An extraordinary role for village community development workers in diagnosing blindness in the community.

OBJECTIVE: To determine the reliability of village community development workers in screening for blindness in the community and to suggest an extraordinary role for these cadres. DESIGN: Diagnostic study. SETTING: Chivi District, Zimbabwe. SUBJECTS: A simple random sample of 148 out of 886 people selected from notification forms. MAIN OUTCOME MEASURE: Sensitivity, specificity and predictive values. RESULTS: The screening method employed was found to have a sensitivity of 93% (95% CI), specificity of 32% (95% CI) and a predictive value for a positive result of 75%. CONCLUSION: The use of village community development workers to screen for blindness in the community has proved to be a reliable alternative when there is shortage of both ophthalmic trained personnel and funds.

A community-based study on utilisation of maternity services in rural Zimbabwe.

To estimate the degree and pattern of utilization of institutional maternity services in a rural area of Zimbabwe, a cross-sectional study was performed in Gutu district about 250 kilometers south of the capital Harare. In August, 1991, 12 out of 43 wards in the district were randomly selected and in each ward about 40 women (in total 520) who had delivered in the previous 12 months were randomly selected and interviewed. There was a high degree of utilization of institutional maternity services by the women (96% 79% and 74%) for antepartum, intrapartum and postpartum care respectively). Women sought this care from a multiplicity of sources depending on a variety of social, geographical and service factors. Very few women (17%) had total pregnancy care at the rural health centre. There was a significant association between the actual place of delivery and nulliparity, whether the previous delivery took place at home, whether the family belonged to the Apostolic Faith sect, and whether the husband spent most time in urban area. For nulliparity, previous delivery at home and belonging to the Apostolic Faith sect the proportion of women delivering at home, at the rural health center/urban maternity clinic, and at hospital was statistically significant. The few maternity waiting shelters that were available lacked basic amenities and were unattractive to the mothers even though 65% either used them or could have done so if they were available.

Hospitalized dysentery cases during an outbreak of Shigella dysenteriae type I: Ndanga District Hospital, Zimbabwe.

OBJECTIVE: To describe the characteristics of patients admitted with bloody diarrhoea; to assess clinical management; and to identify organisms isolated in laboratories and their antimicrobial susceptibility pattern. DESIGN: This was a retrospective study which used data from case files of patients admitted for dysentery at Ndanga District Hospital. The three admission registers from the hospitals male, female and paediatric wards were examined for patients with dysentery as their admitting diagnosis from December 1993 to February 1994. Using case file numbers from the admission registers, we retrieved case files from the records office. SETTING: Ndanga District Hospital in Zaka, Masvingo Province, Zimbabwe. SUBJECTS: All patients admitted for dysentery at Ndanga District Hospital. MAIN OUTCOME MEASURES: Patients sex, age, clinical presentation, complications, drugs given, culture results, and antimicrobial susceptibility, duration of stay and outcome. RESULTS: The peak admission period was the last week of January, during which 17 patients were admitted with bloody diarrhoea. The age distribution of cases was bimodal, children less than five and those 15 to 29 being most likely to be hospitalized; 52pc of the patients were females. Signs and symptoms recorded were bloody diarrhoea 100pc, abdominal pain 45pc, dehydration 38pc, fever 34pc, vomiting 26pc, loss of appetite 20pc, weight loss 17pc and anaemia 5pc. Shigella dysenteriae type 1 (SD1) was isolated in 80pc of the 58 stools examined. Most cases were treated with kanamycin (67pc),nitrofurantion (61pc), and metronidazole (43pc). The average number of antibiotics given per patient was 2.3. Seventeen cases developed complications and four patients died, one each with renal failure, haemolytic uraemic syndrome, and severe anaemia. The other patient who died had developed rectal prolapse. CONCLUSIONS: 80pc of the patients in the study received multiple antibiotics. The most frequently used drugs were kanamycin and nitrofurantion, yet neither of these drugs has been shown to be effective in treating dysentery. While the organisms were largely sensitive to nalidixic acid, little of that was prescribed, almost certainly because it was not available until late in the study period. There is need for adherence to the Ministry's recommended dysentery treatment guideline: prompt treatment with an effective antimicrobial to which the organism has been recently shown to be sensitive, and supportive care and prompt referral if complications arise.

A community-Based Study on Utilisation in a Rural Zimbabwe

To estimate the degree and pattern of utilization of institutional maternity services in a rural area of Zimbabwe; a cross-sectional study was performed in Gutu district about 250 kilometers south of the capital Harare. In August; 1991; 12 out of 43 wards in the district were randomly selected and in each ward about 40 women (in total 520) who had delivered in the previous 12 months were randomly selected and interviewed. There was a high degree of utilization of institutional maternity services by the women (9679and 74) for antepartum; intrapartum and postpartum care respectively). Women sought this care from a multiplicity of sources depending on a variety of social; geographical and service factors. Very few women (17) had total pregnancy care at the rural health centre. There was a significant association between the actual place of delivery and nulliparity; whether the previous delivery took place at home; whether the family belonged to the Apostolic Faith sect; and whether the husband spent most time in urban area. For nulliparity; previous delivery at home and belonging to the Apostolic Faith sect the proportion of women delivering at home; at the rural health center/urban maternity clinic; and at hospital was statistically significant. The few maternity waiting shelters that were available lacked basic amenities and were unattractive to the mothers even though 65either used them or could have done so if they were available

Colorectal carcinoma: presentation and immediate results of surgery at Mpilo Central Hospital.

It has been claimed that carcinoma of the large intestine is extremely rare in the indigenous black population in Africa. Furthermore, the incidence of colorectal carcinoma in black Africans is said to increase when they abandon their customary diet and adopt a more westernised diet. Although colorectal carcinoma is not a common condition in our region, our experience at Mpilo Hospital over the last eight years suggest that it is by no means a rare condition. During this period we treated 90 black patients giving an average admission rate of 11.25 new cases a year. Virtually all our patients would have been on their customary high roughage diet because they either came from rural areas (55.7 percent) or if they lived in town (44.3 percent) they belonged to the working class.