Psychological, sociocultural, and coping experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe: A qualitative study.

This study focused on the psychological, social, and cultural dimensions of infertility among women with infertility in Harare Urban who have utilised traditional healthcare systems to address their infertility problem. It also emphasises their coping strategies for dealing with the challenges encountered along the infertile journey. This was a qualitative study using a phenomenological approach, focusing on the experiences of five women. Data from the interviews was analysed using a simplified version of Hycner's (1985) five-step explication process. The study produced three main themes: psychological experiences, socio-cultural experiences, and coping experiences, along with seven sub-themes. The results showed that women experienced intense distress, sorrow, and self-blame because of their inability to have children, further compounded by the stigma they faced from their families and communities. Women with infertility are subjected to derogatory labels, social contempt, ridicule, and being undervalued, which leads them to develop coping strategies to endure the adverse encounters. These coping mechanisms can have either positive or negative effects on their overall welfare. The exploration of psychological, socio-cultural factors, and coping mechanisms of women with infertility problems' presents a chance to co-create interventions that empower them.

Cette étude s'est concentrée sur les dimensions psychologiques, sociales et culturelles de l'infertilité chez les femmes infertiles de Harare Urban qui ont utilisé les systèmes de santé traditionnels pour résoudre leur problème d'infertilité. Il met également l'accent sur leurs stratégies d'adaptation pour faire face aux défis rencontrés tout au long du parcours stérile. Il s'agissait d'une étude qualitative utilisant une approche phénoménologique, axée sur les expériences de cinq femmes. Les données des entretiens ont été analysées à l'aide d'une version simplifiée du processus d'explication en cinq étapes de Hycner (1985). L'étude a produit trois thèmes principaux : les expériences psychologiques, les expériences socioculturelles et les expériences d'adaptation, ainsi que sept sous-thèmes. Les résultats ont montré que les femmes éprouvaient une détresse, un chagrin et une culpabilité intenses en raison de leur incapacité à avoir des enfants, encore aggravés par la stigmatisation à laquelle elles étaient confrontées de la part de leur famille et de leur communauté. Les femmes infertiles sont soumises à des étiquettes désobligeantes, au mépris social, au ridicule et à la sous-évaluation, ce qui les amène à développer des stratégies d'adaptation pour supporter les rencontres défavorables. Ces mécanismes d'adaptation peuvent avoir des effets positifs ou négatifs sur leur bien-être global. L'exploration des facteurs psychologiques, socioculturels et des mécanismes d'adaptation des femmes souffrant de problèmes d'infertilité présente une opportunité de co-créer des interventions qui les autonomisent.

Experiences of traditional health practitioners in the management of female infertility in Harare urban areas: A qualitative study.

Female infertility is a health and social problem that traditional health practitioners (THPs) have been managing in African communities. This study explored the experiences of THPs in the management of female infertility, specifically focusing on their understanding, diagnosis, and treatment methods for female infertility. This was a qualitative study targeting six THPs in Harare urban areas registered with the Traditional Medical Practitioners Council (TMPC) in Zimbabwe. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed in the description of the study design, analysis and presentation of findings. The findings revealed that the etiology of female infertility was attributed to biomedical, lifestyle, spiritual, and male factors. Management of infertility depended on the type of THP. Spirit mediums relied on divination and dreams to diagnose and treat female infertility. Herbalists focused on the physical evidence provided by the client through history taking. THPs had a client referral system within their TMPC network. All THPs ultimately used medicinal plants for treating female infertility. THPs play an important role in the management of female infertility. Understanding their contributions to the management of female infertility provides an opportunity to obtain insight into their practices, thus identifying areas that responsible Ministries can use to strengthen traditional health care systems and ultimately improve reproductive health care for women in African communities.

L'infertilité féminine est un problème sanitaire et social que les tradipraticiens (PTS) gèrent dans les communautés africaines. Cette étude a exploré les expériences des THP dans la gestion de l'infertilité féminine, en se concentrant spécifiquement sur leur compréhension, leur diagnostic et leurs méthodes de traitement de l'infertilité féminine. Il s'agissait d'une étude qualitative ciblant six PTH des zones urbaines de Harare enregistrés auprès du Conseil des médecins traditionnels (TMPC) au Zimbabwe. Les lignes directrices COREQ (Consolidated Criteria for Reporting Qualitative Research) ont été suivies dans la description de la conception de l'étude, de l'analyse et de la présentation des résultats. Les résultats ont révélé que l'étiologie de l'infertilité féminine était attribuée à des facteurs biomédicaux, liés au mode de vie, spirituels et masculins. La prise en charge de l'infertilité dépendait du type de THP. Les médiums spirituels s'appuyaient sur la divination et les rêves pour diagnostiquer et traiter l'infertilité féminine. Les herboristes se sont concentrés sur les preuves matérielles fournies par le client grâce à l'anamnèse. Les THP disposaient d'un système de référencement des clients au sein de leur réseau TMPC. Tous les THP utilisaient finalement des plantes médicinales pour traiter l'infertilité féminine. Les THP jouent un rôle important dans la gestion de l'infertilité féminine. Comprendre leurs contributions à la gestion de l'infertilité féminine offre l'opportunité d'avoir un aperçu de leurs pratiques, identifiant ainsi les domaines que les ministères responsables peuvent utiliser pour renforcer les systèmes de santé traditionnels et, à terme, améliorer les soins de santé reproductive pour les femmes des communautés africaines.

Traditional management of female infertility in Africa: a scoping review protocol.

INTRODUCTION: Infertility adversely affects the sexual reproductive health and overall quality of life of people. Recent estimates show that about one in six people (both men and women) experience infertility in their lifetime. This scoping review will, therefore, map the existing evidence on traditional management of female infertility in Africa including the effectiveness of the traditional healthcare systems, to inform policy and practice. METHODS: The scoping review will be guided by the Arksey and O'Malley framework in conjunction with the Joanna Briggs Institute updated methodological guidance for scoping reviews. A search strategy will be developed, which will target the following databases: PubMed, Scopus, Embase, CINAHL, Google Scholar and Africa-Wide Information including grey literature. The screening of titles, abstracts and full text will be done by two independent reviewers. Data will be extracted, analysed numerically and thematically. The reporting of the scoping review will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. ETHICS AND DISSEMINATION: This scoping review will not require ethical approval as this is secondary analysis of peer-reviewed articles. The findings of the review will be disseminated on various platforms including conferences, meetings to key stakeholders and in a peer-reviewed journal for wider sharing.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Factors that influence HIV status disclosure among the elderly: perspectives from Shurugwi, Zimbabwe.

Due to the widespread availability of antiretroviral medications, many people with HIV are living longer. Being an HIV-positive elderly, however, brings in complications as far as disclosure of status is concerned. This phenomenological study was carried out to explore factors that influence disclosure among the elderly. Sample data was obtained from 14 participants aged at least 50 years who attended a certain District Hospital for ART. Using the convenience sampling technique, the researchers were able to select those patients who were easily accessible until sample size was reached. The researchers used interpretive thematic analysis that allowed coding of findings. The main findings from the research indicated that stigma, loss of family support, partner's reaction and cultural norms were the main reasons that hindered the elderly to freely disclose their HIV-positive serostatus as it cuts across all their social interactions. In order to reduce the negative consequences of nondisclosure, the elderly, their significant others and the general public need to be educated about the importance of disclosure among the elderly and support groups for the elderly need to be availed.

Exploring the evolution of health promotion in Namibia: opportunities and obstacles during the post-independence era.

Namibia is a Southern African country with social inequalities. This paper discusses the historical development of health promotion in Namibia. The country has achieved tremendous progress in public health after gaining independence in March 1990, with increased life expectancy, reduced tuberculosis and AIDS mortality due to high coverage of antiretroviral therapy (90%) in 2012, and a reduced under-five mortality rate, from 74 deaths per 1000 live births in 1990 to 50 in 2013. However, challenges still exist in achieving health for all. Non-communicable diseases such as cancer, diabetes and cardiovascular diseases are among the top 10 diseases and top 15 causes of death, with diabetes emerging as one of the greatest threats to health. Opportunities and obstacles for effective health promotion are discussed. In conclusion, health promotion in Namibia has the potential to improve the health of the populace.

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review.

BACKGROUND: Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. METHODS: A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. RESULTS: A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. CONCLUSION: This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD  42017063856 .

'If nurses were in our shoes would they breastfeed their own babies?' A qualitative inquiry on challenges faced by breastfeeding mothers on the PMTCT programme in a rural community in Zimbabwe.

BACKGROUND: The Prevention of Mother to Child Transmission (PMTCT) of HIV programme in Zimbabwe has had remarkable success despite the country's economic challenges. The aim of this study was to explore the challenges faced by breastfeeding mothers on the PMTCT programme. METHOD: Narratives from 15 women (age range 19-35 years) were collected at two rural health facilities in Zimbabwe through in-depth interviews over a period of 6 months. Thematic analysis was used to describe breastfeeding mothers' experiences and challenges of being on the PMTCT programme. RESULTS: The findings suggest that breastfeeding women on the PMTCT programme face challenges that include internal, external and institutional stigma and discrimination. Women reported a sense of powerlessness in decision making on following through with the PMTCT programme and were ambivalent regarding disclosure of their HIV status to their partners and significant others. CONCLUSION: HIV and AIDS programmes should pay attention to women's readiness for interventions. There is need to understand women's life experiences to ensure informed and targeted programming for PMTCT.

A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period.

OBJECTIVE: Globally, 13-20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. RESULTS: The mothers' mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2-8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = - 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.

Understanding Ethical, Legal and Societal Issues (ELSIs) in Human Biobanking and Genomics for Research and Healthcare in Zimbabwe: The Genomics Inheritance Law Ethics and Society (GILES) initiative.

Biobanks and human genomics applications are key for understanding health, disease and heredity in Africa and globally. Growing interest in these technologies calls for strengthening relevant legal, ethical and policy systems to address knowledge disparities and ensure protection of society, while supporting advancement of science. In Zimbabwe there is limited understanding of ethical, legal, and societal issues (ELSI) for biobanking and genomics. The Genomics Inheritance Law Ethics and Society (GILES) initiative was established in 2015 to explore the current status and gaps in the ethical and legal frameworks, knowledge among various stakeholders, and to establish capacity for addressing ELSI of biobanking and genomics as applied in biomedical and population research, and healthcare. A multi-methods approach was applied including document reviews, focus group discussions and in-depth interviews among health and research professionals, and community members in six provinces comprising urban, peri-urban and rural areas. Emerging findings indicates a need for updating guidelines and policies for addressing ELSI in biobanking and genomics research in Zimbabwe. Emerging terminologies such as biobanking and genomics lack clarity suggesting a need for increased awareness and educational tools for health professionals, research scientists and community members. Common concerns relating to consent processes, sample and data use and sharing, particularly where there is trans-national flow of biospecimens and data, call for nationally tailored ELSI frameworks aligned to regional and international initiatives. This paper describes the strategy undertaken for the development and implementation of the GILES project and discusses the importance of such an initiative for characterisation of ELSI of human biobanking and genomics in Zimbabwe and Africa. Conducting this explorative study among a wide range of stakeholders over a countrywide geographical regions, established one of the most comprehensive studies for ELSI of human biobanking and genomics in Africa.

Prevalence and factors associated with postnatal depression among women in two rural districts of Manicaland, Zimbabwe.

BACKGROUND: Low- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts. OBJECTIVES: This study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017. METHODS: One hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post-delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed. RESULTS: The mean age of participants was 23.7 years (standard deviation = 6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04-31.74). There was a higher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p = 0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR) = 2.8 (95% CI: 1.2-6.1), aOR = 2.5 (95% CI: 1.2-5.3) and aOR = 2.4 (95% CI: 1.1-5.6), respectively. CONCLUSION: The high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas.

Profiling the mental health of diabetic patients: a cross-sectional survey of Zimbabwean patients.

OBJECTIVE: The burden of diabetes mellitus has exponentially increased in low resource settings. Patients with diabetes are more likely to exhibit poor mental health which negatively affects treatment outcomes. However, patients with high levels of social support (SS) are likely to report optimal mental health. We sought to determine how SS affects the report of psychiatric morbidity and health-related quality of life (HRQoL) in 108 diabetic patients in Harare, Zimbabwe. RESULTS: The average age of participants was 54.1 (SD 18.6) years. Most of the participants were; females (69.4%), married (51.9%), and were of low level of income (43.5%). 37.1% of the participants exhibited signs of psychiatric morbidity [mean Shona Symptoms Questionnaire score-6.7 (SD 3.2)]. Further, patients also reported lower HRQoL [mean EQ-5D-VAS score-64.1 (SD 15.3)] and high levels of SS [mean Multidimensional Scale of Perceived Social Support score-43.7 (SD 11.5)]. Patients who received greater amount of SS had optimal mental health. Being female, unmarried, lower education attainment, having more comorbid conditions, being diagnosed with type 2 diabetes and having been diagnosed of diabetes for a longer duration were associated with poorer mental health. It is important to develop context-specific interventions to improve diabetic patients' mental health.

Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: A narrative review of literature.

BACKGROUND: The perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe. AIM: This narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers. METHODS: Both electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: 'women and antenatal depression', 'prenatal depression', 'postnatal depression', 'postpartum depression', 'depressive disorder', or 'common mental disorder' and 'screening and Zimbabwe'. RESULTS: Although opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression. CONCLUSION: There is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally.

The status of health promotion in Botswana.

Health education and promotion remains an integral part of public health. This paper details health promotion activities in Botswana since the establishment of the profession in 1988. It further describes health promotion infrastructure, investment in health promotion, human resource training and collaborations within the country. Infrastructure and services for health promotion in the country are mainly provided by government through educational institutions, faith based organizations, non-governmental organizations, general medical practitioners and mining companies complementing the Ministry's efforts. More than 1000 health promotion cadres have been trained at certificate, diploma and degree levels by Boitekanelo College and the Ministry of Health through Serowe Institute of Health Sciences.

Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study.

BACKGROUND: Screening women for postnatal depression (PND) provides an opportunity to reach undetected cases and enhance pregnancy outcomes. In Zimbabwe, no validation of depression screening tools has been done on postnatal women in rural settings. OBJECTIVES: This study aims to determine criterion validity of the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9) and the Center for Epidemiological Studies-Depression (CES-D) scale using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria as the reference standard. METHODS: Women (n=462) attending postnatal care at 7 or 42 days at two rural district hospitals in Zimbabwe will be assessed for depressive symptoms using the EPDS, PHQ-9 and CES-D. The women will be interviewed by a clinical psychologist using DSM-5 criteria. Sensitivities, specificities, positive predictive values, negative predictive values and test efficiencies will be calculated for each of the three tools. The area under the receiver operating curve will quantify the overall ability of the three tests to discriminate between those mothers with PND and those without. DISCUSSION: Findings from this study will add to the body of knowledge on PND among women in resource-limited settings. Identifying women with PND will enable healthcare providers to link them with care, which will ultimately improve maternal and child health outcomes. Furthermore, this study will provide evidence on which screening tool would be best for screening PND in rural settings of Zimbabwe.

Prevalence of depression and anxiety among undergraduate university students in low- and middle-income countries: a systematic review protocol.

BACKGROUND: Depression and anxiety symptoms are reported to be common among university students in many regions of the world and impact on quality of life and academic attainment. The extent of the problem of depression and anxiety among students in low- and middle-income countries (LMICs) is largely unknown. This paper details methods for a systematic review that will be conducted to explore the prevalence, antecedents, consequences, and treatments for depression and anxiety among undergraduate university students in LMICs. METHODS: Studies reporting primary data on common mental disorders among students in universities and colleges within LMICs will be included. Quality assessment of retrieved articles will be conducted using four Joanna Briggs critical appraisal checklists for prevalence, randomized control/pseudo-randomized trials, descriptive case series, and comparable cohort/case control. Meta-analysis of the prevalence of depression and anxiety will be conducted using a random effects model which will generate pooled prevalence with their respective 95% confidence intervals. DISCUSSION: The results from this systematic review will help in informing and guiding healthcare practitioners, planners, and policymakers on the burden of common mental disorders in university students in LMICs and of appropriate and feasible interventions aimed at reducing the burden of psychological morbidity among them. The results will also point to gaps in research and help set priorities for future enquiries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017064148.

The status of health promotion in Botswana

Health education and promotion remains an integral part of public health. This paper details health promotion activities in Botswana since the establishment of the profession in 1988. It further describes health promotion infrastructure, investment in health promotion, human resource training and collaborations within the country. Infrastructure and services for health promotion in the country are mainly provided by government through educational institutions, faith based organizations, non-governmental organizations, general medical practitioners and mining companies complementing the Ministry's efforts. More than 1000 health promotion cadres have been trained at certificate, diploma and degree levels by Boitekanelo College and the Ministry of Health through Serowe Institute of Health Sciences

Opportunities and obstacles to screening for perinatal depression among women in Zimbabwe: a narrative review of literature

Background: The perinatal period provides an opportune time for health care providers to screen for and proffer interventions for women suffering from depression. However, routine screening for depression is not done in primary care settings in Zimbabwe. Aim: This narrative review discusses opportunities and obstacles surrounding screening for perinatal depression in primary care settings in Zimbabwe, with a view to stress the importance of routine screening to policy-makers. Methods: Both electronic and manual searches were done on PubMed, PubMed Central, African Journals Online, Google Scholar and the University of Zimbabwe Institutional Repository (UZIR) using the following key terms: 'women and antenatal depression', 'prenatal depression', 'postnatal depression', 'postpartum depression', 'depressive disorder', or 'common mental disorder' and 'screening and Zimbabwe'. Results: Although opportunities for depression screening are possible because of the high antenatal and postnatal service coverage, the potential for universal screening is fraught with human and financial resource constraints, lack of training in mental health care among primary health care providers and lack of locally validated screening tools for depression. Conclusion: There is a need to channel resources into the training of midwives and other primary health care providers on mental health issues affecting women perinatally

Prevalence and factors associated with postnatal depression among women in two rural districts of Manicaland, Zimbabwe

Background: Low- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts. Objectives: This study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017. Methods: One hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed. Results: The mean age of participants was 23.7 years (standard deviation=6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04­31.74). There was ahigher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p=0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR)=2.8 (95% CI: 1.2­6.1),aOR=2.5 (95% CI: 1.2­5.3) and aOR=2.4 (95% CI: 1.1­5.6), respectively. Conclusion: The high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas

Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.