic regression (p < 0.2) were entered into stepwise backward elimination logistic regression models to predict composite adverse maternal and neonatal outcomes. Models' performance was assessed by the area under the curve of the receiver operator characteristic (AUC ROC). The models were validated internally using bootstrap-based methods and externally using the Preeclampsia Integrated Estimate of RiSk dataset. MAIN OUTCOME MEASURES: The co-primary outcomes were composite adverse maternal outcome and composite adverse neonatal outcome. RESULTS: 549 women had severe preeclampsia from whom 567 neonates were born. The predictive model for composite adverse maternal outcome included maternal age, gestational age on admission, epigastric pain, vaginal bleeding with abdominal pain, haemoglobin concentration and platelets; the AUC ROC was 0.796 (95% CI 0.758-0.833). External validation showed poor discrimination (AUC ROC 0.494, 95% CI 0.458-0.552). The model for composite adverse neonatal outcome included: gestational age, platelets, alanine transaminase and birth weight; the AUC ROC was 0.902 (95% CI 0.876-0.927). CONCLUSIONS: While the models accurately predicted composite adverse maternal and neonatal outcomes in the study population, they did not in another cohort. Understanding factors which affect model performance will help optimize prediction of adverse outcomes in severe preeclampsia.

The predictive value of signs and symptoms in predicting adverse maternal and perinatal outcomes in severe preeclampsia in a low-resource setting, findings from a cross-sectional study at Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVES: In low resource settings symptoms and signs may be used to identify which women require intervention to mitigate the risks of severe preeclampsia. This study aimed to report the frequency of signs and symptoms in women with severe preeclampsia and to determine their predictive value for adverse maternal and perinatal outcomes. STUDY DESIGN: A retrospective cross-sectional study of women with severe preeclampsia from 01/01/2016 to 31/12/2018 at Mpilo Central Hospital, Bulawayo, Zimbabwe. Multivariate logistic regression was used to determine whether symptoms and signs were independently associated with the co-primary outcomes. MAIN OUTCOME MEASURES: The co-primary outcome measures were a composite of maternal complications including major organ dysfunction or mortality and a composite measure of severe perinatal morbidity or mortality. RESULTS: Symptoms were present in 58.8% of women with severe preeclampsia; headache and epigastric pain were most commonly reported (47.9% and 22.4% of women respectively). Most symptoms and signs were not independently predictive of adverse maternal or perinatal outcomes. Vaginal bleeding with abdominal pain reduced odds of adverse maternal outcome (Adjusted Odds Ratio (AOR) 0.16, 95% Confidence Interval (CI) 0.03-0.84; p = 0.03), systolic blood pressure of 161-180 mmHg increased odds of adverse maternal outcome (AOR 2.71, 95% CI 1.14-6.41, p = 0.03) and birthweight ≤ 1500 g increased odds of adverse perinatal outcome (AOR 23.21, 95% CI 7.70-69.92, p < 0.001). CONCLUSIONS: Maternal signs and symptoms are ineffective predictors of maternal or perinatal morbidity and mortality; as such they cannot be used alone to predict which women would benefit from intervention in severe preeclampsia.

Maternal survival in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVES: Maternal mortality is an important global subject. This dataset was generated from a retrospective cross-sectional study carried out at Mpilo Central Hospital, covering the period January 1, 2015 to December 31, 2018. The aim of the study was to compare how frequently the exposure to a risk factor was related to maternal death. Maternal deaths that were recorded during the study period were considered as cases. Controls were selected randomly from women of child-bearing age who survived during the study period. Low-resourced countries contribute significantly to global maternal deaths. Understanding risk factors could help reduce maternal mortality. DATA DESCRIPTION: The dataset contains data of 387 pregnant women who were included in the study. Data were collected as secondary data using a data collection sheet, as recorded by the hospital staff that gave all necessary demographic details in birth and mortality registers. The data collected included socio-demographic and clinical data. The independent variables were maternal age, gravidity, parity, antenatal visits, booking status, marital status, educational status, days spent in hospital, mode of delivery, fetal outcomes, and maternal complications. The dependent variable was maternal mortality. The data can be used to determine the relationship between the independent variables and maternal death.

Early onset severe preeclampsia and eclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVES: Early-onset severe preeclampsia is associated with significant maternal and perinatal morbidity and mortality especially in low-resource settings, where women have limited access to antenatal care. This dataset was generated from a retrospective cross-sectional study carried out at Mpilo Central Hospital, covering the period February 1, 2016 to July 30, 2018. The aim of the study was to determine the incidence of early-onset severe preeclampsia and eclampsia, and associated risk factors in a low-resource setting. The reason for examining the incidence of preeclampsia specifically in a low-resource setting; was to document it as women in these settings appear to suffer from poor outcomes. DATA DESCRIPTION: The dataset contains data of 238 pregnant women who had a diagnosis of early onset severe preeclampsia/eclampsia. There were 243 babies from singleton and twin gestations. There were five sets of twins. There were 21,505 live births during the study period giving an incidence of 1.1%. The dataset contains data on maternal socio-demographic, signs and symptoms, therapeutic interventions and mode of delivery, adverse outcomes characteristics, and fetal characteristics. This large dataset can be used to calculate the incidence and risk factors for adverse maternal and fetal outcomes or develop predictive models in severe preeclampsia/eclampsia.

Statistical risk prediction models for adverse maternal and neonatal outcomes in severe preeclampsia in a low-resource setting: proposal for a single-centre cross-sectional study at Mpilo Central Hospital, Bulawayo, Zimbabwe.

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal morbidity and mortality, especially in low-resource settings. Identifying mothers and babies at greatest risk of complications would enable intervention to be targeted to those most likely to benefit from them. However, current risk prediction models have a wide range of sensitivity (42-81%) and specificity (87-92%) indicating that improvements are needed. Furthermore, no predictive models have been developed or evaluated in Zimbabwe. This proposal describes a single centre retrospective cross-sectional study which will address the need to further develop and test statistical risk prediction models for adverse maternal and neonatal outcomes in low-resource settings; this will be the first such research to be carried out in Zimbabwe. Data will be collected on maternal demographics characteristics, outcome of prior pregnancies, past medical history, symptoms and signs on admission, results of biochemical and haematological investigations. Adverse outcome will be defined as a composite of maternal morbidity and mortality and perinatal morbidity and mortality. Association between variables and outcomes will be explored using multivariable logistic regression. Critically, new risk prediction models introduced for our clinical setting may reduce avoidable maternal and neonatal morbidity and mortality at local, national, regional and international level.

Determinants of adverse maternal and perinatal outcomes in severe preeclampsia and eclampsia in a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe.

OBJECTIVE: Severe preeclampsia and eclampsia have dire consequences for both maternal and neonatal health. The objective of this study was to identify determinants of adverse maternal and perinatal outcomes in severe preeclampsia and eclampsia. RESULTS: Binary logistic regression showed the following were significantly associated with adverse maternal outcomes; mothers who had a baby born at 27-29+6 weeks of gestation were 8 times more likely to be associated with adverse maternal outcomes compared to mothers who gave birth at 37-39+6 weeks' of gestation (OR 8.187, 95% CI 1.680-39.911, p = 0.02), holding other variables constant. Platelet count was also statistically significant for adverse maternal outcome. Mothers with platelet counts of 0-49 × 109/l were 46 times more likely to be associated with adverse maternal outcome compared to mothers with normal counts of more than 150 × 109/l (OR 46.429, 95% CI 17.778-121.253, p = 0.001). The following determinants were significantly associated with adverse perinatal outcomes. Mothers with platelet counts of 0-49 × 109/l were 4 times more likely to be associated with adverse perinatal outcomes compared to mothers with platelet counts of above 150 × 109/l (OR 3.690, 95% CI 1.752-7.775, p = 0.001).