TB prevalence in Zimbabwe: a national cross-sectional survey, 2014.

BACKGROUND: We conducted the first national TB prevalence survey to provide accurate estimates of bacteriologically confirmed pulmonary TB disease among adults aged ≥15 years in 2014.METHODS: A TB symptoms screen and chest X-ray (CXR) were used to identify presumptive TB cases who submitted two sputum samples for smear microscopy, liquid and solid culture. Bacteriological confirmation included acid-fast bacilli smear positivity confirmed using Xpert® MTB/RIF and/or culture. Prevalence estimates were calculated using random effects logistic regression with multiple imputations and inverse probability weighting.RESULTS: Of 43,478 eligible participants, 33,736 (78%) were screened; of these 5,820 (17%) presumptive cases were identified. There were 107 (1.9%) bacteriologically confirmed TB cases, of which 23 (21%) were smear-positive. The adjusted prevalences of smear-positive and bacteriologically confirmed TB disease were respectively 82/100,000 population (95% CI 47-118/100,000) and 344/100,000 (95% CI 268-420/100,000), with an overall all-ages, all-forms TB prevalence of 275/100,000 population (95% CI 217-334/100,000). TB prevalence was higher in males, and age groups 35-44 and ≥65 years. CXR identified 93/107 (87%) cases vs. 39/107 (36%) using the symptom screen.CONCLUSION: Zimbabwe TB disease prevalence has decreased relative to prior estimates, possibly due to increased antiretroviral therapy coverage and successful national TB control strategies. Continued investments in TB diagnostics for improved case detection are required.

Human immunodeficiency virus associated pulmonary conditions leading to hospital admission and the pulmonary rehabilitation services received by patients at two central hospitals in Harare.

OBJECTIVE: Use of highly active antiretroviral therapy has led to marked reductions in the incidence of HIV-associated opportunistic infections but has had comparatively less impact on the incidence of some pulmonary diseases. This study was done to determine the pulmonary conditions leading to hospital admissions in people living with HIV/AIDS at two central hospitals in Zimbabwe and the pulmonary rehabilitation intervention received. RESULTS: A total of 92 participants were recruited of which 60 (65.2%) were females. The mean age of the participants was 41.3 years (SD = 9.1). The most common pulmonary condition leading to hospital admission was tuberculosis in 53 (57.6%). About 52 (56.6%) of the participants suffered from pulmonary complications in the last 6 months, 48 (92.3%) were admitted and 26 (50.0%) of the participants received physiotherapy treatment during their admission. None of the participants indicated that they once attended an outpatient pulmonary rehabilitation clinic. Respiratory complication is one of the leading causes of morbidity associated with HIV but no pulmonary rehabilitation services are being offered to these patients. There is need for introduction of pulmonary rehabilitation programs for people living with HIV/AIDS in the current setting.

Prevalence and the correlates of postnatal depression in an urban high density suburb of Harare.

Introduction: Postnatal depression is a common cause of morbidity but is rarely diagnosed or managed in busy primary care settings in most resource limited countries like Zimbabwe. Objectives: This study sought to determine the prevalence of postnatal depression and establish factors associated with postnatal depression. Methods: The study utilized a cross-sectional descriptive design where 295 consenting women (mean age=25.4 years; SD= 5.6 years) attending post natal care services at Mbare Polyclinic were recruited. Data were collected using the validated Shona version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Associations between variables were computed using the chi-square test statistic and where appropriate the Fisher's exact statistic. Results: Prevalence for postnatal depression was 34.2% among women in the study. Univariate analysis revealed that there were no statistically significant associations between mother's age (p=0.120), parity (p=0.396), marital status (p=0.523), level of education (p=0.805), and age of child (p=0.489) and postnatal depression. Conclusion: Findings from this study indicate that there is a high prevalence of postnatal depression in women in Mbare, Zimbabwe. This therefore calls for further studies to identify and address the causes of postnatal depression among women attending postnatal care in Zimbabwe.

Cancer awareness and perceived barriers to health seeking in a rural population.

BACKGROUND: Low cancer awareness may lead to delays in cancer screening behaviour and diagnosis. OBJECTIVES: We set out to assess public awareness of cancer and perceived barriers to seeking help among the rural population of Murewa district in a cross-sectional survey of 384 conveniently selected respondents. METHODS: A self-administered and interviewer guided questionnaires were developed with the guide of the Cancer Awareness Measure (CAM) used in public awareness studies. RESULTS: Awareness of the occurrence of cancer in the population was high with 90.1% responding that they had heard about cancer. However, 60.6% of the respondents could not explain what cancer is. An association was identified between educational level and awareness on the existence of cancer in the population (p = 0.001). Age was also associated with awareness of the existence of cancer in the population (p < 0.001). Level of education was also associated with awareness on types of cancers with breast cancer (p = 0.0014), and prostate cancer (p = 0.001). Barriers to health (help) seeking included low levels of awareness of the availability of cancer screening and not being able to afford treatment services. Other barriers to help seeking included fear of screening and the costs of screening services. Unavailability of preventive and curative services for cancer at primary care level was another barrier to help seeking. CONCLUSION: There is therefore an increasing need for health promotional interventions to raise public awareness of cancer and to create supportive environments for cancer prevention, screening, early detection and treatment.

Application of the International Classification of Functioning, Disability and Health (ICF) framework in record keeping by occupational therapists and physiotherapists at central hospitals in Harare.

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) is a framework that provides a detailed outline of the information that should be included in patient records. Whilst the World Federation of occupational therapists and the World Confederation of Physiotherapists have recommended use of this framework in clinical practice, the extent to which Zimbabwean therapists are applying this framework in patients' assessment and treatment is unknown. OBJECTIVE: This study was conducted to determine the extent to which the ICF framework is being applied in recording information on patient assessment and treatment by occupational therapists and physiotherapists in Zimbabwe. METHODS: A descriptive cross sectional study was carried out in rehabilitation departments at three central hospitals in Harare. Thirty therapists were interviewed on their record keeping practices. Sixty randomly selected records for in-patients receiving rehabilitation services were also evaluated for completeness using a checklist developed using ICF guidelines. Data were analysed using Microsoft excel and Epi info. RESULTS: Forty-three percent (12) of the records were rated as good and another (43%) as satisfactory. None of the records reviewed were 100% complete according to the ICF guidelines. Personal factors were the most recorded (82%) component and the least recorded were environmental factors (18%) affecting patient functioning. There were no statistically significant associations between application of the ICF framework and profession (p = 0.680), ICF application and years in clinical practice (p = 0.557) and training and record keeping practices (p = 1.000). CONCLUSION: Standard guidelines for evaluating patients with different conditions derived from the ICF checklist should be designed for occupational therapists and physiotherapists to standardise information recorded during management of patients seeking rehabilitation services.

Determinants of premature births in two central hospital Harare, Zimbabwe, 2011.

Introduction: Prematurity is a major determinant of neonatal morbidity and mortality in Zimbabwe. Although 8-10% of deliveries are premature , prematurity contributes 33% of neonatal deaths. Identifying local risk factors for prematurity could help incoming up with local intervention and prevention strategies. Design: 1:1 unmatched case control study. Setting: Harare and Parirenyatwa central hospitals maternity units. Subjects: All mothers who delivered in the units June to July 2011. Acase was a mother who had delivered a premature baby and control was a mother who delivered a term baby. Results: We interviewed 188 cases and 188 controls. Independent risk factors for premature delivery were -A previous premature delivery [AOR 3.15 95% CI 1.17 8.49, 4.61] being admitted with a medical complication in pregnancy[AOR 2.15 95% CI 1.18-3.92]. Birth interval > 24 months [AOR 0.26 95% CI 0.12 0.59] being well nourished evidenced by BMI ≥20kg/m [ AOR 0.926 95% CI 0.88 0.97] and MUAC ≥23cm [AOR 0.95 95% CI 0.91 0.95] reduced the risk of premature delivery. HIV test was done on 87% of participants, 12% were positive (66% controls, 33% cases) (p≤0.001). Conclusion: Birth interval < 24 months, previous premature delivery, only one ANC attendance, maternal under nutrition and being hospitalized with complications in pregnancy were associated with premature delivery. There was no association with HIV infection. Efforts should be made to give food supplements to pregnant undernourished women.