Economic development and women's blood pressure: field evidence from rural Mashonaland, Zimbabwe.

A survey of 515 non-pregnant women at 12 geographically chosen research sites in rural Mashonaland shows significant differences in mean blood pressure, controlled by age cohorts. Three levels of economic development are identified: (1) the traditional economy on communal lands, with lowest blood pressure, (2) the wage economy in areas of large-scale commercial agriculture, with elevated blood pressure and (3) the wage economy in mining areas, with the highest elevation of blood pressure. The area is dominated by the primate city, Harare, up to distances of 300 km and beyond, from which forces of change and modernization emanate. It is seen that potassium, sodium and the sodium potassium ratio, are distance-related to Harare and that women's blood pressures tend to follow suit. The rise of body sodium in young persons at risk, often accompanied by declining potassium intake and other changes of modernization, suggest that more attention should be focused on rural areas in Africa, now in the throes of economic change.

Prevalence of hypertension among women in rural Zimbabwe: a comparison of pregnant and non-pregnant women.

OBJECTIVES: To determine the prevalence of pregnancy induced hypertension (PIH) in rural Zimbabwe. DESIGNS: A blood pressure survey conducted in three socio-economic strata of rural Zimbabwe, communal lands, commercial farms and mining areas. SETTING: Rural Zimbabwe, Mashonaland West Province. SUBJECTS: 627 pregnant (> 20 weeks gestation) and 483 non pregnant (ages 16 to 45) women. MAIN OUTCOME MEASURE: Prevalence of PIH. RESULTS: PIH was defined in two ways: 1. A combination of > or = 2+ proteinuria and systolic and/or diastolic pressure > or = SD above the mean for all pregnant women (> or = 123/75 mmHg). 2. > or = 1+ proteinuria and blood pressure of 140 and/or 90 mmHg. Eight women met definition 1 and seven met definition 2, giving a prevalence of 0.8pc; 1.3pc and 3.2pc in communal lands, commercial farms and mines respectively. In non-pregnant women the prevalence of hypertension (> or = 160 and/or 95 mmHg) was 3.5pc; 5.4pc and 15.1pc in communal lands, commercial farms and mines respectively. CONCLUSION: PIH is rare in rural Zimbabwe. Hypertension among non-pregnant women of child bearing age is most common in mining communities which have many similarities to urban environments.

Breast cancer screening in rural populations: a pilot study.

This report describes the development and implementation of a pilot intervention project designed to determine the economic, logistic, behavioral, and attitudinal variables that influence rural women's participation in a community-based breast cancer screening program. This paper reports on survey responses of women who registered for this pilot breast cancer screening program. It includes information on all women who registered for the project--both those who received breast cancer screening and those who did not. The study is a pilot intervention project, the overall goal of which was to develop a network of community providers, organizations, and volunteers to facilitate breast cancer screening among rural women. Of the 159 women registered for this pilot program, 101 (63.5%) were screened (receiving both a clinical breast examination and mammogram). The attitudes of women surveyed through the project confirm the importance of a physician recommendation for breast cancer screening. More than 90 percent of both the screened and unscreened groups of women stated that a doctor's recommendation to have breast cancer screening is important. Further, nearly 42 percent of the unscreened group had never had a physician recommend breast cancer screening. Despite existing barriers to screening, this pilot study demonstrated that health care professionals and regional organizations that have not traditionally been associated with delivering health care in this particular community setting can successfully work together to implement breast cancer screening programs.

Establishing a collaborative practice in a comprehensive breast clinic.

BREAST CANCER IN women is a major health concern due to the high prevalence of subtle changes in breast tissue that are difficult to diagnose. Consequently, women require information about benign and malignant breast changes. Nurse practitioners (NPs) can play an important role in helping women with breast concerns by incorporating clinical expertise with teaching and counseling skills. Establishing clinics in which information, screening, and diagnosis of breast cancer are readily available will help decrease women's anxiety and enhance their ability to act as self-advocates within the healthcare system. A comprehensive breast clinic was developed, incorporating NP and physicians in a collaborative model of care. Defining roles within the model was an ongoing process as each provider developed areas of expertise and interest. The NP role emerged as an integral part of the practice, increasing the efficiency, availability, and effectiveness of clinic services.

Trends in cervical cancer incidence among young black and white women in metropolitan Detroit.

BACKGROUND: Although the overall incidence of invasive cervical cancer in the United States has declined over the past several decades, recent studies suggest that rates for both invasive and in situ cervical cancer are rising among younger women. METHODS: Trends in cervical cancer incidence among females between the ages of 15 and 39 years were evaluated using data from the Metropolitan Detroit Cancer Surveillance System, a population-based registry and founding participant in the SEER Program of the National Cancer Institute. Age-adjusted and age-specific rates for all black and white women in this age group were evaluated as well as rates for married and single women for the period 1973-1991. RESULTS: Incidence trends vary by race and marital status. A nonlinear increasing trend was evident (P < 0.01), for in situ cervical cancer among white women, with rates for single white women exhibiting the largest increase. Rates among black women for in situ cervical cancer exhibited a nonlinear decreasing trend (P < 0.01), with rates for married black women declining by 75%. Among single white women, invasive cervical cancer exhibited an increasing linear trend (P < 0.01), although the number of cases was small. CONCLUSIONS: Differences in trends among black and white women may reflect a combination of greater exposure to risk factors associated with cervical carcinoma as well as differential access to diagnostic and treatment services. Appropriate groups should be targeted for educational, screening, and follow-up services.

A descriptive study of the changing roles and practices of traditional birth attendants in Zimbabwe.

In Zimbabwe, traditional birth attendants (TBAs) attend more than 50% of the births. Training courses to improve their skills have been offered since 1983. Although there are many assumptions about the TBAs' work, there has been little formal investigation. This is a descriptive study of the practice and attitudes of trained and untrained TBAs in Zimbabwe. Seventy-one midwives were divided into groups according to geographic area and attendance at an upgrading course. Data were obtained through informal small group interviews and observation. Findings indicate that TBAs have traditionally been both health educators and health providers. Midwives who have attended the training course exhibit improved practices, refer more high-risk pregnant women to clinics, and perceive themselves to be attending fewer births. As a result of delivering fewer babies, the TBAs believe that they have lost credibility as health educators.