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.

The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study.

BACKGROUND: Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. METHODS: A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. RESULTS: Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2-4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was 'unexplained' in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. CONCLUSION: Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.

Clinical and demographic characteristics of cervical cancer patients presenting at Parirenyatwa Hospital, Zimbabwe.

Cervical cancer is the leading cause of cancer deaths in women in Africa, predominately due to late diagnosis. This study aims to identify risk factors, potential prognostic indicators, and optimal treatment modalities for Zimbabwean cervical cancer patients. Medical records for 1063 cervical cancer patients were reviewed for sociodemographic, clinical, treatment, and response data. All data were analysed using SPSS version 25. More than half of the cohort was pre-menopausal (63%) with low (2%) history of cervical cancer screening. Schistosoma ova were observed in 2.4% of the tumour specimens. More than 50% were diagnosed at stage 3 and later, with a high frequency of comorbidities (~68%). This study highlights a need for improving screening education and uptake in Zimbabwe. Moreover, the current data provides a dataset for understanding cervical cancer pathogenesis and treatment responses in an African cohort.

Estimating abortion incidence and unintended pregnancy among adolescents in Zimbabwe, 2016: a cross-sectional study.

OBJECTIVE: To estimate age-specific abortion incidence and unintended pregnancy in Zimbabwe, and to examine differences among adolescents by marital status and residence. DESIGN: We used a variant of the Abortion Incidence Complications Methodology, an indirect estimation approach, to estimate age-specific abortion incidence. We used three surveys: the Health Facility Survey, a census of 227 facilities that provide postabortion care (PAC); the Health Professional Survey, a purposive sample of key informants knowledgeable about abortion (n=118) and the Prospective Morbidity Survey of PAC patients (n=1002). SETTING: PAC-providing health facilities in Zimbabwe. PARTICIPANTS: Healthcare providers in PAC-providing facilities and women presenting to facilities with postabortion complications. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was abortion incidence (in rates and ratios). The secondary outcome measure was the proportion of unintended pregnancies that end in abortion. RESULTS: Adolescent women aged 15-19 years had the lowest abortion rate at five abortions per 1000 women aged 15-19 years compared with other age groups. Adolescents living in urban areas had a higher abortion ratio compared with adolescents in rural areas, and unmarried adolescent women had a higher abortion ratio compared with married adolescents. Unintended pregnancy levels were similar across age groups, and adolescent women had the lowest proportion of unintended pregnancies that ended in induced abortion (9%) compared with other age groups. CONCLUSIONS: This paper provides the first estimates of age-specific abortion and unintended pregnancy in Zimbabwe. Despite similar levels of unintended pregnancy across age groups, these findings suggest that adolescent women have abortions at lower rates and carry a higher proportion of unintended pregnancies to term than older women. Adolescent women are also not a homogeneous group, and youth-focused reproductive health programmes should consider the differences in experiences and barriers to care among young people that affect their ability to decide whether and when to parent.

Evaluating the quality and coverage of post-abortion care in Zimbabwe: a cross-sectional study with a census of health facilities.

BACKGROUND: An estimated 65,000 abortions occurred in Zimbabwe in 2016, and 40 % resulted in complications that required treatment. Quality post-abortion care (PAC) services are essential to treat abortion complications and prevent future unintended pregnancies, and there have been recent national efforts to improve PAC provision. This study evaluates two components of quality of care: structural quality, using PAC signal functions, a monitoring framework of key life-saving interventions that treat abortion complications; and process quality, which examines the standards of care provided to PAC patients. METHODS: We utilized a 2016 national census of health facilities in Zimbabwe with PAC capacity (n = 227) and a prospective, facility-based 28-day survey of women seeking PAC in a nationally representative sample of those facilities (n = 1002 PAC patients at 127 facilities). PAC signal functions, which are the critical services in the management of abortion complications, were used to classify facilities as having the capability to provide basic or comprehensive care. All facilities were expected to provide basic care, and referral-level facilities were designed to provide comprehensive care. We also assessed population coverage of PAC services based on the WHO recommendation for obstetric services of 5 facilities per 500,000 residents. RESULTS: We found critical gaps in the availability of PAC services; only 21% of facilities had basic PAC capability and 10% of referral facilities had comprehensive capability. For process quality, only one-fourth (25%) of PAC patients were treated with the appropriate medical procedure. The health system had only 41% of the basic PAC facilities recommended for the needs of Zimbabwe's population, and 55% of the recommended comprehensive PAC facilities. CONCLUSION: This is the first national assessment of the Zimbabwean health system's coverage and quality of PAC services. These findings highlight the large gaps in the availability and distribution of facilities with basic and comprehensive PAC capability. These structural gaps are a contributing barrier to the provision of evidence-based care. This study shows the need for increased focus and investment in expanding the provision of and improving the quality of these essential, life-saving PAC services.

Genetic Susceptibility for Cervical Cancer in African Populations: What Are the Host Genetic Drivers?

Human papillomavirus (HPV) is an essential but not a sufficient cervical cancer etiological factor. Cancer promoters, such as host genetic mutations, significantly modulate therapeutic responses and susceptibility. In cervical cancer, of interest have been viral clearing genes and HPV oncoprotein targets, for which conflicting data have been reported among different populations. This expert analysis evaluates cervical cancer genetic susceptibility biomarkers studied in African populations. Notably, the past decade has seen Africa as a hotbed of biomarker and precision medicine innovations, thus potentially informing worldwide biomarker development strategies. We conducted a critical literature search in PubMed/MEDLINE, Google Scholar, and Scopus databases for case-control studies reporting on cervical cancer genetic polymorphisms among Africans. We found that seven African countries conducted cervical cancer molecular epidemiology studies in one of Casp8, p53, CCR2, FASL, HLA, IL10, TGF-beta, and TNF-alpha genes. This analysis reveals a remarkable gap in cervical cancer molecular epidemiology among Africans, whereas cervical cancer continues to disproportionately have an impact on African populations. Genome-wide association, whole exome- and whole-genome sequencing studies confirmed the contribution of candidate genes in cervical cancer. With such advances and omics technologies, the role of genetic susceptibility biomarkers can be exploited to develop novel interventions to improve current screening, diagnostic and prognostic methods worldwide. Exploring these genetic variations is crucial because African populations are genetically diverse and some variants or their combined effects are yet to be discovered and translated into tangible clinical applications. Thus, translational medicine and flourishing system sciences in Africa warrant further emphasis in the coming decade.